HCBS Settings Rule

Last week, the Centers for Medicare & Medicaid Services (CMS) provided updated portions of the CMCS Home and Community-Based Services (HCBS) Toolkit: the HCBS Basic Element Review Tool for Statewide Transition Plans and the HCBS Content Review Tool for Statewide Transition Plans. The full HCBS toolkit, including the updated portions, is available online at http://www.medicaid.gov/hcbs/

New HCBS Resource: Questions and Answers About the Home and Community Based Services (HCBS) Settings Rules

The Arc is pleased to share a new Q&A document designed to be a resource to assist advocates understand the impact of the HCBS Settings Rule as the March 17, 2015 deadline for states to submit a transition plan to the Centers for Medicare and Medicaid Services (CMS) approaches. The document provides answers to frequently asked questions about the Rule as well as links to primary source documents and additional information members of The Arc may find helpful as they advocate for the full inclusion and community participation of people with I/DD.

Centers for Medicare & Medicaid Services (CMS) Leader Resigning

Marilyn Tavenner, the chief administrator for the federal agency that oversees Medicaid, Medicare and most of the Affordable Care Act is resigning at the end of the month. She was confirmed overwhelmingly by the Senate in May, 2013 and oversaw the roll out of the Affordable Care Act. Prior to her announcement, several other key leaders at CMS had resigned including Cindy Mann, who was the Deputy Administrator and Director of the Center for Medicaid and CHIP Services. Under the leadership of Ms. Tavenner and Ms. Mann, several important initiatives were advanced and there was increased openness to working with advocates and stakeholders.

Updates to the Centers for Medicare & Medicaid Services Website

Last week, the Centers for Medicare & Medicaid Services (CMS) announced several changes to the Medicaid.gov website including a new home page with quick links including federal policy guidance and other new technical assistance resources.   Additionally, they have expanded State Medicaid and CHIP profiles to provide a more complete picture of the many policy and programmatic features that make up each state’s Medicaid and CHIP programs.  New elements include a state-specific list of approved state plan amendments and waivers and links to detailed Medicaid managed care profiles.

The Centers for Medicare and Medicaid Offering a New Toolkit

To assist states as they implement the final Home and Community-Based Services (HCBS) rule released in January of this year, the Centers for Medicare and Medicaid (CMS) created the Statewide Transition Plan Toolkit for Alignment with the HCBS Final Regulation’s Settings Requirements. This document provides information on the content and process of the transition plan requirements. The Arc, together with other advocates has made recommendations to improve implementation of the regulations.

Joint Employment in Consumer-Directed Programs

Last week, the Department of Labor (DOL) held a briefing to address joint employment in consumer-directed programs as outlined in the Federal Register in October 2013. Officials reviewed an Administrator’s Interpretation from last month that defines companionship services, clarifies the duties test, and limits the use of the companionship services exemption and the live-in domestic service employee overtime exemption to individuals or their representatives only. Most workers in consumer-directed programs will have a third-party joint employer and therefore must be paid in compliance with the Fair Labor Standards Act’s minimum wage and overtime requirements. However, the exemption may be applied in situations in which the consumer is the sole employer. Third party employers may no longer claim exemptions under this rule. The Centers for Medicare & Medicaid Services recently released guidance on state options for Medicaid reimbursement for overtime and travel costs that may result from the Final Rule. For more information, please visit www.homecare.gov for a fact sheet and other information related to minimum wage and overtime pay for direct care workers.

Centers for Medicare and Medicaid Services Clarifies Medicaid Coverage of Autism-Related Services

Last week, the Centers for Medicare and Medicaid Services (CMS) released an information bulletin outlining options for Medicaid to provide children with coverage of autism-related services. The bulletin discusses the opportunities and associated requirements for covering services under a variety of authorities including the Medicaid EPSDT mandate.  The bulletin does not require states to cover the services but clarifies how states can cover the services if they choose.  View the information bulletin.

The Department of Health and Human Services Announces Availability of Navigator Grants

The Department of Health and Human Services released a Notice of Funding Availability for grants for the navigator program authorized by the Affordable Care Act. The grants are available to organizations in states that the federal government is running or partnering with to maintain the private health insurance marketplaces. Navigators assist people with enrolling in health insurance programs. Organizations that are interested must submit a letter of intent by July 10. For pre-application webinars or more information, visit the Centers for Medicare and Medicaid Services website.

New Resources Regarding the Early and Periodic Screening, Diagnostic and Treatment Services (EPSDT) Benefit in Medicaid

The Centers for Medicare and Medicaid Services (CMS) has new resources explaining the Early and Periodic Screening, Diagnostic and Treatment services (EPSDT) benefit in Medicaid. The following guides are now available:

  • EPSDT – A Guide for States: Coverage in the Medicaid Benefit for Children and Adolescents – This guide provides a comprehensive overview of the children’s benefit and summarizes CMS policy on screenings, diagnostic services, and treatment services. It also covers permissible limitations, medical necessity, and access topics.
  • Keep Kids Smiling: Promoting Oral Health Through the Medicaid Benefit for Children & Adolescents – The second guide explains the dental and oral health dimensions of the EPSDT benefit, and explores a variety of specific ways states can, and have, improved their delivery of dental and oral health services to enrolled children.
  • Paving the Road to Good Health: Strategies for Increasing Medicaid Adolescent Well-Care Visits – The third guide shares a collection of approaches states can use to better engage adolescents in staying healthy and getting regular check-ups.

CMS has also developed, in partnership with the National Academy for State Health Policy (NASHP), an EPSDT Compendium that is located on the NASHP website. This webpage features information about states’ EPSDT implementation efforts across dimensions such as care coordination, behavioral health, data collection and reporting, oral health, medical necessity, and improving access to care.

Technical Assistance to Help States Comply With New Home and Community-Based Setting Rules

The Centers for Medicare and Medicaid Services (CMS) reposted technical assistance documents for states to assist them in complying with the new home and community-based setting rules.   Documents originally posted on the CMS website were taken down and the original links are no longer active.  A new set of documents was posted on March 20 and stakeholders may want to review them for any changes.