Proposed CMS Regulations Help People With Disabilities Live in Their Communities

More people with disabilities who wish to live in the community and not in institutions would be able to do so under proposed regulations released April 14 by CMS

The proposed rule makes it easier for states to provide home- and community-based services in the Medicaid program.

The regulations 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 one target group per waiver. This creates administrative difficulties for states that can delay opportunities for persons with disabilities to either remain in or transition to community living situations. The three target groups whose services could be combined into one demonstration are aged or disabled, people with developmental disabilities 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.

Home- and community-based settings under the proposal cannot be located on the campus of a facility that provides institutional treatment or custodial care. The proposal also would prohibit housing complexes design expressly for persons with disabilities to qualify as “home- and community-based settings.” The goal of such waivers is to integrate people into the social mainstream with equal opportunities and the chance to make choices.

In the 1999 Supreme Court decision Olmstead v. L.C., the Justices ruled that, under the Americans with Disabilities Act, institutionalizing a person with a disability who can benefit from and wants to live in the community is discrimination.

These proposed new rules will assist states in meeting their obligations under Olmstead and the Americans with Disabilities Act.

CMS rules also would clarify that individuals have the opportunity to design their own array of services and supports under the “person-centered” philosophy that is strongly supported by this administration. Those services can include such things as personal care and respite services for caregivers.

The proposed rules follow an advance notice of proposed rulemaking that the agency published the Federal Register in 2009. After that notice the agency received more than 300 public comments on that earlier draft. This notice not only reflects many of those comments, but continues to solicit further input from the public.

The proposed rule, CMS-2296-P, published in the Federal Register on April 15 and will remain open for public comment for 60 days.

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