CMS Still Figuring Out Assisted Living’s Role in Community-Based Care

The Centers for Medicare and Medicaid Services (CMS) released its final rule implementing the Medicaid Community First Choice (CFC) option, but it’s still figuring out what assisted living’s role is in the program.

Community First Choice provides incentive for states to expand Medicaid coverage of beneficiaries in noninstitutional settings where it’s effective from both a health standpoint for patients who want to receive care at home or in the community, and from a cost standpoint for the provider. States that choose to participate in the program are eligible for a 6% increase in their federal Medicaid matching funds.

The CFC rule is final, but the revised definition of ‘home- and community-based settings’ is not final, and CMS will issue another proposed rule seeking public comment on the revised setting definition. 


“While some serious issues remain to be addressed, the new proposed definition of HCBS settings is much more workable than what was previously proposed,” said Karl Polzer, NCAL’s senior director of policy, in a statement.

Many weighed in on the original proposed definition of HCBS settings, with most advocating for the inclusion of assisted living facilities. The comments shows an element of confusion and disagreement regarding the initial definition and what it encompassed. 

“The proposed provisions caused more confusion and disagreement than clarity, and we believe further discussion and consideration on this issue are necessary,” CMS said in the final rule. 


The agency now intends to issue new proposed regulation providing a ‘setting’ criteria for the CFC program, developed in light of all the comments that were received, and inviting additional comments on the revised proposal. 

“Over the past year, NCAL and many other organizations have expressed deep concerns that the definitions of HCBS settings in the proposed CFC rules, as well as proposed rules for the Medicaid 1915(c) program, would prevent most assisted living settings from participating in the Medicaid program, thereby eliminating an important long term care choice for seniors,” said Polzer.

CMS did clarify it intends to propose that HCBS don’t include nursing facilities, institutions for mental diseases, intermediate care facilities for people with mental retardation, long-term care hospitals, or any other locations with the qualities of an institutional setting as determined by the secretary. 

The CFC option is now in full effect; read the final rule here

Written by Alyssa Gerace

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