In January of 2014, the Centers for Medicare and Medicaid Services (CMS), the federal agency that administers a significant portion of the funds and rules regarding institutionalized and home care, issued a new publication relative to home and community based services.
The rule that was announced is basically a decision after years of review and effort from all areas of those involved, including nursing homes, health care administrators, attorneys, home care organizations, etc. Similar to the Medicaid rules, the federal government will establish the rules but allow states to administer the programs and services available within their specific jurisdictions. Naturally, there will be a transition process while each state administers its own program after it initiates its own internal rules, regulations, and administrative procedures.
As each state begins its own implementation, there will be further information provided by CMS, which will then be interpreted by each state to allow it to comply with the federal rule. Nonetheless, this is a significantly beneficial program to allow individual states to permit additional home and community based programs, as opposed to requiring people to be institutionalized. In the past, Medicaid and Medicare would pay for many programs once it was both financially and medically necessary for a person to be institutionalized. It is now going to be easier to obtain home services with various plans to be administered by the state and permit individuals to remain in their homes.
There was a Supreme Court case called Olmstead which basically provided that a person did not have to be in the most restrictive setting, but rather, could remain in a least restrictive setting and obtain care, and this decision also supported the Americans with Disabilities Act. Community services under the new program will continue to allow many individuals to remain home, which will be beneficial for the individual, the families, and also hopefully the government, as this will also provide for less expense to care for elders in the community, as opposed to requiring institutionalized care.
This rule will take some time to be fully effective, but there will be further information provided in all states shortly, so anyone concerned with this new program should pay particular attention to the federal and state regulations as they are promulgated.
Hyman G. Darling, Esq.
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