April 13, 2015

Okay…remember what I said about change last week? This week I’m going to explain a big change that is in the works at the Federal level that will affect the delivery of services in every state.

 This big change is called the CMS Final Rule. CMS is the acronym for Centers for Medicaid and Medicare Services. They determine the regulations for the payment of services to Medicaid recipients. The vast majority of our funding is through Medicaid waiver dollars, so any changes in their rules is something we have to pay close attention to.

 I’ll digress a little here to explain how most of our funding works. There are 2 major pieces. One piece is the Governor’s budget. Those are called “state dollars” or base funding. Those are the dollars that we are talking about when we ask our legislators to support our services. The second piece of our funding is from federal Medicaid dollars and is called the FFP or “Federal Financial Participation.” So, the total budget amount for our services is a combination of the Governor’s budgeted amount plus a match from the federal Medicaid dollars of over 51%.

 To get those federal Medicaid dollars, states must follow the CMS regulations I mentioned. There are new regulations that actually went into effect over a year ago that are called the CMS Final Rule. Each state is required to develop a transition plan and be in compliance with these new rules within a 5 year timeframe or risk losing their federal Medicaid dollars.

 The CMS Final Rule “strengthens the requirements for personal autonomy, community integration, and choice in home and community-based services funded through Medicaid. It makes clear that the requirements apply to both residential and non-residential settings and sets specific and more stringent rules for provider owned or controlled residential settings. It requires an independent assessment of individual needs and strengths and a person-centered planning process ensure that individuals receive the services they need in a manner they prefer.”

More on this next week..

April 13th, 2015 Uncategorized
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