CMS Urges Improvements to Home-Based Waiver Program

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After receiving a bad report card on its home-based waiver program, the Centers for Medicare and Medicaid Services sent a letter to all state Medicaid directors urging them to improve beneficiaries’ access to medical equipment.

In a July 7 report, the U.S. General Accounting Office said that lack of oversight and substandard care plague waiver programs that are designed to move beneficiaries home from an institution. Seeming to respond to that report, CMS suggested to states ways to provide medical equipment to beneficiaries prior to the transition home.

“Purchases of [medical equipment] are typically made after the individual has moved into the community,” CMS told the Medicaid directors. “However, the delay in receiving and adapting to such equipment often causes hardships for the individual and/or caregiver.”

The letter went on to clarify the avenues through which states may achieve the above goal. Specifically, CMS suggested that:

• states could arrange for manufacturers and other sellers of HME to make the equipment available for a trial period prior to community placement
• states could pay for some HME provided prior to a beneficiary’s discharge using a home- and community-based services waiver; and
• states could pay for some HME prior to a beneficiary’s discharge from an institution by evoking the nursing facility benefit.

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