CMS Releases Paper on Managed HCBS

The Centers for Medicare & Medicaid Services (CMS) has issued a memo and brief technical assistance paper that outlines the enrollment authorities that States may consider when designing managed HCBS programs, the CMS review and approval processes for each, and rate setting techniques that may be useful. According to the State Medicaid Directors (SMD) Letter distributing the document, it was created “in response to increasing interest in the use of managed care as a delivery system for Home and Community Based Services (HCBS).” This tool may also be of interest to other stakeholders who are interested in the use of managed care to effectuate global budgets to assist individuals in accessing HCBS. The document intends to” provide information about current policy guidance for States interested in using a managed care delivery system for home and community based services.” CMS points out that “it is incumbent upon States to comply with all applicable federal requirements in the Social Security Act and the Code of Federal Regulations for operating waivers and State Plans as they relate to requirements for managed care, eligibility, home and community based services, and any other requirements pertaining to the State’s specific proposal.” The paper identifies those important areas and provides “practical guidance for using these authorities.” The paper refers to the delivery of home and community based services (HCBS), not specifically home and community based waivers authorized by section 1915(c) of the Social Security Act.