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Appendix II 213Olmstead Update No: 3Subject: HCFA UpdateDate: July 25, 2000Dear State Medicaid Director:On January 14, 2000, we transmitted the first in a series of letters describing the Supreme Court’s decisionin the case of Olmstead v. L.C. We observed the fact that Medicaid may be of great assistance toStates in fulfilling their civil rights responsibilities under the Americans with Disabilities Act (ADA). Wealso promised to review federal Medicaid policies and regulations to identify areas in which policy clarificationor modification would facilitate your efforts to enable persons with disabilities to be served inthe most integrated settings appropriate to their needs.This letter summarizes some of the recent Health Care Financing Administration (HCFA) efforts toreview Federal policies in order to facilitate fulfillment of the ADA. These efforts have been directedtowards supporting States’ initiatives in the following critical areas:• Assisting people with disabilities to make a successful transition from nursing homes and otherinstitutions into the community;• Expanding the availability and quality of home and community-based services; and• Ensuring that services are comparably available to all.The attached enclosures consist of policy changes and clarifications that HCFA is making that will giveStates more flexibility to serve people with disabilities in different settings. These serve as guidance onhow States may use the flexibility that Medicaid offers to expand services in a variety of ways.We appreciate the ideas that you and members of the disability community have contributed so far.Most of the clarifications and policy reforms described in this letter emanate from your communications.We continue to invite new ideas because further policy work is required.We have established an ADA/Olmstead website that contains questions and answers in response toinquiries received since the January 14th letter. The address is http://www.hcfa.gov/medicaid/olmstead/olmshome.htm.The website also contains related letters to State Medicaid Directors andGovernors and links to other relevant websites. We encourage you to continue forwarding your policyrelatedquestions and recommendations to the Olmstead workgroup through e-mail atADA/Olmstead@hcfa.gov or in written correspondence to:DHHS Working Group for ADA/Olmsteadc/o Center for Medicaid and State OperationsHCFA, Room S2-14-26, DEHPG7500 Security BoulevardBaltimore, MD 21244-1850We look forward to a continuation of our work together to improve the nation’s community-based servicessystem.Sincerely,Timothy M. Westmoreland, DirectorEnclosures
214 UNDERSTANDING MEDICAID HOME AND COMMUNITY SERVICES: A PRIMERHCFA POLICY CHANGES AND CLARIFICATIONSATTACHED TO THIS LETTERPolicyClarification/Interpretation/Policy Change:Purpose: Assisting people with disabilities tomake a successful transition from nursing homesand other institutions into the community.Attachment 3-a: Earliest Eligibility Date inHCBS Waivers.Attachment 3-b: Community TransitionAttachment 3-c: Personal AssistanceRetainer.Discusses a policy change regarding the earliest dateof service for which Federal financial participation(FFP) can be claimed.Explains some of the ways that Medicaid funding maybe used to help elderly people and individuals with adisability transition from an institution to a communityresidence.Discusses a HCFA policy change indicating that a Statemay make payment for personal assistance servicesunder a Medicaid HCBS waiver while a waiver participantis temporarily hospitalized or away from home.Purpose: Expanding the availability and qualityof home and community-based service.Attachment 3-d: Habilitation.Attachment 3-e: Out-of-State Services.Clarifies that habilitation services, including prevocational,educational, and supported employment services,are available under an HCBS waiver to people of allages, in all target groups, if so specified by the State.Clarifies the circumstances under which MedicaidHCBS waiver services may be provided out-of-state.Purpose: Ensuring that services are comparablyavailable to all.Attachment 3-f: Services Provided Under aNurse’s Authorization.Attachment 3-g: Prohibition of HomeboundRequirements in Home Health.Clarifies that States may receive FFP for services providedat the authorization of a nurse, if the providersmeet qualifications specified under the State Plan orMedicaid waiver for these services.Notifies that the use of a “homebound” requirementunder the Medicaid home health benefit violatesFederal regulatory requirements at 42 CFR 440.230(c)and 440.240(b).
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Understanding MedicaidHome and Comm
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Gary Smith, the Primer’s principa
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viiiUNDERSTANDING MEDICAID HOME AND
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IntroductionPeople of all ages with
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Introduction 31998—is the group m
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Introduction 5This Primer has been
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CHAPTER 1Medicaid Coverage of Home
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Medicaid Coverage of Home and Commu
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CHAPTER 2Financial Eligibility Rule
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Financial Eligibility Rules and Opt
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CHAPTER 3Health and Functional Crit
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Health and Functional Criteria for
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CHAPTER 4Options for Designing Serv
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Options for Designing Service Cover
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as barriers to coverage (i.e., comp
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CHAPTER 5Factors to Consider WhenCh
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Factors to Consider When Choosing C
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Factors to Consider WhenChoosing Co
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CHAPTER 6Transitioning People fromI
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Transitioning People from Instituti
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Guide to Chapter 7Consumer Directio
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Supporting Informal Caregiving 1Inf
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under an HCBS waiver program. This
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Guide to Chapter 9Outreach, Applica
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