Improving health is our policy
Delineates the findings of the Senate relative to the status of long-term care in the country, calling upon the 111th Congress to address long-term services and supports in a comprehensive manner and that these services also be made available in the community.
Self-effectuating. No further implementation guidance required.
On a related note, on Dec. 15 and as a follow-up to CMS’ ongoing implementation of its Medicaid HCBS final rule, CMS released the final elements of the HCBS toolkit – information that is intended to assist states in implementing the requirements of the final HCBS regulation that pertain to both residential and non-residential settings (available here and here). CMS stated at the time that this technical guidance “complete[s] the subregulatory guidance that [the agency] plan[s] to issue at this time,” reiterating that states have until March 15, 2015 to submit their statewide transition plans in this vein, which CMS noted “should address HCB settings requirements for both residential and non-residential services.” More information about the HCBS toolkit, please see here.
On a related note, on Jan. 23, 2015, Sen. Hatch and Rep. Upton wrote (press release) to CMS asking about the status of states’ implementation of statutory eligibility and asset transfer criteria for Medicaid long-term services and supports (LTSS), including CMS’ support in facilitating compliance.
SEC. 2406. SENSE OF THE SENATE REGARDING LONG-TERM CARE. (a) FINDINGS.—The Senate makes the following findings: (1) Nearly 2 decades have passed since Congress seriously considered long-term care reform. The United States Bipartisan Commission on Comprehensive Health Care, also know as the ‘‘Pepper Commission’’, released its ‘‘Call for Action’’ blueprint for health reform in September 1990. In the 20 years since those recommendations were made, Congress has never acted on the report. (2) In 1999, under the United States Supreme Court’s decision in Olmstead v. L.C., 527 U.S. 581 (1999), individuals with disabilities have the right to choose to receive their long-term services and supports in the community, rather than in an institutional setting. (3) Despite the Pepper Commission and Olmstead decision, the long-term care provided to our Nation’s elderly and disabled has not improved. In fact, for many, it has gotten far worse. (4) In 2007, 69 percent of Medicaid long-term care spending for elderly individuals and adults with physical disabilities paid for institutional services. Only 6 states spent 50 percent or more of their Medicaid long-term care dollars on home and community-based services for elderly individuals and adults with physical disabilities while 1⁄2 of the States spent less than 25 percent. This disparity continues even though, on average, it is estimated that Medicaid dollars can support nearly 3 elderly individuals and adults with physical disabilities in home and community-based services for every individual in a nursing home. Although every State has chosen to provide certain services under home and community-based waivers, these services are unevenly available within and across States, and reach a small percentage of eligible individuals. (b) SENSE OF THE SENATE.—It is the sense of the Senate that— (1) during the 111th session of Congress, Congress should address long-term services and supports in a comprehensive way that guarantees elderly and disabled individuals the care they need; and (2) long term services and supports should be made available in the community in addition to in institutions.
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