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ALFA Lauds Action to Define ‘Assisted Living’ as Home and Community-Based Setting

ALFA applauds the Center for Medicare and Medicaid Services’ decision to expand its definition of settings eligible for Medicaid reimbursement for home and community-based services, which will help assisted living residents experience the independence and dignity they deserve.

The final rule addresses several sections of Medicaid law under which states may use federal Medicaid funds to pay for home and community-based services (HCBS). CMS said the rule reflects its intent to ensure individuals receiving services and supports through Medicaid’s HCBS programs have complete access to the benefits of community living.

CMS said in its announcement of the final rule that it is “moving away from defining home and community-based settings by ‘what they are not’ and toward defining them by the nature and quality of individuals’ experiences.”

ALFA appreciates that CMS valued its comments and feedback during the rule-making process.

“We strongly believe this rule is a positive step forward for Medicaid eligible seniors who deserve the opportunity to live in assisted living communities if they so choose,” said ALFA Vice President of Public Policy Maribeth Bersani. “Assisted living was started as a home- and community-based alternative to skilled nursing care 25 years ago. Our mission has always been to be person-centered and consumer-driven. We are pleased to finally have that recognition from CMS.”

The rule’s provisions establish a more “outcome-oriented” definition of home and community based settings than basing it solely on a setting’s location, geography or physical characteristics.

The CMS also specifies that service planning for Medicaid HCBS participants must be developed through a person-centered planning process addressing health and long-term services and support needs, which may include representatives who have been freely chosen by the individual to contribute to that process.

Key Provisions

The final rule requires that all home and community-based settings meet certain qualifications including:

  • The setting is integrated in and supports full access to the greater community;
  • It is selected by the individual from among the setting options;
  • It ensures individual rights of privacy, dignity and respect; and freedom from coercion and restraint;
  • Optimizes autonomy and independence in making life choices; and
  • Facilitates choice regarding services and service providers.

Implementation of the final rule begins March 17, but it includes a transition period for up to five years for states to comply.

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