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LTSS Roadmap - HCBS

Guidance for the LTSS roadmap planning model providing information on home and community based services.

Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: August 03, 2016

HCBS LTSS Models

HCBS are person-centered care programs that are delivered in the home and community setting and address the needs of persons with functional limitations and in need of assistance with activities of daily living. For the purposes of this website, the emphasis of HCBS is on elders and persons with disabilities.

Overview of HCBS waivers from Medicaid.gov

HCBS are often funded by state waivers. Waivers are part of a State's Medicaid program, but they provide a special group of services to a certain population. Waivers usually require medical and financial eligibility, but eligibility requirements may not be exactly the same as Medicaid eligibility in that State.

Learn more about State waivers as a way to fund LTSS.

Within states, the provision of HCBS is divided between “lead agencies” and other service providers. A lead agency acts as the primary care coordinator in a certain region, such as a county’s department of human and social services. Tribes can apply with their state to become lead agencies, based on state eligibility requirements.See Oneida Nation's story about becoming the lead agency for a state waiver.

Service providers contract with the lead agency in their area to provide services. If a tribe is not a lead agency, it will contract with the appropriate county, state, or managed care organization in its region to provide services and coordinate care.

Eligibility Requirements

Eligibility for HCBS services vary by state. See state resources to learn more.

Examples of Home- and Community-Based Services

Health Services: meeting medical needs

  • Home health
    • Skilled nursing
    • Therapies: Occupational, speech, and physical
    • Dietary management by registered dietician
    • Pharmacy
  • Durable medical equipment
  • Case management
  • Personal care
  • Caregiver and client training
  • Health promotion and disease prevention
  • Hospice care (comfort care for patients likely to die from their medical condition)

 

 

Human Services: supporting daily living

  • Senior centers
  • Adult day care
  • Financial management
  • Transportation and access
  • Home delivered meal program
  • Congregate meal site
  • Telephone reassurance
  • Homemaker and chore services
  • Respite care
  • Home repair and modification
  • Home safety assessment
  • Legal services
  • Financial services
  • Information and referral services
  • Personal emergency response system
 

 

Benefits and Challenges of the HCBS Model

Benefits

  • Cost effectiveness: usually less than half the cost of residential care
  • Quality of life: proximity to family and community, increased autonomy, etc.
  • Culturally responsive: spiritual and cultural activities and support
  • Familiarity: in own home or small residential facility in community; also, some waivers permit family members to be caregivers
  • Can provide counseling/clergy to assist with bereavement
 

Challenges

  • Nonfamily caregivers with limited access to elderly in remote locations, especially during winter months
  • Availability of qualified caregivers
  • Caregiver burnout
  • Potential cultural bias or barriers in the acuity assessment process
  • Sudden medical changes could put client at risk because of lack of 24/7 medical professional availability
  • Access to providers
 

Considerations

• Skilled nursing care includes only medical services that a registered nurse must perform.
• Other daily caregiving tasks fall primarily to family members under this model.

 

National HCBS Model Programs

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DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.