How the American Recovery and Reinvestment Act Impacts Home and Community-Based Services

President Obama signed the American Recovery and Reinvestment Act into law on Feb. 17, 2009. There are various components of the bill that will affect those providing home and community-based services (HCBS). The stimulus package provides emergency funding for state Medicaid programs to help reduce the incidence of state Medicaid cuts in HCBS, as well as providing additional funding for senior nutrition programs, prevention and wellness programs, and employment programs for older adults.

The bill also prevents the implementation of 2009 budget cuts to hospice providers and the Medicaid regulations that would have shifted additional Medicaid costs to the states.

• Blocks the proposed cut (of 4 percent) in Medicare payments to hospice providers for Fiscal Year 2009. The Budget Neutrality Adjustment Factor (BNAF) for hospice reimbursement will not be phased out until Oct. 1, 2009, to allow CMS and hospice providers time to work on a permanent fix to this reimbursement problem.
• Provides senior nutrition programs an additional $100,000,000 to provide essential services to older adults across the country.
• Extends the moratoria on the Medicaid regulations, initially scheduled to go into effect on April 1, 2009, that would have shifted about $100,000,000 of Medicaid costs to the states for targeted case management, provider taxes, school–based services, intergovernmental transfers, graduate medical education, and rehabilitation services. The moratoria is now extended to June 30, 2009.
• Provides Senior Community Service Employment Program (SCSEP) an additional $120,000,000.
• Provides an additional $650,000,000 will be provided to carry out evidence-based clinical and community-based prevention and wellness strategies authorized by the Public Health Services Act, that deliver specific, measurable health outcomes to address chronic disease rates. Some Administration on Aging (AoA) programs would be included in this section and therefore receive some additional funding. Also, $1,000,000,000 will be provided for the Prevention and Wellness Fund (which includes the Centers for Disease Control and Prevention’s (CDC) Immunization Program and its Healthcare-Associated Infection Program).