OMB Receives HCBS Pending Final Rule from CMS
November 19, 2013 03:21 PM
On November 5, The Office of Management and Budget (OMB) received for review CMS-2249-F, a pending final rule (the Rule) from the Centers for Medicare and Medicaid Services (CMS) that will simplify the ability of states to administer their home and community-based services (HCBS) programs. The Rule was first published as a proposed rule in April 2008, and then published as a second proposed rule in May 2012.
To see the regulatory history, please click here.
To see the May 2012 proposed rule, please click here.
The Rule had not been previously finalized as CMS deemed it non-compliant with the Affordable Care Act. Upon completion of OMB’s present review, CMS will publish the Rule as a final rule in the Federal Register.
First, the Rule clarifies the ability of states to furnish HCBS through the 1915(i) State Plan Option, which allows states to provide HCBS without needing a waiver or demonstration program.
The Rule also features provisions that would allow for 5-year demonstrations and waivers for dual eligibles, i.e. those eligible for services under both Medicare and Medicaid. To see previous briefs from the National Council on Medicaid Home Care – a NAHC affiliate - on the duals demonstrations, please click here.
The Rule additionally provides for circumstances in which Medicaid need not pay the individual practitioner providing services directly. Rather, Medicaid can pay a third party on the provider’s behalf, when these payments are related to training and health and welfare contributions.
The Rule also defines “home and community-based settings” as they relate to Community First Choice and the 1915(i) State Plan Option.
The Council welcomes the Rule’s movement to OMB review, and its eventual passage as a final rule. This Rule, once finalized, will help states in expanding their HCBS services by simplifying the process needed for approval.
The Council encourages providers to continue advocating for mechanisms to improve access to HCBS services through their state associations, as well as through state and federal governments. Home care providers are encouraged to keep abreast of HCBS developments in their states, and nationally, and to contact the Council with any questions or concerns.