Deficit Reduction Act (DRA)

Statistics show a significant percentage increase in older persons able to receive LTSS outside of nursing homes, however unnecessary institutionalization is still a routine problem. This report clearly delineates the limitations on progress, including differences in Medicaid structure around nursing home vs. HCBS waiver coverage. The authors recommend specific steps that federal and state governments should take to reduce unnecessary institutionalization.

This letter informs States of several changes to Section 1915(i) of the Social Security Act (the Act) made by the Affordable Care Act (ACA). These changes, which become effective October 1, 2010, include revised and new 1915(i) provisions for removal of barriers to offering HCBS services through the Medicaid State plan. This letter is intended to provide guidance on important changes to the law including: Number Served & Statewideness, Financial Eligibility, Targeted Benefits and Services.

Effective July 1, 2010, this rule makes significant clarifications regarding benchmark benefits packages. States have utilized these packages to provide expanded HCBS beyond those available through the Medicaid State Plan. Clarifications include the provision of non-emergency medical transportation, and children’s access to the full range of Medicaid EPSDT benefits. The attached file contains the official text of the rule as entered into the Federal Registry.

Guidance is offered on the implementation of section 6087 of the Deficit Reduction Act of 2005 (DRA) Public Law Number 109-171. Section 6087, the “Optional Choice of Self-Directed Personal Assistance Services (PAS) (Cash and Counseling)” amended section 1915 of the Social Security Act by adding subsection (j). Guidance also applies to section 1915(c) HCBS waiver programs when states offer the self-direction opportunity and permit participants to purchase “individual directed goods and services.”

This issue of "In Focus" explores health technology especially how it relates to Transformation Grants. States that received grants from the Centers for Medicare and Medicaid Services (CMS) to advance the use of electronic health records and e-prescribing programs confronted challenges other states are likely to face as they implement health information technology initiatives using funds from the Stimulus Bill.

In 2006, Congress authorized states to add HCBS as an optional state plan benefit. Because the new benefits (referred to as 1915i) expands access, its addition to the Medicaid service menu has been welcomed by enrollees and advocates alike. This webinar will present an analysis of Medicaid’s new HCBS state plan option, which will include a discussion of the issues surrounding it, the states that have adopted it, and legislative proposals to modify it to ensure it achieves its intended purpose.

New York spends more than most states on Medicaid and long-term care. To understand why this is, the following traits are evaluated: demographics of residents over 65; poverty level; long-term care spending, budgets, and services; and quality of nursing home care. The findings identify a number of demographic and program factors likely contributing to the high rate of spending.

Long-term care services for the elderly and for younger populations with disabilities are a significant component of national health care spending. In 2006, long-term care spending was almost $174 billion, most of it paid by the federal-state Medicaid program. This report focuses on concerns about the financing, the already substantial public role, which presages rapid spending increases as the “baby boom” population ages may lead policymakers to revisit these issues.

The Veterans Health Administration plans to partner with the Aging Network in order to be serving over 109,000 veterans using HCBS by 2011. February 25 and 26, 2009, these organizations met in Boston to develop the partnership, work out next steps, and identify challenges. Presentations provide details on existing infrastructure, Nursing Home Diversion, financial management services, and existing research on HCBS and self-direction.

Find answers to your questions about FMS. The Cash & Counseling National Program Office originally presented this overview during a technical assistance call. It defines self-direction and reviews the duties of FMS agencies and issues in the field. Among these are definitions of services and employee categories, types of FMS, tax and labor laws, costs, and funding models.