Home care planning: 4 things LTC planners should know about the new regs

PPACA and the regulations may reshape LTC providers by limiting which ones can bill Medicaid for home and community-based services.

Above: The late Sen. Ted Kennedy, the father of the CLASS Act. (AP photo/Toby Jorrin)

2. CMS pulled back from plans to shun assisted living facilities, but the final rule could still cause headaches for entities that try to provide multiple levels of care, or entities that try to care for people with dementia in a home-like setting.

Originally, when CMS published drafts of the new regulations, it was thinking about excluding assisted living facilities (ALFs) from access to Medicaid home care benefits programs.

ALFs, residents and consumer groups protested. CMS ended up saying that an apartment in an ALF may qualify as a “home.” But, apparently in response to regulator and consumer group hostility toward institutional care, CMS has created a complicated definition of “home.”

Entities apparently will have a hard time getting an apartment classified as a home if it’s in an ALF that’s in the same building as a nursing home. If, however, an ALF shares a building with apartments for seniors who are still capable of living on their own, the apartment in the ALF will probably fit the CMS definition of “home.”

If an LTC services provider owns or controls a “residential setting,” then an apartment in the provider’s ALF might count as if an ALF if it has a lockable door, residents have a choice of roommates, residents have the freedom to decorate their living units, residents can eat whenever they want, and residents can have visitors whenever they want.

3. The new regulations could expand demand for LTC planners, managers and advocates.

Entities are supposed to use “person-centered service plans” to document the care options available and the consumer’s needs and preferences. 

LTC programs and entities have been trying to use a person-centered approach for years, but PPACA now makes that the law. The implementing regulations set formal requirements for the services. In the Medicaid LTC benefits area, the regulations give consumers the right to invite anyone they want to “person-centered planning meetings.”

Now, for example, a state is supposed to use an independent agent to evaluate whether a consumer is eligible for LTC benefits.

 4. The U.S. Department of Health and Human Services (HHS) — the parent of CMS — is making person-centered planning training a major focus.

You may have thought HHS was too busy setting up the PPACA public exchange system and keeping Medicare solvent to think much about person-centered LTC planning, but the Assisted Living Federation of America (ALFA) says the Administration for Community Living is helping each HHS agency do as much as it can to promote person-centered planning and consumer self-direction.

The Administration for Community Living is also developing a person-centered counselor training program for state LTC benefits program advisors. 

HHS Secretary Sylvia Mathews Burwell (File photo)