Summary
Prohibits cost-sharing for individuals obtaining services through a home and community based services (HCBS) waiver who would otherwise qualify for institutional care, by 2012 at the earliest.
Implementation Status
CMS posted an informational bulletin regarding implementation of this provision on October 31, 2011. It was formally codified in the April 2010 Final Rule governing the Part D program (pp. 21458-60).
Statutory Text
SEC. 3309. ELIMINATION OF COST SHARING FOR CERTAIN DUAL ELIGIBLE INDIVIDUALS. Section 1860D–14(a)(1)(D)(i) of the Social Security Act (42 U.S.C. 1395w–114(a)(1)(D)(i)) is amended by inserting ‘‘or, effective on a date specified by the Secretary (but in no case earlier than January 1, 2012), who would be such an institutionalized individual or couple, if the full-benefit dual eligible individual were not receiving services under a home and community-based waiver authorized for a State under section 1115 or subsection (c) or (d) of section 1915 or under a State plan amendment under subsection (i) of such section or services provided through enrollment in a medicaid managed care organization with a contract under section 1903(m) or under section 1932’’ after ‘‘1902(q)(1)(B))’’.