White House

The Medicaid Home and Community-Based “Settings” Regulation

In 2014, CMS issued a regulation that established a number of new policy and programmatic requirements for Medicaid HCBS.  One of the most significant components of this regulation created new requirements on providers of HCBS who receive Medicaid funding. This regulation requires states and providers to ensure that individuals enrolled in HCBS programs live and receive services in integrated, community-based settings. As part of the regulation, new restrictions are placed upon providers that could potentially isolate beneficiaries from the broader community. This rule is frequently referred to as the “HCBS settings” regulation.  Although the regulation originally required all HCBS settings to be in compliance by March 17, 2019, CMS released an informational bulletin in 2017 that extended the compliance deadline until March 17, 2022. 

States must establish clear plans detailing how they intend to ensure compliance with the regulation.  These “Statewide Transition Plans” include a wide range of information about the types of HCBS provided in the state Medicaid program, the types of providers and settings delivering the services, and the regulatory framework used to ensure compliance.  CMS reviews these plans and issues initial approval when the state completes a review of statute and regulations governing HCBS providers to determine how they support or are inconsistent with the rule and then issues final approval once the state assesses its providers to determine how their practices comport with the regulation.  A list of the statewide transition plans and their current status is available here.

Medicaid Managed Long-term Services and Supports

Over the past decade, there has been significant growth in the number of states that utilize managed care organizations to deliver some or all of their long-term services and supports.  Managed care is one tool that a number of states are using as they seek to better integrate LTSS into the continuum of supports available to individuals; to improve care coordination and quality of services, to increase predictability in budgeting, and to control costs.  ADvancing States  provides technical assistance to states and also tracks the integration of services across the country. 

See the Medicaid Integration Tracker and the MLTSS map for more information. 

Electronic Visit Verification

President Obama signed the 21st Century CURES Act into law on December 13, 2016.  One portion of the Act requires state Medicaid programs to implement Electronic Visit Verification (EVV) for personal care and home health care, or face reductions in the federal share of payments for noncompliant services.  The law originally required these reductions to begin in 2019 for personal care services and in 2023 for home health care services; however, NASUAD partnered with several provider and participant advocacy organizations to advocate for a delay in this timeline.  Congress enacted a one-year delay to the reductions for personal care, which now will begin in 2020.  The timeline for home health remains the same.

ADvancing States hosts monthly conference calls for state staff involved in policy and technical implementation of EVV.  

For more information on EVV and the CURES Act, click here to review the paper published by ADvancing States in April 2018.

HCBS Rebalancing

Across the country, states are working to ensure that individuals who receive long-term services and supports can live in home and community-based settings if they choose.  Unfortunately, a number of important grants supporting HCBS have expired leaving a lack of resources to continue accelerating the pace of change.  ADvancing States has worked with our partners to advocate for an extension of funding for the successful Money Follows the Person (MFP) grant program, which expired in 2016. In 2019, Congress passed several pieces of legislation that in totality resulted in an additional $254.5 million for MFP grants. In June 2019 the House passed legislation that would extend MFP for 4.5 more years with approximately $2billon of additional funding; however, the legislation has not been taken up in the Senate.  

For information on the House’s passage of MFP extension, click here