Fact Sheets

STATE PLAN HOME AND COMMUNITY BASED SERVICES PROGRAM PROPOSED RULE

Today, CMS is releasing a final rule and a proposed rule designed to expand State Medicaid coverage for home and community-based services (HCBS).

This fact sheet describes the proposed rule for the Home and Community-Based Services State plan benefit, otherwise known as the “1915(i)” benefit. 

The rule provides additional guidance to States regarding the 1915(i) option first authorized in 2005 and enhanced by the Affordable Care Act.  This option permits States to offer home and community-based services without the use of a waiver.  Under 1915(i), States can receive federal reimbursement for services that were previously only eligible for federal funding through a waiver or demonstration.

The 1915(i) option makes these services more accessible by not requiring that an individual meet an institutional level of care in order to receive these services when they are offered by a State.   Additionally, because it a State plan benefit, cost neutrality as compared to institutional services is not required, as it would be under the previous waiver or demonstration authority.   As a result, States will have the ability to provide a full array of home and community based services to individuals who do not qualify for an institutional level of care but have significant services needs, which can include individuals with mental health conditions, Autism Spectrum Disorder, acquired immune deficiency syndrome, or Alzheimer’s disease.  States are permitted to design targeted benefits to meet the needs of individuals with these conditions or other special needs.

Many of the services individuals will be able to receive under this option are services that have been available through home and community-based services waivers, such as personal care and homemaker services that assist individuals with their activities of daily living and in maintaining their living space, day treatment programs, case management services, and respite care services.  Under this rule, these services would be a permanent feature of the Medicaid program and available to all States. This rule also introduces a less burdensome process for States to amend their programs to provide these services.

As with home and community-based services waivers, States will be able to offer eligible individuals the option to self‑direct services, affording individuals maximum choice and control over the the services they receive.  As with other State plan services, the benefits must be provided Statewide, and States may not limit the number of eligible people served. 

The rule also contains other provisions related to home and community-based services:

• The rule proposes a definition of home and community-based settings that will serve as a common definition for services offered through the Community First Choice (CFC) option and the 1915(i) State plan option.  The CFC stat ute specifies that home and community-based settings do not include a nursing facility, institution for mental diseases, or an intermediate care facility for the mentally retarded.  Based on comments we received on this issue in the CFC proposed rule, we decided to revise the setting provision and allow for additional public comment before finalizing.  This proposed rule includes that new language and requires that home and community-based settings must exhibit specific qualities. 
• The rule implements an Affordable Care Act provision providing for a five-year approval or renewal period for demonstration and waivers programs through which a State serves individuals who are dually eligible for Medicare and Medicaid benefits. 

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