Chapter 4
Home- and Community-Based Care  TOP

Introduction

Home- and community-based care (HCBC) is one of the five programs for which Title II funds may be spent. HCBC provides services to clients in their homes or in a community-based setting, may reduce costly stays in hospitals and nursing homes and offers clients the benefit of being treated in a more comfortable and familiar environment. Health services research has documented the cost effectiveness of this approach as well as the psychosocial benefits to their clients.

Legislative Background  TOP

Section 2612 of the CARE Act states that a State may use amounts provided under Title II "(3) to provide home- and community-based care services for individuals with HIV disease in accordance with section 2614;"

Sec. 2614 states that a State may make grants under section 2612(a)(2) to entities to

"(1) provide home- and community-based health services for individuals with HIV disease pursuant to written plans of care prepared by a case management team, that shall include appropriate health care professionals, in such State for providing such services to such individuals;

"(2) provide outreach services to individuals with HIV disease, including those individuals in rural areas; and

"(3) provide for the coordination of the provision of services under this section with the provision of HIV-related health services provided by public and private entities.

"(b) PRIORITY.—In awarding grants under subsection (a), a State shall give priority to entities that provide assurances to the State that—

"(1) such entities will participate in HIV care consortia if such consortia exist within the State; and

"(2) such entities will utilize amounts provided under such grants for the provision of home- and community-based services to low-income individuals with HIV disease.

"(c) DEFINITION.—As used in this part, the term 'home- and community-based health services'—

"(1) means, with respect to an individual with HIV disease, skilled health services furnished to the individual in the individual's home pursuant to a written plan of care established by a case management team, that shall include appropriate health care professionals, for the provision of such services and items described in paragraph (2);

"(2) includes—

"(A) durable medical equipment;

"(B) homemaker or home health aide services and personal care services furnished in the home of the individual;

"(C) day treatment or other partial hospitalization services;

"(D) home intravenous and aerosolized drug therapy (including prescription drugs administered as part of such therapy);

"(E) routine diagnostic testing administered in the home of the individual; and

"(F) appropriate mental health, developmental, and rehabilitation services; and

"(3) does not include—

"(A) inpatient hospital services; and

"(B) nursing home and other long term care facilities."

Operation of Home- and Community-Based Services  TOP

In funding home- and community-based care services, some States pool their allocations for these services with resources from other funding streams including Title I dollars. Also, Medicaid will reimburse certain personal care services, but not other home care services. States must make a concerted effort to determine clients' eligibility for Medicaid. CARE Act funding provides reimbursement only for people who do not receive and do not qualify for other health care coverage or for those needed services not covered under an individual's existing coverage.

Keeping in mind that the CARE Act is the payer of last resort, States must ensure that Medicaid is utilized to the fullest extent for home- and community-based care services covered by both funding streams.