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Anthony Cirillo

Calif First State to Get Regulatory Approval for Community First Choice

By November 14, 2012

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California has become the first state to get regulatory approval for a federally funded program aimed at keeping elderly and disabled individuals out of nursing homes.

The Centers for Medicare & Medicaid Services Community First Choice establishes a new state option to provide home and community-based services. It does so by enhancing "Medi-Cal's [Medicaid's] ability to provide community-based personal attendant services and support to seniors and persons with disabilities who otherwise would need institutional care," the California Department of Health Care Services said in a statement.

States may provide services to Medicaid-eligible individuals whose income does not exceed 150% of poverty. States that have set a higher Medicaid income eligibility level for those who require institutional care can use that higher income level. There must be a state determination that, but for the provision of home- and community-based services, the individual would need nursing facility care.

Home and community attendant services provided in a community setting must be based on an individual care plan developed through an assessment of the individual's functional need. States taking up this option must provide the following:

  • Assistance with activities and instrumental activities of daily living (ADLs and IADLs) and health-related tasks, including hands-on assistance, cuing, and supervision.
  • Acquisition, maintenance, and enhancement of skills to complete those tasks.
  • Back-up systems, such as beepers, that will ensure continuity of care and support.
  • Training on hiring and dismissing attendants, if desired by the individual.

By approving the First Choice program, CMS will now give the state a 6% increase in its federal medical assistance percentage for funds spent on personal attendant services. California will immediately get the increased federal funding, with the state slated to get an additional $573 million in government funds in the first two years.

No doubt the nursing home industry is probably up and arms about this. That is why AHCA president Mark Parkinson earlier this year urged members to go deeper into the services they provide. The continuum of care is indeed blurring and more people will want care in the home. And that also flies in the face of the assisted living world where aging in place in assisted living was talked about extensively at ALFA this year.

A bigger vision for healthcare is needed. Who is going to step up and really address the elephant in the room? People do not want what we offer. They want to be home. So would you. So let's come together to figure out how to accommodate that and still run a profitable enterprise.

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