House Proposes Community Integration Act of 2014
October 6, 2014 01:57 PM
On September 18, Rep. Matt Cartwright (D-PA) introduced the Community Integration Act of 2014 (H.R. 5547) in the House of Representatives. This follows Sen. Tom Harkin (D-IA) introducing the same bill, S. 2515, in the Senate on June 24. The Act aims to strengthen Medicaid beneficiaries’ opportunities to receive home and community-based services (HCBS). The National Council on Medicaid Home Care – a NAHC affiliate - discusses the bill’s key provisions below.
Access to HCBS. The Act seeks to amend the Social Security Act to give Medicaid beneficiaries “the choice and opportunity” to receive institutional-level of care in a “home and community-based setting.” The Act stipulates that this choice and opportunity should be “equal” to institutional settings by ensuring that care in home and community-based settings “is widely available on a statewide basis” for those in all states.
Definition of Home and Community-Based Setting. The Act defines a home and community-based setting as, among other things, including “public or private housing where the individual resides” that ensures privacy, maximizes autonomy, and is integrated into the community. This definition largely mirrors that of the Centers for Medicare & Medicaid Services’ (CMS’) recent HCBS rule issued this January. For the Act’s full definition of home and community-based setting, see pages 5-6, here.
For a previous Council brief on the HCBS rule, click here.
Prohibitions of Public Entities. According to the Act, any public entity that receives payment under a state plan or waiver cannot:
“Impose or utilize policies, practices, or procedures” that would:
Restrict the availability of HCBS to those with disabilities;
Limit HCBS “based on the specific disability of an otherwise eligible individual”;
“Arbitrarily restrict” a disabled individual “from full and meaningful participation in life”;
“Unnecessarily delay or restrict” HCBS services to those requiring them;
Fail to implement “adequate payment structures to maintain a sufficient workforce” to provide HCBS to all that are eligible; and
Limit access to information on HCBS, either to those currently institutionalized, or those that are about to be institutionalized.
For complete details on the prohibitions of public entities, see pages 7-9, here.
For full details on applications to waiver, see pages 12-13, here.
Enforcement of the Prohibitions. The federal government reserves the right to reduce the federal matching assistance percentage (FMAP) to any state that violates these prohibitions. See page 10, here.
Housing. The Act also mandates that, 180 days after the Act is enacted, states should develop plans to increase housing for those with disabilities. CMS had excluded room and board from the state plan benefit in its recent HCBS rule.
Reducing unnecessary institutionalization. On September 19, the American Bar Association (ABA) issued a letter to Rep. Cartwright indicating its support for H.R. 5547. In its letter, the ABA states that this Act “will reduce unnecessary institutionalization and enable many individuals to live independently and attain full integration into their communities.” The Council echoes the ABA’s sentiment, and believes that this bill is promising in reducing unnecessary institutionalization, while encouraging HCBS utilization.
Mandatory HCBS benefit. The ABA, in its letter, also calls for HCBS to become a mandatory Medicaid benefit for those qualifying for intuitional-level long term care. The Council also supports establishing Medicaid home care as a mandatory benefit. For details, see 21-23 of our 2014 Policy blueprint, here. The Council sees this Act as a positive step in both making HCBS a mandatory Medicaid benefit, and encouraging states to embrace broader coverage of HCBS under Medicaid generally.
Unanswered questions. The Act, while promising, leaves several questions unanswered. It does not specify a funding mechanism for the additional access to HCBS. It does not delineate Medicare and Medicaid’s role in providing the additional HCBS. The Act also does not address to what additional standards, if any, managed care organizations will be held to in providing sufficient access to HCBS.
The Council also looks forward to further clarification on what states are expected to do to implement “adequate payment structures to maintain a sufficient workforce” to provide HCBS to all that are eligible. For example, the Council supports overtime requirements for Medicaid home care workers so long as the overtime is adequately funded by the Medicaid program itself.
While the political climate leading up to mid-term elections makes it unlikely that the Community Integration Act of 2014 will become law during this Congress, it is well poised to be picked up in its current form for passage in the next Congress. The Council encourages its members and the Forum of State Associations to advocate for the Act as it removes barriers to HCBS, and moves HCBS closer to parity with institutional care in Medicaid. The Council will continue to monitor developments of the Act. Members should contact the Council with any questions or concerns.