Specialized Information for:

Nursing HomesAssisted Living/Board & Care Home and Community Based Services
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Home and Community Based Services

Significant efforts are underway at both the state and national levels to "rebalance" the long-term care system to give consumers needing long-term care services more choices in where and how they receive those services. "CHOICES," "Money Follows the Person," "Nursing Home Transition and Diversion" are some of the terms being used and programs developed to give consumers more choice to explore community options. Here you will find information about these different programs, including Aging and Disability Resource Centers (ADRCs) which are single points of entry to long-term care services being developed around the country.

See our MDS 3.0 page for related information.

Long-Term Care Ombudsman Program & HCBS

Charting the Long-Term Care Ombudsman Program's Role in a Modernized Long-Term Care System
This Long-Term Care Ombudsman Program Strategic Directions Work Group Meeting Report, by the National Ombudsman Resource Center (NORC), prepared by the National Association of State Units on Aging (NASUA), seeks to help long-term care ombudsmen to define their role and develop coordination efforts in a new long-term care system.

The Who, What, When, Where and How of Ombudsman Services for Home Care Consumers (November 2013)

  • Presented by: Beck Kurtz, Director of Office of Long-Term Care Ombudsman Programs - Administration of Community Living

Georgia Home Care Ombudsman (November 2013)

  • Presented by: Melanie McNeil, Georgia State Long-Term Care Ombudsman

Ombudsman Services for Home-Care Consumers in DC (November 2013)

  • Presented by: Lynne Person, DC State Ombudsman - Office of the DC Long-Term Care Ombudsman Program

Home Care Ombudsman Programs Status Report: 2007
Ombudsman programs in twelve states are authorized or mandated under state law to provide advocacy on behalf of consumers who receive home and community based care. Over the last seven years the Long-Term Care Ombudsman Program's involvement in home care advocacy has changed little; the numbers of complaints, types of individual and systems issues, and the level of support have remained relatively stable. This paper updates and expands information previously collected on home care ombudsman programs in 2000. New information reported here was gathered in April/May 2007 through a web-based questionnaire and a teleconference.

The Role of the Long-Term Care Ombudsman in Home Care Advocacy (June 2001)
This technical assistance paper, prepared by the National Association of State Units on Aging (NASUA), includes information on the scope of Home Care Ombudsman Programs' responsibilities, the types of complaints which may be reported, program funding, access issues, training and systems advocacy activities.

Strategy Brief:  Ombudsman Program Connections to Home- and Community-Based Service (July 2004)
This document presents discussion highlights from a National Dialogue Forum convened by NASUA on the topic. The primary issues discussed by the participants included: the ombudsman program's role in providing information about home care to consumers; consumer access to home care services; advocacy for quality home care options and relationships with the home- and community-based services system.

Home and Community Based Services Final Regulations

On January 10, 2014 the Centers for Medicare and Medicaid Services (CMS) issued the Medicaid Home and Community-Based Services (HCBS) settings final rule (CMS-2249-P2).  The final regulation addresses several sections of Medicaid law under which states may use federal Medicaid funds to pay for HCBS. The rule establishes requirements for the qualities of settings that are eligible for reimbursement for Medicaid HCBS provided under sections 1915(c), 1915(i), and 1915(k). Click here to read the final rule.

CMS has released several fact sheets on the final rule, which can be viewed here:

FAQs Concerning Medicaid Beneficiaries in Home and Community-Based Settings who Exhibit Unsafe Wandering or Exit-Seeking Behavior (December 2016)
The Centers for Medicare & Medicaid Services (CMS) released FAQs concerning Medicaid Beneficiaries in Home and Community-Based Settings who Exhibit Unsafe Wandering or Exit-Seeking Behavior.  These FAQs give states and stakeholders guidance on how to protect individual choice and adhere to the requirements of person-centered planning for those individuals with dementia and who exhibit unsafe wandering and exit-seeking behaviors. In the FAQs, CMS highlights that "person-centered planning, staff training and care delivery are core components of provider operations to meet HCBS requirements while responding to unsafe wandering or exit-seeking behavior in an individualized manner." 

CMS Announces Extension for States Under Medicaid Home- and Community-Based Settings Rule
The Centers for Medicare & Medicaid Services (CMS) has announced a five-year extension for state Medicaid programs to meet the Home- and Community-Based (HCBS) settings requirements for settings operating before March 17, 2017. States now have until March 17, 2022, to demonstrate compliance for the final rule. See the announcement from CMS here. This extension is in response to states' request for more time to demonstrate compliance with the regulatory requirements and ensure compliance activities are collaborative, transparent, and timely. For more information, please visit here

Information from ACL

Webinar: What is ACL’s Interest in HCBS Quality
ACL launched a webinar series reflecting the agency's commitment to and development of measures for home and community-based services (HCBS) quality. The series provides a platform for internal and external stakeholders to share developments and collaborate on HCBS quality efforts. A transcript (PDF), recording, and slides (PDF) from the first webinar in this series are available. The webinar included and overview of ACL's work on HCBS quality measures, why this work is important, and an update on HCBS quality measures progress, including findings and impact. For more information visit the ACL website.

HCBS Resources

Understanding and Advocating for Effective Implementation of the Home and Community-Based Services Settings Rule (October 2017)
This guide is designed to provide elder law attorneys with a better understanding of the HCBS settings rule and how they can advocate for a strong, effective system that achieves the spirit and intent of the rule.  The guide includes an overview of the rule, a process for states to comply with the HCBS Rule, opportunities for advocacy to promote your clients' best interests, and a review of special issues including dementia care and evictions.  Development of this guide was supported by Consumer Voice and the NAELA Foundation.

State Transition Plans for New Medicaid HCBS Regulations: Four Tips for Consumer Advocates

How New HCBS Rules Affect Adult Day Services and Assisted Living — Guides for Advocacy with State Medicaid Programs

Each state Medicaid program currently is developing its plan to implement new federal rules for Medicaid Home and Community-Based Services (HCBS). Under the new rules, HCBS services must be provided in non-institutional settings, and in a non-institutional manner. HCBS consumers must have the support necessary so that they can access the greater community. Consumers must have choices regarding services, service providers, and schedules. Additional requirements apply specifically to residential settings like assisted living facilities. The federal rules set broad standards, but many details remain to be determined by individual states. States are required to come into compliance by March 2019, and they currently are developing “transition plans” to set policy in that state for 2019 and thereafter. In developing a plan, a state must consult with stakeholders and obtain federal approval for the plans.

To assist state advocates, Justice in Aging and the National Consumer Voice for Quality Long-Term Care have developed two guides on how the HCBS rules can be used to improve services for older persons.

New Medicaid Home and Community-Based Services Rules - SLTCO Dialogue (May 28, 2014)
This webinar discussed the new Medicaid Home and Community-Based Services Rules that went into effect March 17, 2014, which for the first time set standards to ensure Medicaid HCBS is provided in the most integrated community setting and require person-centered care.  Eric Carlson with the National Senior Citizens Law Center and Robyn Grant with the Consumer Voice gave a quick overview of the new rules and how they will impact consumers, and Becky Kurtz with AoA at ACL and Elizabeth Priaulx with the National Disability Rights Network shared the federal perspective and new resources.

NSCLC WEBINAR: Understanding and Impacting Implementation of New Medicaid Home and Community-Based Services Rules
This webinar and a new NSCLC guide to the new rules provides consumer advocates and other stakeholders with a clear explanation of the rules and share guidance for state engagement. Advocates, state policymakers, national advocates, and regulators can learn about what the rule means for residential settings, service planning, and the community-integration transition process.

HCBS Advocacy.org
HCBSadvocacy.org is a platform for the aging and disability communities to post information and resources regarding the new HCBS settings rule and steps each state is making to comply with the new rule.

Transitions and Long-Term Care: A Look at MDS 3.0 Section Q and Money Follows the Person (January 30, 2012)
The Administration on Aging hosted a webinar giving an overview of MDS 3.0 Section Q and Money Follows the Person and detailing how these programs affect the aging network.

Webinar Materials:

ADRC Technical Resource Center 
The ADRC Grant Program, a cooperative effort of the Administration on Aging (AoA) and the Centers for Medicare & Medicaid Services (CMS), was developed to assist states in their efforts to create a single, coordinated system of information and access for all persons seeking long term support to minimize confusion, enhance individual choice, and support informed decision-making. The ADRC Technical Assistance Exchange (TAE) provides technical assistance through one-on-one support, semi-annual ADRC national meetings, weekly newsletters, monthly webcasts and a variety of other ways.

Money Follows the Person ToolKit
Developed by the Rutgers Center for State Health Policy, National Academy for State Health Policy and the NCB Development Corporation in 2006, this toolkit compiles information from numerous sources about nursing home transition and Money Follows the Person (MFP) initiatives.

Money Follows the Person: Impediments to Implementation: A Fact Sheet on Program Start up, Capacity and Access
Developed by NASUAD. The Money Follows the Person Rebalancing Demonstration Program (MFP) was designed to assist states in rebalancing their long-term care systems, and to help Medicaid beneficiaries transition from institutions to the community. Since its inception, MFP has faced many barriers to implementation, most of which have resulted in the program transitioning fewer individuals than originally anticipated. In efforts to clarify the origin and impact of these early problems and ongoing capacity and access challenges, NASUAD prepared a fact sheet, outlining some of the most commonly-reported programmatic complications, such as the unanticipated consequences of statutory compliance and a lack of accessible, affordable housing for MFP participants.

Nursing Facility Transition: A Resource Kit for Long-Term Care Ombudsman
This resource kit provides information and materials for ombudsman programs about nursing facility transition. It is designed to provide state ombudsmen with an easy to use reference point for basic information about state and federal nursing facility diversion and transition initiatives and to facilitate exploration of ombudsman program roles in helping residents who wish to leave the nursing facility.

Information to Share with Consumers

Piecing Together Quality Long-Term Care - A Consumer's Guide to Choices and Advocacy 
This guide from the National Consumer Voice for Quality Long-Term Care (the Consumer Voice) and accompanying fact sheets are designed for advocates and consumers who are currently receiving or who may in the future receive long-term services and supports in the community.  The purpose of these materials is to inform advocates and consumers about options for long-term services and supports, and to empower consumers - through education - to effectively advocate on their own behalf.

Veteran Directed Home and Community Based Services

The Administration for Community Living (ACL), on behalf of the Department of Health and Human Services (HHS) began a partnership with the Veteran’s Health Administration to serve Veterans of all ages at risk of nursing home placement through the Veterans Directed Home and Community Based Services (VD-HCBS) Program.

ACL and VHA’s long-range national vision is to have a long-term service and supports system that is person-centered, consumer-directed and helps people at risk of institutionalization to continue to live at home and be engaged in community life. The VHA will increase access to HCBS to serve the growing demand of veterans who desire home care and prefer independence at home over living in a nursing facility.

The VD-HCBS program provides Veterans the opportunity to self-direct their long-term supports and services and continue to live independently at home. Eligible Veterans manage their own flexible budgets, decide for themselves what mix of goods and services best meet their needs, and to hire and supervise their own workers. Through an Options Counselor, the Aging & Disability Network provides facilitated assessment and care/service planning, arranges fiscal management services, and provides ongoing options counseling and support to Veterans, their families and caregivers.

Department of Justice ADA Mediation Program
In enacting the ADA, Congress specifically encouraged the use of alternative means of dispute resolution, including mediation, to resolve ADA disputes. Through its ADA Mediation Program, the Department refers appropriate ADA disputes to mediators at no cost to the parties. The mediators in the Department of Justice program are professional mediators who have been trained in the legal requirements of the ADA. The Department's program has resolved many ADA disputes quickly and effectively.

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