LeadingAge is urging the Centers for Medicare & Medicaid Services to place a two-year pause on the recently enacted Medicaid Home and Community-Based Settings (HCBS) Final Rule for adult day and assisted living providers serving people with dementia or those over the age of 55.
The rule, which was finalized in 2014 but took effect on March 17, aims to ensure that HCBS services are separate and distinct from institutions as a way to protect the civil rights of those using HCBS. But for those in adult day and assisted living, who do not fit clearly in the two categories envisioned by the regulation, the rule is having the “chilling effect of limiting access to HCBS for older Medicaid beneficiaries.” This is according to a white paper released Thursday by LeadingAge, which represents nonprofit aging services providers.
“While the intent of the Settings Rule is laudable, in practical application, it is problematic,” Katie Smith Sloan, president and CEO of LeadingAge, said in a statement accompanying the white paper.
The report points out that older adults who use adult day services have physical or cognitive disabilities and need support, services and/or supervision. Among the rule’s flaws, it includes “impractical” regulations for HCBS providers such as the requirement to offer employment opportunities. Offering employment options to those who have finished their careers — and especially for those with dementia — does not make sense, LeadingAge said.
Some requirements also place unnecessary burdens on an already-strained nursing workforce, according to LeadingAge. Under the rule, HCBS providers must organize field trips or outings to “support full integration into the community.” LeadingAge argues this is often an impossible task, especially for agencies that are short-staffed. The rule is also unclear on what activities are compliant. One provider reported bringing residents to a nearby DollarTree store, since it was the only close destination available.
Further worsening the challenges of staffing shortages, the rule prevents HCBS and institutional care providers from sharing staff, even for non-care-related functions such as human resources. This, says LeadingAge, can place more administrative stresses on providers and prevents them from consolidating staff to reduce inefficiencies.
In seeking a two-year moratorium, LeadingAge requests the Biden administration develop specific guidance for aging service providers during that time. If it becomes apparent that more time for rulemaking will be needed, LeadingAge is requesting an extension on the moratorium.
“This rule, however well-intentioned, simply does not work for aging services. And sadly, those most impacted are older adults and families, as well as the providers who serve them,” Sloan said in a statement. “It’s time to take action: CMS must develop guidance that works.”
