Experienced in-home male nurse in uniform helping an aged patient to rise from the bed

This Thursday is the cut-off for states to submit corrective action plans (CAPs) for their home- and community-based services (HCBS) programs in advance of the March 17 HCBS regulatory deadline. But the Centers for Medicare & Medicaid Services is concerned that states are dragging their heels on the CAPs.

 “Today’s conversation is in the name of information sharing, technical assistance, reiterating expectations that we are a partner in adhering to the settings regulation, and yet we’re quite serious that it needs to have meaning and beneficiaries need to be able to see their lives reflected in the in the words in the regulation,” Melissa Harris, deputy director for the Disabled and Elderly Health Programs Group, said earlier this month, according to the Inside Health Policy news outlet.

The warning comes as HCBS stakeholders have voiced concerns that a majority of providers are turning away referrals because of limited staff capacity, and the workforce crisis is putting a severe strain on resources. CMS officials have been adamant that workforce shortages are not a justification for not meeting basic civil right requirements such as access to food and freedom to have visitors.

If states anticipate they will be unable to come into compliance with the final rule by March 17, they have until Dec. 1 to submit CAPs, CMS has said. States’ CAPs should include details on which criteria they need more time to complete — excluding criteria that protect basic civil and constitutional rights.

In May, CMS issued a recalibrated strategy to help states comply with the HCBS final rule and the March 17 deadline. To continue federal reimbursement beyond the transition period, the following criteria must be met:

  • States must receive final Statewide Transition Plan approval. 
  • States and providers must be in compliance with all settings criteria not directly impacted by public health emergency disruptions, including public health emergency (PHE)-related workforce challenges. 
  • Time-limited CAPs are available to states to authorize additional time to achieve full compliance with settings criteria that are directly impacted by PHE disruptions.

The federal government issued the HCBS rule in 2014 to enable Medicaid beneficiaries to receive services in HCBS settings rather than in skilled nursing facilities. Among other provisions, the final rule amends the regulations for the 1915( c) HCBS waiver program in several ways to improve the quality of services for individuals receiving HCBS. These ways include defining person-centered planning requirements.