New Medicaid Rule Aiming to Improve Services for People with Disabilities

In this post:

• Overview Of New Medicaid Rule

• What Does The Rule Require?

• Progress and Shortcomings So Far

• Looking Ahead

• Waiver Consulting Group's advice for providers on implementing the new Medicaid settings rule

Overview of the New Medicaid Rule

After of delays, a landmark new Medicaid Rule aiming to improve services for People with Disabilities, is finally taking effect this week that establishes new standards for home and community-based services for people with disabilities. However, many states remain unprepared to fully meet the requirements of this long-awaited regulation.

The so-called "settings rule" from the Centers for Medicare & Medicaid Services sets criteria for what types of programs can qualify as community-based to receive Medicaid funding. Issued back in 2014, the rule faced years of extensions and pushbacks from states before the deadline arrived this Friday.

Under the new standards, services must be provided in integrated, non-isolating settings that offer privacy, dignity, and autonomy. The aim is to ensure people with disabilities can access critical services while still participating fully in their communities, rather than being segregated in restrictive institutions.

Disability advocates have strongly supported this rule to expand opportunities for independent living. However, implementing such sweeping changes to Medicaid services has proven challenging for states.

Many have requested delays and submitted corrective action plans laying out how they will eventually comply. State officials cite obstacles like staffing shortages, limited funding and logistical barriers to restructuring existing programs.

The COVID-19 pandemic further hampered efforts over the last few years. But disability rights groups note that certain basic requirements should be met by now regardless.

This week's deadline marks major progress, though inconsistent compliance across states remains an issue. The fight for full implementation will continue beyond just meeting this long-delayed target date.

Ultimately, the settings rule seeks to empower people with disabilities through improved Medicaid services. But fulfilling its promise will require ongoing work to bring all states into alignment with the new standards. For now, the years-long journey to improve community integration continues.

What Does the Rule Require?

The settings rule establishes that home and community-based settings must have certain qualities to receive Medicaid funding. These include:

- Integration in and access to the broader community

- Privacy, dignity and respect

- Independence in making choices about activities and lifestyle

- Control over schedule, environment and who they interact with

Originally the deadline for states to comply was 2019, but extensions pushed it to 2022 amid varied preparedness.

Progress and Shortcomings So Far

Some states have made significant progress towards implementing the settings rule, such as assessing settings and providing more community-based options. However, advocates point to ongoing shortfalls across the country.

Many settings still fail to meet the criteria, from large congregate facilities to small group homes. Restrictive practices like rigid schedules and lack of privacy remain common. Accessibility, transportation and availability of services continue plaguing some states.

Disability groups have raised concerns over states designating non-compliant settings as compliant. They emphasize that implementation, not just assessments, is key.

Looking Ahead

While this week's deadline represents a milestone, the work is far from over. States must not only comply on paper but also enforce the rule and ensure quality. Advocates will continue monitoring implementation and pushing for the promises of the rule to fully materialize.

Although long-delayed, the settings rule remains a crucial step towards providing comprehensive, community-based services through Medicaid. Fulfilling its vision will require renewed commitment from states and ongoing advocacy. The years ahead will determine whether this reform translates into meaningful improvements nationwide.

Waiver Consulting Group's advice for providers on implementing the new Medicaid settings rule

• Review the specific criteria and requirements for settings under the rule. Identify any gaps your organization needs to address to come into compliance.

• Create an action plan for making necessary changes to policies, procedures, physical environment and operations. Set clear deadlines and assign responsibilities.

• Train all staff on the settings rule and what it means for service delivery. Emphasize the important of dignity, autonomy and integration.

• Evaluate your organizational culture and make changes to embrace the values of inclusion, independence and person-centeredness underlying the rule.

• Develop new tools and processes to ensure compliance is maintained. This may involve checklists, audits, quality assurance protocols and feedback methods.

• Be proactive and transparent with state regulators. Seek guidance on timelines and provide regular updates on your transition process.

• Identify resources and supports to assist with implementation, such as assistive technology, accessibility modifications and partnerships with community organizations.

• Include people with disabilities and their families in the transition process through surveys, advisory boards and open communication.

• View this as an opportunity to improve services, not just a compliance exercise. The settings rule can catalyze innovation.

• Stay up to date on best practices and connect with peer organizations also implementing the changes.

With proper planning and commitment, providers can successfully transition to the new Medicaid standards. While challenging, the ultimate outcome will be expanded independence and improved quality of life for people with disabilities.

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