Last week, the House both passed the Improving Medicaid Programs and Opportunities for Eligible Beneficiaries (IMPROVE) Act (H.R.7217). This bill includes reauthorization of the Money Follows the Person (MFP) program for three months. MFP provides grants to states to transition people from institutions to community-based settings. According to a report from the U.S. Department of Health and Human Services, this program has helped over 63,000 people transition into the community and has saved Medicare and Medicaid almost $1 billion as of 2013. The Arc strongly supports reauthorization of MFP. Additionally, the bill extends Medicaid’s spousal impoverishment protections for Home and Community Based Services beneficiaries for three months. The spousal impoverishment protection allows the spouse of a Medicaid Long Term Services and Supports (LTSS) beneficiary to maintain a modest amount of income and resources for food, rent, and medication.
Correction: The original version of this article incorrectly stated that the IMPROVE Act extended MFP for three years and that it had passed both chambers.
Last week, the Centers for Medicare & Medicaid Services (CMS) released Frequently Asked Questions (FAQs) related to Home and Community-Based Services (HCBS) Settings Rule. The guidance focuses on the process for states to use in overcoming the presumption that certain settings have the characteristics of an institution, and highlights the heightened scrutiny review that CMS will give such information submitted from states.
Last week, Senator Chuck Grassley (R-IA), together with Senator Ron Wyden (D-OR) and Senator Bob Casey (D-PA), introduced S. 1604, Transition to Independence Medicaid Buy-In Option, bipartisan legislation which would, as stated in Sen. Grassley’s press release, “create a demonstration project to encourage states to improve opportunities for individuals with disabilities to obtain employment in the community, gaining self-determination, independence, productivity, and integration and inclusion.” Ten states, over a period of five years, would receive bonus payments for meeting benchmarks which are outlined in the bill’s technical summary.
Last week, the deadline for states to submit their transition plans to CMS outlining how they will come into compliance with the HCBS Settings Rule passed. Several states have yet to submit their final plans; in fact some states are still collecting public comment in response to their proposals. CMS has not yet approved any of the transition plans which have been submitted for consideration. Federal resources and state by state details, including draft and final plans, can be found at www.hcbsadvocacy.org. The Arc will continue to monitor this issue.
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/
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.
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.
Last week, the Administration for Community Living (ACL) released guidance which outlined standards for person-centered planning and self-direction. ACL has indicated that these principles will be embedded into all of the Department of Health and Human Services (HHS)-funded home and community based services (HCBS) as well as within other non-HHS-funded HCBS and long term services and support programs. All HHS entities that provide HCBS funding are expected to incorporate the principles into their regulations, guidance, and/or the technical assistance provided to states. Additional information is available in a recent ACL Blog post from Sharon Lewis, Principal Deputy Administrator of ACL and Senior Advisor on Disability Policy, HHS.
Last week, the Senate Committee on Health, Education, Labor and Pensions held a hearing on “Moving Toward Greater Community Inclusion – Olmstead at 15,” in recognition of the anniversary of the Supreme Court’s June 26, 1999 decision in Olmstead v. L.C. In its decision, the Supreme Court held that the unnecessary segregation of people with disabilities violates their civil rights under the Americans with Disabilities Act of 1990. Witnesses included Ricardo Thornton and Donna Thornton, two self-advocates from Washington, DC who have a long history of working closely with The Arc. The Thorntons shared their experience of living at DC’s former public institution for people with intellectual and developmental disabilities – and subsequently leaving the institution, getting married, and raising a family together. Other witnesses included Emmanuel Smith, PABSS (Protection and Advocacy for Beneficiaries of Social Security) Advocate, Disability Rights Iowa, Des Moines, IA; Norma Robertson-Dabrowski, Director of Nursing Home Transitions, Liberty Resources, Philadelphia, PA; Gail Godwin, Executive Director, Shared Support Maryland, Baltimore, MD; and Dr. Troy Justesen, Director of Public Policy, Utah Developmental Disabilities Council, Orangeville, UT. Visit the Committee web site to view video of the hearing and written testimony.
At the hearing, Committee Chairman Tom Harkin (D-IA) announced his introduction of the Community Integration Act (S. 2515), to ensure “people with disabilities can choose to live in the community and receive the same supports and services they would receive in institutional settings.” As summarized in Chairman Harkin’s announcement, the Act would:
- Eliminate the Nursing Home Bias in Medicaid by clearly allowing the provision of similar care or services in home- and community-based settings.
- Prohibit states from making anyone ineligible for home- and community-based services based on a particular disability.
- Require states that have found an individual to be eligible for nursing or institutional care to similarly find those same individuals to be eligible for care in home- and community-based settings.
- Set clear requirements for states regarding the provision of services in home- and community-based settings.
- Require annual reporting by states about the number of individuals with disabilities in institutional settings and the number that have been transitioned to home- and community-based settings.
Last week the Department of Labor (DOL) provided additional interpretation on how the home care rules apply to consumer directed services funded by Medicaid. States and provider organizations had raised concerns about how the Fair Labor Standards Act (FLSA) requirements about who is an employer apply to these services. The interpretation will require each public or private agency that administers or participates in a consumer-directed, Medicaid-funded home care program to evaluate whether it is an employer under the FLSA. The interpretation provides several examples of how FLSA requirements apply to different situations. Guidance and additional information about the rule can be found on the DOL website.