The Assisted Living Consumer Alliance (ALCA) has submitted a comment letter to CMS on proposed regulations that will guide implementation of Medicaid Home and Community-Based Services (HCBS) waivers.  Most importantly, the proposed regulations will set requirements for when a setting can be considered community-based and thus eligible for HCBS funding.  ALCA’s comments tracked to a significant extent the comments submitted by the National Senior Citizens Law Center, one of ALCA’s founding member organizations.  While ALCA offered several recommendations for revising CMS’s proposed regulations, ALCA’s overall message was one of support for the regulations’ efforts to improve the quality and availability of home and community-based services.

ALCA’s comment letter specifically addressed two aspects of the proposed regulations, HCBS settings and person-centered planning.  ALCA suggested revisions in order to better guarantee the home-like character of HCBS settings.  For one, ALCA suggested that if the final regulation uses the term “assisted living,” CMS should develop a more precise definition, as states use differing terminology and the term does not have a universal meaning.  ALCA also recommended revisions to make HCBS funding potentially available in retirement communities that include a nursing facility, or in housing complexes designed around an individual’s diagnosis or disability.  ALCA’s suggested revisions also support private occupancy, the acceptance of visitors, and the ability of a beneficiary to “age in place” in a setting. 

ALCA also supported the regulatory proposal for person-centered planning, noting that the proposed requirements would bring more dignity and independence to participants.  In order for person-centered planning to achieve these goals, ALCA offered recommendations to strengthen and clarify the proposed requirements.  The recommendations included specifying a right to challenge the denial of a participant’s chosen service and/or provider, or any failure of the service plan or planning process to comply with regulatory requirements.  Additionally, ALCA recommended that CMS better articulate states’ responsibilities to ensure that a person-centered process reflects “cultural considerations.”

In general, ALCA expressed support for CMS’s proposed new regulations, which when adopted should improve the lives of Medicaid beneficiaries who rely on long-term services and support.  ALCA’s suggested modifications are consistent with the purpose of the regulations and will serve to strengthen the quality and availability of Medicaid home and community-based services.

comments_on_HCBS_settings.pdf