Thursday, May 11, 2017

Feds extend the date for implementation of the Home and Community-Based Settings Rule to 2022

The Centers for Medicare and Medicaid Services (CMS) has just notified states that they will have until March 2022 to fully implement the 2014 Home and Community-Based Settings (HCBS) Rule. This adds another three years to the initial March 2019 date for states to transition to the new rule, although I hope this will also be a time to reconsider some the rule's more controversial aspects. I have written many blogposts about the rule and some of its harmful consequences. And no, I do not think that these are all unintended mistakes in the way the rule was written. At its worst, the rule is being used to close programs for people with DD in the name of protecting their civil rights and to drive providers out of business who serve people with the most severe disabilities.

Here are excerpts from the Bulletin announcing the change:


CMCS Informational Bulletin
DATE: May 9, 2017
FROM: Brian Neale, Director
SUBJECT: Extension of Transition Period for Compliance with Home and Community-Based Settings Criteria

Health and Human Services Secretary Thomas E. Price, M.D. and Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma, MPH, issued a letter to the nation’s Governors on March 14, 2017, affirming the continued HHS and CMS commitment to partnership with states in the administration of the Medicaid program and noting key areas where we will improve collaboration with states and move towards more effective program management. One of the areas of the increased flexibility CMS intends to extend to states is in the provision of home and community-based services (HCBS), and this information will provide additional clarity on immediate steps taken to act on that commitment. [emphasis added]

Language in the preamble to the final HCBS regulations governing services provided under sections 1915(c), 1915(i) and 1915(k) of the Social Security Act, in a response to comments submitted on the regulations proposing the settings criteria, recognized that compliance with the new regulations would be a complex process requiring a balancing of interests. As a result, CMS indicated that states were permitted to propose transition plans (i.e., Statewide Transition Plans) encompassing up to five years after the effective date of the regulations for settings reflected in existing state plans and waivers to come into compliance with the regulation.

In recognition of the significance of the reform efforts underway, CMS intends to continue to work with states on their transition plans for settings that were operating before March 17, 2014 to enable states to achieve compliance with the settings criteria beyond 2019. Consistent with the preamble language, states should continue progress in assessing existing operations and identifying milestones for compliance that result in final Statewide Transition Plan approval by March 17, 2019. However, in light of the difficult and complex nature of this task, we will extend the transition period for states to demonstrate compliance with the home and community-based settings criteria until March 17, 2022 for settings in which a transition period applies. We anticipate that this additional three years will be helpful to states to ensure compliance activities are collaborative, transparent and timely.

If you have any questions, please contact Mike Nardone, Director, Disabled and Elderly Health Programs Group, at 410-786-7089. 

See also:

 "Legal Vulnerabilities of CMS’s Regulation of Home- and Community-Based 'Settings'"

"The Olmstead Decision has been Misinterpreted"

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