Highlights from CMS HCBS Settings Rule

On its August 15 open door forum call discussing the HCBS Settings Rule, the Centers for Medicare and Medicaid Services (CMS) went over the status of the rule’s implementation. It also discussed additional issues that influence implementation after the passage of the 21^st Century Cures Act in the last Congress before proceeding to Q&A.

Currently, 35 states have initial approval for their Statewide Transition Plans (STPs), and 4 states have final approval. CMS believes most of the remaining states will be able to submit their plans soon. For those whose states have not yet begun assessments, CMS recommends either: 1) going to www.medicaid.gov/hcbs  to see the most recent version of their state plan and get a sense of when the assessments are scheduled, or 2) to contact CMS directly to discuss the difficulties providers face.

CMS stated it is aware that many questions remain surrounding the “heightened scrutiny” provision of the rule and is engaged with its state partners to reduce uncertainty. CMS staff on the call directed callers to its sub-regulatory guidelines on the aforementioned website for more clarification.

CMS also mentioned that HCBS and other waiver providers will be expected to comply by 2019 with electronic visit verification (EVV) requirements as a result of the 21^st Century Cures Act. It is working with states to ensure this is addressed, including hosting trainings on the topic. Some states already had EVV in place prior to the passage of the Cures Act. While what EVV looks like will vary by state, CMS is in the process of devising best practices recommendations for EVV which are required to be issued to states by January 2018. They suggested guidance could be coming out in the coming weeks and ANCOR has followed up with CMS to stay involved in the process.

CMS concluded the call with a Q&A session that included discussion on the HCBS Settings Rule’s application to children’s services, its implications for settings that are not yet constructed or undergoing expansion, and addressing challenges in the relationship between providers and state officials surrounding implementation. Although Q&A was limited, multiple ANCOR members were able to weigh in.