CMS requests comments on proposed waiver rules

Summarized by our friend Steve Gold, the two CMS proposed changes are:

1. To change waivers so they can be "based on need, rather than diagnosis or condition." CMS states that the proposed change will "strengthen person-center principles."

Note - there are currently about 350 waivers serving about 1 million people. Each waiver must serve one of three specific target populations - mentally retarded or developmentally disabled, or both; aged or disabled, or both; or mentally ill. CMS writes that the "impediment to serving more than one target group through an HCBS waiver relates to the division between the target groups..., not the associated institutional settings where those target groups would otherwise receive services but for the provision of HCBS."

The proposed change is intended to increase flexibility to combine target groups in one HCBS waiver, or to offer services based on individuals needs, instead of what target group they may fall in.

2. To address residential settings and housing, CMS recognizes that "some individuals who receive HCBS in a residential setting managed or operated by a service provider have experienced a provider-centered and institution-like living arrangement, instead of a person centered and home-like environment with freedoms that should be characteristic of any home and community-based setting."

CMS proposed that persons receiving HCBS services "must reside in the home or community," meaning either "resides in a home or apartment that is NOT owned, leased or controlled by a provider of any health-related treatment or support services; OR resides in a home or apartment that is owned, leased or controlled by a provider of one or more health-related treatment and support services, and that meets standards for community living...."