Kathleen Sebelius (AP photo/Charles Dharapak)

The Obama administration wants state Medicaid programs to help more elderly and disabled people get long-term care (LTC) at home and in adult daycare centers, not just in nursing homes.

The Centers for Medicare & Medicaid Services (CMS), an arm of the U.S. Department of Health and Human Services, lays out plans for moving Medicaid into the home and community-based services arena in a final rule.

The rule, set to appear in the Federal Register Thursday, implements Section 2401 of the Patient Protection and Affordable Care Act (PPACA).

PPACA included the Community Living Assistance Support Services (CLASS) Act program, a voluntary, government-run LTC benefits program. Opponents got that provision repealed in January 2013. Even officials in the Obama administration conceded that the program — which would have required the program to offer benefits to people who already qualified for LTC benefits but happened to have jobs — would have been difficult to sustain.

But PPACA also includes many other provisions that related to LTC services.

PPACA Section 2401 calls for HHS to set up programs to encourage state Medicaid programs to offer more home- and community-based care services.

Medicare already pays for some home health care services.

In a discussion of comments on a draft version of the regulations, CMS officials note that commenters had different views on whether care providers should be able to get Medicaid benefits for providing home care in assisted living facilities.

CMS officials said in a preamble to the final rule that they will not require that the provider of home care services be separated from the housing provider.

“We agree with commenters that the issue of choice regarding the provision of services can be addressed as part of the person-centered planning process and reflected in the individual’s person-centered service plan,” officials said. “States must ensure that when an individual chooses a home and community based setting, the individual has made an informed choice among options.”

Officials also talk about guidelines for care delivered in private homes and family homes.

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