CMS Releases SMDL on HCBS Settings and Heightened Scrutiny
March 22, CMS released a State Medicaid Director Letter that provides new and additional guidance regarding how states should assess settings for compliance with the requirements around community integration that were included in the 2014 Home and Community Based Services (HCBS) Regulation.  The letter touches upon a wide range of issues, including:

  • How to determine if a setting should be considered “isolating” for purposes of the requirements;
  • The process and information that should be submitted to CMS as part of their review of settings that the state feels are not institutional;
  • Clarifications regarding what the requirements are for privately owned residences as well as for settings that do not receive Medicaid HCBS funding; and
  • Considerations for assessing settings in rural settings.

Click here to access the full letter.

HCBS Heightened Scrutiny Training Session
Thursday, March 28, 2019 from 1:30pm – 3:30pm ET

CMS will conduct an HCBS Settings Heightened Scrutiny FAQ training session on March 28, 2019 at 1:30 PM.  The training will provide participants with an overview of CMS’s approach to conducting heightened scrutiny reviews of presumptively institutional settings, as described in our recently released guidance. Topics will include identification of settings that isolate beneficiaries receiving HCBS, information on presumptively institutional settings to release for stakeholder input and to submit to CMS, and how CMS will review information on specific settings.   Individuals from the Disabled and Elderly Health Programs Group (DEHPG), including the Division of Long Term Services & Supports (DLTSS) will present the training.
Please register to attend this training at: https://neweditions.adobeconnect.com/hcbs_heightened_scrutiny_training_session/event/registration.html

Other states:
Tennessee’ state legislature introduced a bill that would require TennCare (our state Medicaid agency) to submit a request to CMS to receive its federal portion of their Medicaid funds in the form of a block grant.

Major Recent Events – From the Arc of the United States

Budget & Appropriations: Senate Republicans Release FY 2020 Budget Resolution With Instructions That Could Affect Medicaid

On March 22, Senate Budget Committee Chairman Mike Enzi (R-WY) released a draft budget resolution for fiscal year (FY) 2020. The budget proposes to reduce the deficit by $538 billion over five years compared to current law, primarily through reductions in mandatory spending. Additionally, it provides reconciliation instructions for five committees to reduce the deficit by a total of $94 billion. To learn more about the budget proposal, see the committee website. Unlike the president’s budget, budget resolutions in the House and Senate can be enacted and have the force of law. While the Senate budget is not nearly as extreme as the president’s budget, it’s inclusion of reconciliation instructions is the first step to developing legislation that could change the structure and financing of the Medicaid program. The House would need to pass the identical measure for such legislation to be developed.

Tax Policy: ABLE Age Adjustment Act Reintroduced in House

On March 18, Representatives Tony Cardenas (D-CA), Cathy McMorris Rodgers (R-WA), Steve Cohen (D-TN), Brian Fitzpatrick (R-PA), Michael Turner (R-OH), Max Rose (D-NY), and Debbie Wasserman Schultz (D-FL) reintroduced the ABLE Age Adjustment Act (H.R.1814). This bill amends the Stephen J. Beck, Jr. Achieving a Better Life Experience (ABLE) Act to increase the maximum age of onset limit from before 26 to before 46. Its companion bill, S.651, was introduced in the Senate on March 5. The Arc supports the ABLE Age Adjustment Act.