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A federal rule changes how subsidized home- and community-based services are funded.   The changes are because of new standards by the U.S. Centers for Medicare and Medicaid Services. Among the policies, the agency says all housing should:

  • Support a flexible and free system that integrates individuals with disabilities in a community setting, rather than placing them in a segregated living and work environment;
  • Emphasizes independence and autonomy; and
  • Discourage institutional “warehousing” of those with disabilities.

States have five years to comply with the new rule.

The goal is to have them supported and given the ability to determine where they live and work whenever possible.  The federal rule is in the spirit of a 1999 Supreme Court ruling that said people with disabilities must be able to live in the most integrated setting appropriate for their needs.

The Centers for Medicare & Medicaid Services (CMS) issued a final rule January 10, 2014 to ensure that Medicaid’s home and community-based services programs provide full access to the benefits of community living and offer services in the most integrated settings.  The rule, as part of the Affordable Care Act, supports the Department of Health and Human Services’ Community Living Initiative. The initiative was launched in 2009 to develop and implement innovative strategies to increase opportunities for Americans with disabilities and older adults to enjoy meaningful community living.

Some argue a more inclusive environment is beneficial for those with significant disabilities and fear that the current programs designed for that purpose will be shut down in the transition. To have a more community-centered experience for those with significant disabilities, it would take more staff members and more money, which has as of late has been extremely tight.

In this final rule, CMS specifies that service planning for participants in Medicaid HCBS programs under section 1915(c) and 1915(i) of the Act must be developed through a person-centered planning process that addresses health and long-term services and support needs in a manner that reflects individual preferences and goals. The rules require that the person-centered planning process is directed by the individual with long-term support needs, and may include a representative whom the individual has freely chosen and others chosen by the individual to contribute to the process. The rule describes the minimum requirements for person-centered plans developed through this process, including that the process results in a person-centered plan with individually identified goals and preferences. This planning process, and the resulting person-centered service plan, will assist the individual in achieving personally defined outcomes in the most integrated community setting, ensure delivery of services in a manner that reflects personal preferences and choices, and contribute to the assurance of health and welfare

Under the final rule, Medicaid programs will support home and community-based settings that serve as an alternative to institutional care and that take into account the quality of individuals’ experiences.  The final rule includes a transitional period for states to ensure that their programs meet the home and community-based services settings requirements.  Technical assistance will also be available for states.

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