The "Community First Choice Option" was authorized by the Affordable Care Act and provides an incentive for States to expand their Medicaid coverage for person-centered home and community-based attendant services and supports. States that elect the Community First Choice option are eligible for a 6 percentage point increase in their federal medical assistance percentage. Individuals who require an institutional level of care are eligible for the services, which will be offered in community-based settings. Obviously this rule encourages aging-in-place.
States electing the Community First Choice option will make available home and community-based attendant services and supports to assist beneficiaries in accomplishing activities of daily living, instrumental activities of daily living, and health-related tasks. Beneficiaries may "self-direct" services, which affords individuals maximum choice and control over the services they receive. States may choose to also provide coverage for transition costs to assist Medicaid beneficiaries who are leaving institutions in transitioning to the community. States may also choose to provide for the provision of services that increase independence or substitute for human assistance, such as non-medical transportation services.
It will interesting to see how states react to this as ironically the same week this was rule was issued there was a report on states slashing respite care services. In some respects moving services into the community could provide relief for caregivers.
States must meet several specific requirements:
- They must develop their Community First Choice benefit with the input of a stakeholder council that includes a majority of members with disabilities, elderly individuals, and their representatives.
- Establish and maintain a comprehensive continuous quality assurance system specifically for this Community First Choice benefit.
- Collect and report information for Federal oversight and the completion of a Federal evaluation of the program.
- During the first 12 month period in which the Community First Choice benefit is implemented, the State must maintain or exceed the level of expenditures for home and community-based attendant services provided under the State plan, waivers or demonstrations for the preceding 12 month period.
The Affordable Care Act directs that the Community First Choice benefit may only be available in a "home or community" setting, and this rule does not finalize language regarding the definition for such settings. CMS is committed to offering States a reasonable transition period (of not less than one year) to make any needed changes to come into compliance with the final rule so as to minimize any disruption to State systems that were established in compliance with the proposed regulations.
The statute requires CMS to conduct an evaluation by December 31, 2015 in order to determine the effectiveness of the Community First Choice option in allowing individuals to lead an independent life, the impact on the physical and emotional health of individuals receiving these services, and a comparative analysis of the costs of services provided under Community First Choice and those provided in an institution.
My message has been consistent. The movement toward community-based services is an opportunity for aging services providers such as home health care. That said, smart assisted living and nursing homes will create brand extensions so that they can extend their service offerings to capitalize on the movement outside their facilities.
Learn more ~ or join the conversation!
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