HCBS

Much innovation in the LTSS system has originated at local levels and later reached the national level after testing and support from the government, foundations and others. A new paper reviews five innovative LTSS programs to explore how they were successfully scaled up and implemented in more places. This report builds on the widely accepted model for understanding the expansion of an innovation developed by sociologist E.M. Rogers, who coined the phrase “early adopter.” Its five recommendations adapt Rogers’s framework to selecting and promoting LTSS innovations.

Late yesterday CMS released a State Medicaid Director Letter (SMDL 22-003) providing guidance for the first-ever HCBS Quality Measure Set, the first of two planned guidance documents from CMS. The HCBS Quality Measure Set is included in the SMD, starting on page 14. The list of measures includes the NQF number (if applicable), measure steward, and data collection method, as well as information on whether each measure addresses section 1915(c) waiver assurances and/or can be used to assess access, LTSS rebalancing, and/or community integration and HCBS settings requirements.

“Aging in place" refers to living independently, safely, and comfortably in one’s home for as long as possible. In order to do so, home modifications and additional support are often needed to ensure that older adults are safe and have their needs met over the course of their aging. During January and February 2022, the University of Michigan National Poll on Healthy Aging asked a national sample of adults age 50–80 about their perspectives on aging in place and how they feel about home modifications and available social supports.

The majority of individuals who need long-term services and supports (LTSS) in the United States rely on unpaid assistance from family and friends. The economic value of the unpaid care they provide is estimated to be over $470 billion annually. Unmet needs and waiting lists for Medicaid Home and Community Based Services (HCBS) place significant strain on individuals with disabilities and their families. This report explores how increasing access to HCBS services can reduce out-of-pocket costs for families and strengthen employment and financial wellbeing of family caregivers.

On Thursday, October 21, 2021 CMS launched a new “one-stop shop” for state Medicaid agencies and stakeholders on Medicaid.gov to advance transparency and innovation for home and community-based services. Through this new webpage, state Medicaid agencies and stakeholders can access information about states’ plans to enhance, expand, and strengthen home and community-based services across the country using new Medicaid funding made available by the American Rescue Plan Act of 2021 (ARP).

States received approval for temporary changes to their HCBS programs from CMS, within the Department of Health and Human Services to enable states to limit in-person contact to reduce the spread of COVID-19. This GAO report describes the temporary changes to Medicaid HCBS programs and examines CMS’s monitoring and evaluation of the effects of those changes.

The GAO released a report on the impacts of the 2013 regulation that revised the domestic service employment and companionship services under the Fair Labor Standards Act (FLSA). This rule, which became effective in 2015, had the effect of extending minimum wage and overtime protections to a broader range of home care workers, many of whom provide Medicaid-funded home and community based services (HCBS).

On July 31, Governor Tom Wolf of Pennsylvania announced, by an executive order, an overhaul of the state services and systems to protect the most vulnerable Pennsylvanians. The executive order establishes an Office of Advocacy and Reform, Child Advocate, and Council on Reform. The executive order also lists responsibilities of the state agencies and the Governor’s Office of Performance through Excellence.

The Centers for Medicaid & Medicare Services released a report that profiled the 10 states with the greatest change in Long-Term Services and Support (LTSS) system balancing. The report highlights characteristics of the 10 states and compares their change in LTSS system balancing with other states and provides a national overview on LTSS system balancing. State profiles consist of characteristics and strategies states utilized in their progress towards rebalancing their LTSS systems.

CMS released an informational bulletin that provides guidance regarding new constructions and the HCBS heightened scrutiny process. The 2014 Medicaid HCBS regulation’s settings regulation requires an in-depth assessment, called heightened scrutiny, for certain providers that are presumed to be institutional. This guidance provides clarification and flexibility to states, including an overview of three potential scenarios for how newly constructed settings could receive Federal funding