CMS Issues Final Rule, Empowers Beneficiaries

The Centers for Medicare & Medicaid Services (CMS) has issued a final rule that will allow states to use their Medicaid funds for consumer-directed services without a Medicaid waiver. Many more Medicaid beneficiaries will now be able to take charge of their own personal assistance services instead of having those services directed by an agency. This CMS ruling (pdf 263k) guides participating states to allow Medicaid beneficiaries in need of help with the activities of daily living to hire, direct, train, or fire their own personal care workers. Under the new rule, beneficiaries will have the option to hire qualified family members already familiar with the individual’s needs to perform personal assistance (not medical) services. If a state adopts the plan, beneficiaries could receive a cash allowance to hire their own workers to help with bathing, preparing meals, household chores, and other related services that help a person to live independently. Allotments could also be used to purchase items that help foster independence such as a wheelchair ramp or microwave oven. The beneficiaries also have the option of someone else managing their cash allotment. “This new rule should expand the availability of consumer-directed programs, an important development for consumers interested in taking greater control of their own long term care services,” said PHI National Policy Director Steven Edelstein. “But states must also focus on efforts to build and sustain the direct-care workforce necessary to provide these services to ensure that this choice is real and not an unfulfilled promise.” Enrollment in new state plans is voluntary and the state must also provide traditional agency-delivered services if the beneficiary wishes to discontinue self-directed care. The final rule will take effect November 3. Aaron Toleos, Online Communications Directoratoleos@phinational.org