Tuesday, April 19, 2011 Proposed Rule Aims to Keep Medicaid Beneficiaries in Community Care A recently issued proposed rule aims to make it easier for states to provide home and community based services in the Medicaid program, allowing more people with disabilities to stay in their communities. The regulations the Centers for Medicare and Medicaid Services (CMS) is proposing would, for the first time, allow states to target multiple groups in a single home-and-community based (HCBS) waiver demonstration. Under current rules, states must serve 1 target group per waiver. This creates administrative difficulties for states that can delay opportunities for people with disabilities to either remain in or transition to community living situations. The 3 target groups whose services could be combined into 1 demonstration are: (1) people who are aged or have disabilities; (2) people with developmental disabilities; (3) and those with mental illness. The proposed rule also clarifies what constitutes a true HCBS setting and sets out new requirements for "person-centered" care plans. Under the proposal, home and community based settings cannot be located on the campus of a facility that provides institutional treatment or custodial care. The proposal also would prohibit housing complexes designed expressly for people with disabilities to qualify as "home and community based settings." The goal of the waivers is to integrate people into the social mainstream with equal opportunities and the chance to make choices. In addition, the proposal clarifies how beneficiaries can design their own array of services and supports under the "person centered" philosophy. Such services could include things as personal care and respite services for caregivers. The proposed rule, CMS-2296-P, published in the Federal Register April 15, will be open for public comment for 60 days.