INCAL members are entitled to receive full IHCA membership services. INCAL members also benefit from national representation and services of the American Health Care Association (AHCA) and its assisted living partner, the National Center for Assisted Living (NCAL).
CMS Issues Toolkit for Medicaid 1915 (c) and 1915 (i) Waiver Programs
CMS issued new guidance yesterday in the form of a “Home and Community Based Settings Toolkit” to assist states with the process states they follow for developing their 1915 (c) and 1915 (i) waiver plan amendments and renewal applications. The toolkit is designed to help states determine which settings will be considered home- and community-based settings (HCBS). The components of the five-piece tool kit can be found at the bottom of the home page at www.medicaid.gov/hcbs. A PDF version of the toolkit is available below.
The agency further describes the qualities HCBS settings and the options that must be provided by states to Medicaid beneficiaries. Specifically, CMS spells out those settings that are presumed to have the qualities of an institution and will fall under “heightened scrutiny” for both waiver programs. The guidance includes decision trees for states to follow in making heightened scrutiny determinations for the transition plan process and the standard waiver process.
Additional guidance is also provided about the characteristics of settings that CMS believes have the effect of isolating individuals from the broader community, including settings that focus on people with a specific disability. CMS says: “Settings that may have the following two characteristics alone might, but will not necessarily, meet the criteria for having the effect of isolating individuals:
- The setting is designed specifically for people with disabilities, and often even for people with a certain type of disability.
- The individuals in the setting are primarily or exclusively people with disabilities and on-site staff provides many services to them.”
These provisions provide some flexibility for disease and disability specific communities, so long as they also meet additional criteria related to the isolation of individuals. However, providers and beneficiaries will need to work closely with state authorities regarding this presumption. As stated in the final rule and in this guidance, community integration and personalized care planning will be critically important to making determinations about whether communities are deemed HCBS.
It is worth noting that the guidance contains a “carve out” for CCRCs when making determinations about multiple “co-located and operationally related communities.” The guidance discussing “…Settings That Have the Effect of Isolating Individuals…”states “In CMS’ experience, most Continuing Care Retirement Communities (CCRCs), which are designed to allow aging couples with different levels of need to remain together or close by, do not raise the same concerns around isolation as the examples above, particularly since CCRCs typically include residents who live independently in addition to those who receive HCBS.”
The guidance also contains an optional questionnaire tool for states to use in making assessments of residential settings that asks a series of questions in 22 areas. An additional questionnaire is included for provider owned/controlled communities that asks questions in seven additional areas related to the environment.
One area of concern surrounds how determinations will be made regarding restrictive measures. For instance, it is still unclear what steps a community will need to follow to place restrictions on egress for residents with dementia who may permanently or intermittently be unable to recognize danger or be disoriented to place and time. AHCA/NCAL will seek further clarification in this area but providers are encouraged to engage in a discussion with their state authorities about what steps they should follow in making these determinations and how this should be documented in the individual person-centered care plan.
The final HCBS waiver rule on which this guidance is based took effect on March 17. More guidance to states for implementing the rule will be forthcoming. AHCA/NCAL will continue to monitor and report on CMS’ guidance as it is issued.
2015 First Quarter Accomplishments
2015 Second Quarter Accomplishments
2015 Third Quarter Accomplishments
2014 First Quarter Accomplishments
2014 Second Quarter Accomplishments
2014 Third Quarter Accomplishments
2014 Assisted Living Performance Measure Survey Report
2014 Annual Report
2013 First Quarter Accomplishments
2013 Second Quarter Accomplishments
2013 Assisted Living Performance Measures Survey
We’ll keep you up to date on the latest regulatory activities for assisted living and residential care issues.
Assisted Living State Regulatory Review 2012
Assisted Living State Regulatory Review 2013
State-by-State Highlights and Policy Changes 2012
State Medicaid Reimbursement Policies and Practices in Assisted Living
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Assisted living is a long-term care alternative for seniors who need more assistance than is available in a retirement community, but who do not require the extensive medical care and attention provided in a nursing facility. Individuals in assisted living facilities receive, as needed, supervision, personal assistance and health care services in a way that promotes maximum independence. Your INCAL membership gains you access to the National Center on Assisted Living member-only content, as well as:
Clinical Practice Guidelines
Life Safety and Disaster Preparedness
Labor, Workforce, and OHSA documents and information
Guiding Principles for Assisted Living (this can help members with marketing materials)
Guiding Principles for Dementia Care