HHS expands Medicaid community services

The U.S. Department of Health & Human Services on Friday amended Medicaid regulations on home and community-based service programs for elderly and disabled beneficiaries. Then new rule supports the 2009 Community Living Initiative promoting federal partnerships to discourage institutional seclusion of the disabled, which is a type of unlawful discrimination.  

"People with disabilities and older adults have the right to live, work, and participate in the greater community," HHS Secretary Kathleen Sebelius said in the announcement. "HHS, through its Community Living Initiative, has been expanding and improving the community services necessary to make this a reality."

The final rule is scheduled for publication Thursday and will take effect 60 days later. Under its provisions, state Medicaid programs may use federal dollars to fund home and community-based healthcare settings, according to a Centers for Medicare & Medicaid Services fact sheet. The rule redefines these settings based on outcomes instead of location. And the rule sets a transition period for states to develop compliant programs offering beneficiaries full access to advantages of community life and health services in integrated settings.  

The rule also lets states target services to specific groups, including customers with mental illnesses and/or those with physical, intellectual or developmental disabilities.It also creates a beneficiary-directed planning process addressing long-term support needs "in a manner that reflects individual preferences and goals," the fact sheet said.

Improving home healthcare is a focus not only for the government but for Medicaid contractors and their business partners experimenting with new uses of technology. For example, Aetna Better Health of Illinois joined with Addus Home Care, a national provider of home and community-based services, to test the benefits of equipping home care aides with smart phones.

Finally, the costs of publicly-financed home care have been making news. While home health services are cheaper than prolonged hospitalization and may reduce readmission risks, Medicaid home care improvements are on deck as CMS tries to control overall post-acute care expenses. In November, the agency announced a 1.05 percent reimbursement cut to home care providers for 2014.

For more:
- read the HHS announcement
- here's the CMS fact sheet
- see the pre-publication version of the final rule (.pdf)
- check out Aetna's pilot study announcement

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