CMS Issues Final Rule To Empower Medicaid Beneficiaries To Direct Personal Assistance Services

Main Category: Medicare / Medicaid / SCHIP
Article Date: 30 Sep 2008 - 4:00 PDT

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A final rule that would allow more Medicaid beneficiaries to be in charge of their own personal assistance services, including personal care services, instead of having those services directed by an agency, was announced by the Centers for Medicare & Medicaid Services (CMS).

The rule, on display today at the Federal Register, guides states who wish to allow Medicaid beneficiaries who need help with the activities of daily living to hire, direct, train or fire their own personal care workers. Beneficiaries could even hire qualified family members who may already be familiar with the individual's needs to perform personal assistance (not medical) services.

"This new plan would give Medicaid beneficiaries significant freedom to determine how their personal assistance services are delivered and by whom," said Kerry Weems , CMS acting administrator. "As health care is not simply an economic transaction, this plan represents a fundamental shift that restores a person's ability to improve their overall health by taking greater control of his or her own decisions," Weems said.

If a state adopts a self-directed personal assistance services state plan option, beneficiaries could receive a cash allowance to hire their own workers to help with such activities as bathing, preparing meals, household chores and other related services that help a person to live independently. Allotments could also be used to purchase items that help foster independence such as a wheelchair ramp or microwave oven. The beneficiaries also have the option to have their cash benefit allotment managed for them.

The rule would put into place a provision of the Deficit Reduction Act of 2005 that allows states to elect a state plan option to provide care in ways that previously required waivers of existing Medicaid laws. Such waivers are subject to certain budgetary requirements and are temporary in nature.

Before a state could request this change to its state plan, it must have an existing personal care services benefit, or be operating a home or community-based services waiver program.

Enrollment in this new state plan option is voluntary and the state must also provide traditional agency-delivered services if the beneficiary wishes to discontinue self-directed care.

States choosing this option must have necessary quality assurances and other safeguards in place to assure the health and welfare of participants. States must also furnish sufficient information, training, counseling and assistance to participants in order to help them effectively manage their budgets and their personal assistance services.

The notice of final rule will be published in the October 3, 2008, issue of the Federal Register . The final rule will be effective November 3, 2008.

Centers for Medicare & Medicaid Services

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