Situation Report | May 17, 2021
The U.S. Centers for Medicare and Medicaid Services (CMS) has released guidance on states’ use of enhanced federal medical assistance percentage (FMAP) monies for certain Medicaid home and community-based services (HCBS) expenditures. The funds were provided under the American Rescue Plan Act.
The guidance was issued the evening prior to a previously planned HCA meeting with Administration officials on the funds. HCA requested the May 14 meeting to discuss the Executive’s intent on the spending mechanism of the funds, and to discuss the Administration’s timeline for rollout. As previously reported, the state budget includes a $1.6 billion appropriation from the enhanced FMAP, including approximately $700 million for HCBS, which has yet to be disbursed. All parties agreed that the meeting will be rescheduled once the Administration and HCA had time to appropriately review the CMS guidance document.
Further Details of CMS Guidance
States must use the federal funds attributable to supplement, not supplant, existing state funds expended for Medicaid HCBS in effect as of April 1, 2021, and states must use state funds equivalent to the amount of federal funds attributable to the increased FMAP to implement or supplement the implementation of one or more activities to enhance, expand, or strengthen HCBS under the Medicaid program.
The guidance lists eligible services for the enhanced FMAP, including: home health services; personal care; self-directed personal care; private duty nursing; Managed Long Term Services and Supports; waiver programs; Programs of All-Inclusive Care of the Elderly (PACE); case management; rehabilitative services; and more.
The guidance also includes which types of activities can be funded. These include: new and/or additional HCBS; increased rates for home health agencies and PACE; PPE purchase and COVID-19 testing; hazard pay, overtime pay, and shift differential pay for home health workers and direct support professionals that are not already included in the service rate/rate methodology; funding for adult day centers to make physical, operational, or other changes to safely deliver services during the COVID-19 public health emergency; activities to recruit and retain home health workers and direct support professionals; workforce training; support for family caregivers; assistive technology; addressing Social Determinants of Health and Health Disparities; expanding use of technology and telehealth; and more.
HCA Public Policy staff is currently reviewing the complex guidance and will provide the Governor’s office and Division of Budget (DOB) with the Association’s feedback.
HCA encourages providers to review the guidance and submit their feedback to HCA Public Policy & Advocacy Director Alyssa Lovelace for further discussion with both the Governor’s office and CMS in the coming days.