New Home and Community-Based Services Funds, NCQA Opportunities

May 18, 2021 · Matt Brock

The American Rescue Plan Act could be the answer for organizations seeking to create or strengthen Home and Community-Based Services (HCBS) programs. The pandemic-fueled rescue plan increases federal matching rates (FMAP) for Medicaid HCBS spending by 10 percentage points.  

But here’s the thing. You must start planning now.  

The window to apply for these added funds closes next March 31. The act specifies that states should use the enhanced funds to “implement (or supplement the implementation of) one or more activities to enhance, expand, or strengthen” Medicaid HCBS. As you may imagine, we have some ideas about where these funds could benefit your work and our aligned missions.  

The Rescue: A Quality Investment 

As one of the nation’s chief health care quality voices, we first want to applaud the federal government for making this investment. We are encouraged to see a continued commitment to strengthening home and community-based services, something we’ve long supported as a quality imperative.

So… good for you, Centers for Medicare and Medicaid Services (CMS). Keep the innovations coming.  

In a letter to state Medicaid directors, CMS initially outlined how organizations can tap into funding allocated to accelerate long-term services and supports (LTSS) reform. It could also be used to improve current LTSS infrastructure and to “enhance, expand, or strengthen” Medicaid HCBS. States will, in some cases, must apply for waivers to access the funding. But once approved, they’ll have until 2024 to spend the money.  

Opportunity Options 

A number of states already utilize NCQA programs to drive quality in their Medicaid HCBS and LTSS programs.  Here are a few of the tools you might consider adopting as you consider applying for the enhanced Medicaid match: 

• Case Management (CM-LTSS) is a known solution supported by the Administration on Community Living for community-based organizations that want to contract with health systems. 

• Multicultural Healthcare Distinction provides a foundation to address disparities (a CMS priority). Already, three state Medicaid programs and Covered California endorsed MHC Distinction by requiring organizations to earn it.  

• Quality Improvement using valid measurement (HCBS quality measures;  LTSS) is a critical complement to the roadmap that well-developed quality standards provide. NCQA’s current LTSS measures and forthcoming patient goal setting measures—person-centered outcomes (PDO)— will provide key support for states that seek to demonstrate accountability.  

NCQA looks forward to assisting regional, state and local organizations as they take on new and existing challenges and this rare opportunity. We are grateful for the investment. We know, ours is a shared mission to improve quality.