Medicaid Waivers for HCBS: CMS Issues Final Rule

Members | January 22, 2017 | by Peter Notarstefano

The Center for Medicare and Medicaid Services (CMS) has issued its long awaited final rule on the use of Medicaid waivers in home and community-based services (HCBS) settings. The final rule moves away from earlier definitions based on setting, location, or geography, and takes a more "outcome oriented" approach focused on the nature and quality of the individual's experience. As we review the provisions of the rule, we will provide more details and analysis.

The Center for Medicare and Medicaid Services has issued its long-awaited final rule on the use of Medicaid waivers in home and community-based services (HCBS) settings

The rule, which covers section 1915(i) state plan programs as well as waiver programs under 1915(c) HCBS waivers and (k) Community First Choice, will: 

  • Implement new flexibilities created by the Affordable Care Act.
  • Define person-centered care requirements for (c) and (k) waivers.
  • Allow states to combine waiver programs under (c) to facilitate streamlining these programs. States will be allowed up to 5 years to transition to this new rule. 

Outcome Oriented Approach

Most importantly for LeadingAge members, in establishing the qualifications for settings eligible for reimbursement under the waiver programs, the final rule moves away from earlier definitions based on setting, location, or geography. 

The rule takes a more "outcome oriented" approach that focuses more on the nature and quality of the individual's experience.

As we review the provisions of the rule, more details and analysis will be provided. 

Fact Sheet: Medicaid Waivers for HCBS

CMS has issued fact sheets and a press release announcing the rule and summarizing its key provisions.

The rule will be published in the Federal Register on Jan. 16, 2014.