The Centers for Medicare and Medicaid Services has issued a final rule establishing Medicaid incentives for home and community-based services for chronically ill patients in lieu of being treated in a nursing home or other institution.

The Community First Choice Option program offers a 6 percent increase in federal Medicaid matching funds to participating states. The rule authorizes use of “back-up systems and supports,” which could include persons identified by a patient as back-up support, or “assistive” technologies such as personal emergency response systems and other mobile communication devices.

The rule is purposely vague on identifying assistive technologies, the inset being to support inclusion of technologies as they are developed, according to CMS. In addressing a specific comment based on the proposed rule, however, CMS indicated telemedicine technologies are a useful method of providing back-up systems or supports. The rule is available here and will be published May 7 in the Federal Register. Also available is a proposed rule for a separate home and community-based care program that was authorized in 2005 and enhanced under the Affordable Care Act.

CMS also has announced the first 16 organizations--selected from more than 130 applications--to participate in the previously announced Independence at Home Demonstration program for Medicare beneficiaries. The three-year program starting in 2015 will include up to 10,000 voluntary Medicare fee-for-service patients. More information and the list of initial pilot organizations are available here.

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