Senate Committee Asks CMS to Clarify Medicaid HCBS Eligibility

September 23, 2016 | Aging Services Risk, Quality, & Safety Guidance

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​The Centers for Medicare and Medicaid Services (CMS) should provide additional clarification on the care settings that can qualify for Medicaid services as home- and community-based services (HCBS) and on the processes for appeal for settings deemed ineligible, the U.S. Senate Special Committee on Aging said in a September 6, 2016, letter to the agency. Referencing the 2014 rule establishing HCBS guidelines (see the January 17, 2014, Issues in Continuing Care Risk Management), the committee notes that according to CMS, although HCBS eligibility is determined by services provided rather than by geographic setting, some settings are presumed not to be HCBS; these include settings located in a building where institutional care is also provided and settings that isolate Medicaid-participating HCBS beneficiaries from the broader community.

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