Tag Archives: Home and Community Based Care

Medicaid Legislation with Medicaid Rebate Misclassification Penalty Heads to President Trump

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 … Continue Reading

Trump Administration Signals More Administrative Flexibility for State Medicaid Programs, with Emphasis on “Most Vulnerable Populations”

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 … Continue Reading

CMS Seeks Input on Ways to Accelerate Medicaid Home and Community-Based Services

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 Trump … Continue Reading

CMS to Host Webinar on Medicaid HCBS Quality Measures (Sept. 9)

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 chronic … Continue Reading

CMS Independence at Home Demonstration Yields $25 Million in Savings in First Year

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 chronic … Continue Reading

HHS Workshop: Integrating Plans for Long-Term Services and Supports & Health Care Delivery through Health IT (Oct. 16)

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 focus on … Continue Reading

HHS OIG Identifies “Top 25” Priorities

The OIG has released its “Compendium of Priority Recommendations,” which lists 25 priority issues for which the OIG has open recommendation and that, if implemented, would best protect the integrity of HHS programs. The 25 top priorities are as follows: Medicare Policies and Payments: address wasteful Medicare policies and payment rates for clinical laboratories, hospitals, and … Continue Reading

CMS Finalizes Rule to Strengthen Home- and Community-Based Services (HCBS) Options

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 the … Continue Reading

OIG Recommends Enforcement of Federal Standards for HCBS in Assisted Living Facilities

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, … Continue Reading

OIG, GAO Review Medicaid HCBS Programs

The OIG has issued a report that assesses state oversight of services provided through 1915(c) home and community-based services (HCBS) waiver programs.  According to the OIG, seven of the 25 states reviewed did not have adequate systems to ensure the quality of care provided to beneficiaries through these waiver programs.  Moreover, while CMS renewed the … Continue Reading

HHS Establishes Administration for Community Living

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 … Continue Reading

OSHA Announces National Emphasis Program for Nursing and Residential Care Facilities

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 … Continue Reading

HHS Suspends Implementation of ACA CLASS Program

After extensive debate on the financial sustainability of the ACA’s “community living assistance services and support” – or CLASS – program, HHS Secretary Sebelius has informed members of Congress that she does “not see a viable path forward for CLASS implementation at this time.” By way of background, the CLASS program was included in the ACA … Continue Reading

CMS Guidance on ACA State Balancing Incentive Payments Program

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 funding opportunities … Continue Reading

CMS Proposes Revisions to Rules for Medicaid Home and Community-Based Services (HCBS) Waivers

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 that are not … Continue Reading

CMS Open Door Forum on “Partnership for Patients: The Community-Based Care Transitions Program” (May 5)

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; improve … Continue Reading

CMS Proposes Medicaid Community First Choice Option Under ACA

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 make … Continue Reading

CLASS Independence Advisory Council Nominations Sought

HHS has published a notice announcing the establishment of the Affordable Care Act’s (ACA) CLASS Independence Advisory Council, which will help implement the ACA national voluntary insurance program for purchasing “community living assistance services and support” or “CLASS.” The Council specifically is charged with providing HHS with guidance on the development of the CLASS Independence … Continue Reading

Other Recent ACA Guidance and Reports

The Obama Administration continues to issue guidance documents and summary information regarding the ACA, including the following: The OCIIO has posted “Questions and Answers on Enrollment of Children Under 19 Under the New Policy That Prohibits Pre-Existing Condition Exclusions.” CMS has issued a memo to state Medicaid directors providing guidance on provisions of the ACA … Continue Reading

HHS Announces ACA Grants to Help Individuals Navigate Health, Long-term Care Options

The Department of Health and Human Services (HHS) has announced the availability of $60 million in Affordable Care Act grants for states and communities to help individuals and their caregivers better understand and navigate their health and long-term care options. Funding also can be used to support state Medicaid agencies as they transition individuals from … Continue Reading