The Centers for Medicare and Medicaid Services (CMS) issued two rules concerning community-based services for people with disabilities – one final rule and one proposed rule.
The final rule implements the Community First Choice (CFC) Option, a provision of the Affordable Care Act that provides an incentive to states to expand community-based attendant services and supports to people with disabilities who are eligible for institutional level of care. States that choose the CFC option will receive a 6% increase in their federal Medicaid share (FMAP) for those services. The rule requires states to provide CFC services only in a “home and community” setting. Unfortunately, the rule does not include the definition of a home and community setting. The definition in the proposed rule generated so many comments that CMS decided to revise the definition and seek public input again. The revised definition will appear in the proposed rules implementing the Home and Community Based State Plan option described below. Once a definition is finalized it will apply across all of the home and community programs – 1915(c) waiver programs, the 1915(i) State Plan option, and the 1915(k) CFC Option. The CFC final rule should appear in the Federal Register on May 7.