Home and Community Based Care

The Centers for Medicare and Medicaid Services (CMS) released a pair of proposed rules on April 27, 2023 that make substantial changes to the structure of Medicaid and the Children’s Health Insurance Program (CHIP), both in the traditional fee-for-service setting and for services provided through managed care organizations (MCOs), and incorporate feedback from stakeholders in

The House and Senate have both approved H.R. 1839, the Medicaid Services Investment and Accountability Act of 2019, clearing it for President Trump’s signature.  Notably, the legislation would: subject drug manufacturers to a new civil monetary penalty (CMP) for knowingly misclassifying or misreporting covered outpatient drugs under a Medicaid drug rebate agreement (such as by knowingly submitting incorrect drug product information).  The penalty would equal up to two times the difference between the rebate amount the manufacturer paid and the amount the manufacturer would have paid if the drug had been correctly classified.  The CMP would be imposed in addition to any other penalties or recoveries.  Furthermore, the legislation would strengthen requirements for recovery of unpaid rebate amounts, without regard to whether the manufacturer knowingly made the misclassification or should have known that the misclassification would be made, and it dedicates funding to improve oversight and enforcement of drug rebate obligation compliance.  These provisions would take effect on the date of enactment, and would apply to covered outpatient drugs supplied by manufacturers under rebate agreements on or after the enactment date.

The bill also would:
Continue Reading Medicaid Legislation with Medicaid Rebate Misclassification Penalty Heads to President Trump

In her first act as CMS Administrator, Seema Verma joined HHS Secretary Tom Price in writing to the nation’s Governors to urge collaboration on improving the Medicaid program, with an emphasis on services for “truly vulnerable” populations. Price and Verma contend that the “expansion of Medicaid through the Affordable Care Act (ACA) to non-disabled, working-age

CMS is requesting public input on policy options it can consider to accelerate the provision of home and community-based services (HCBS) to Medicaid beneficiaries.  Note that while supporting increased availability of quality HCBS services has been a priority for the Obama Administration, it is unclear what priority future HHS and CMS leadership in the

On September 9, 2015, CMS is hosting a webinar on the development of quality measures for Medicaid fee-for-service beneficiaries using home- and community-based services (HCBS).  Specifically, the webinar will discuss efforts to establish measures of potentially avoidable hospitalizations due to:  severe pressure ulcers; acute ambulatory care sensitive conditions (e.g., dehydration, urinary tract infections); and

The CMS Independence at Home Demonstration saved more than $25 million during its first performance year while delivering high-quality patient care, according to a June 18, 2015 CMS announcement. The Independence at Home Demonstration is an ACA innovation model testing the effectiveness of delivering comprehensive primary care services at home to Medicare beneficiaries with multiple

On October 16, 2014, the Administration for Community Living (ACL) and the HHS Office of the National Coordinator on Health Information Technology (ONC) are holding a public workshop entitled “Putting the Person at the Center: Integrating Plans for Long-Term Services and Supports and Health Care Delivery through Health Information Technology.” The workshop will

On January 16, 2014, CMS published a final rule that implements expanded federal support for HCBS offered as an optional benefit through state Medicaid programs, as authorized by the Affordable Care Act (ACA) and the Deficit Reduction Act. Specifically, the rule establishes eligibility requirements for Medicaid HCBS provided under sections 1915(c), 1915(i), and 1915(k) of

A recent OIG report examined the extent to which home and community-based services (HCBS) for beneficiaries residing in assisted living facilities (ALF) furnished under a section 1915(c) waiver comply with federal and state requirements. Based on sample of 150 beneficiaries in the seven states with the highest numbers of beneficiaries receiving HCBS in ALFs (Georgia

HHS is establishing a new Administration for Community Living (ACL) designed to: reduce the fragmentation in federal programs address the community living service and support needs of both the aging and disability populations; enhance access to quality health care and long-term services and supports for all individuals; promote consistency in community living policy across other

The Occupational Safety and Health Administration (OSHA) has launched a National Emphasis Program for Nursing and Residential Care Facilities intended reduce occupational illnesses and injuries in these settings. OSHA notes that safety and health hazards of particular interest for nursing and residential care workers include exposure to blood and other potentially infectious material; exposure to

CMS has released guidance to states on implementation of Section 10202 of the ACA, which establishes the State Balancing Incentive Payments Program. This program is designed to provide “a strong financial incentive to stimulate greater access to non-institutionally based long-term services and supports (LTSS).” The letter discusses the structure of the program, implementation timeframe, and

CMS has issued a proposed rule that would provide states with additional flexibility in obtaining waivers to offer Medicaid HCBS. Among other things, the rule would: allow states to combine more than one target population in a single waiver if certain conditions are met; promote person-centered service and support plans; describe characteristics of settings

On May 5, 2011, CMS is hosting a national forum on the ACA-mandated Community-Based Care Transitions Program (CCTP). The CCTP is designed to encourage the development of partnerships between hospitals with high readmission rates and community based organizations in order to: improve transitions of beneficiaries from the inpatient hospital setting to other care settings

On February 25, 2011, CMS published a proposed rule that would implement an Affordable Care Act (ACA) provision to allow states to provide Medicaid home and community-based attendant services and supports through the Community First Choice (CFC) state plan option. According to CMS, the goal of the program is “to give States additional resources to