CMS Rule Could Have a Devastating Impact on Seniors Opportunity to Participate in HCBS

A revised proposed rule from the U.S. Centers for Medicare and Medicaid that will guide implementation of Medicaid Home and Community-based Service (HCBS) waivers could have a devastating effect on the opportunity for seniors to participate in the program according to the Assisted Living Federation of America (ALFA).

“A recurring theme in our comments is that the proposed rule focus on the specific needs of the individual, and not on the physical setting as the determination for a home and community-based environment,” said Richard P. Grimes, president and CEO of ALFA in a letter.

The group strongly objects to rules that define a home and community based setting based on the size of the apartment or the number of people who may live in an assisted living community.


“Individuals must have the choice to live where they want to live. The core values of respect, dignity, privacy, independence, autonomy and choice are the foundation for person-centered planning. When operationalized, each individual is treated as a unique person with inherent value. Our belief is that this is the true measure of a home and community-based setting,” said Grimes.

In addition to commenting on the proposed rule, ALFA also addressed the background section of it that outlines eight specific conditions assisted living communities, and only assisted living communities, must meet to qualify for the waiver program.

“Given the numerous congregate care options available to seniors today, it is completely unfair in this case to single out assisted living or to treat it differently from all the other options. While we provided comments related to each of the eight conditions, a potential result of the conditions is less access to quality community-based options,” Grimes said.


The comments were provided to CMS as part of a request for comments on a proposed rule to 42 CFR Part 441 of the Federal Register and as it relates to implementation of Medicaid Home and Community Based Services waiver under section 1915(c) of the Social Security Act.

View a copy of the comments.

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