Home And Community-Based Setting Requirements

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On January 16, 2014, the Centers for Medicare and Medicaid Services (CMS) published the final rule related to home and community based services under Section 1915 of Title XIX. The final rule addresses long-term care services and supports through home and community-based service programs under the 1915(c), 1915(i), and 1915(k) Medicaid authorities in the most integrated setting appropriate. The rule will require considerable work to comply with, and we believe by working together it presents an opportunity to enhance the quality of life for the individuals and families we mutually serve.

The final rule covers: (1) providing new "settings" requirements for home and community-based services; (2) implementing the Section 1915(i) State Plan option to provide HCBS through the State plan; (3) permitting a five-year approval period for Section 1915(b) and Section 1915(c) waivers that serve dual eligibles; (4) allowing for direct payment to third parties that provide benefits or training for Medicaid providers in certain circumstances; and (5) changing a number of requirements applicable to Section 1915(c) waivers.

South Carolina Healthy Connections Medicaid must complete several tasks to be compliant with the modifications of the final rule. These tasks include: (1) the development of a transition plan outlining the Agency's plan of action to address all necessary changes to be made; (2) an open comment period on the transition plan; and (3) administering on-site assessments of our preexisting home and community based service facilities.

Healthy Connections is grateful for your commitment as we improve the home and community-based setting requirements and focus on the nature and quality of individuals' experiences. There will be more information made available through Bulletins, Advisories, and website postings as our team develops increasing levels of detail.

If you have any additional questions or concerns at this time, please feel free to contact Kelly Eifert, Project Manager, by phone at 803-898-3075 or by email at Kelly.Eifert@scdhhs.gov. You may also contact Lisa Ragland, Quality Assurance Coordinator, at 803-898-1387 or by email at RAGLAND@scdhhs.gov.

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