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American Rescue Plan Act Enhanced Funding for Home and Community-Based Services

June 29, 2022 Update: The District submitted its May 2022 ARPA Section 9817 Quarterly Narrative and Spending Update to CMS on May 6, 2022. The quarterly update provides detail on the District’s progress toward implementation of proposed ARPA initiatives, an overview of expenditures, and proposes additional activities that enhance, expand, or strengthen Medicaid HCBS for CMS review and approval. The District is awaiting CMS approval of the submission. Both documents are available for review below.

February 9, 2022 Update: The District submitted its February 2022 ARPA Section 9817 Quarterly Narrative and Spending Update to CMS on February 2, 2022. The quarterly update provides detail on the District’s progress toward implementation of proposed ARPA initiatives and proposes additional activities that enhance, expand, or strengthen Medicaid HCBS for CMS review and approval. On February 7, 2022 the District received an additional partial approval for enhancement activities submitted previously. The District will respond to CMS outstanding questions on proposed initiatives in the near term. Both documents are available for review below.

November 10, 2021 Update: The District submitted its November 2021 ARPA Section 9817 Quarterly Narrative and Spending Update to CMS. The quarterly update provides detail on the District’s progress toward implementation of proposed ARPA initiatives and proposes additional activities that enhance, expand, or strengthen Medicaid HCBS for CMS review and approval. The District also submitted and amended version of its ARPA Section 9817 Initial Narrative and Spending Plan. The amended initial plan incorporates District responses to the August 31, 2021 partial approval and CMS request for additional information. Both documents are available for review below.

September 30, 2021 Update: The District has received partial approval of its Initial Narrative and Spending Plan effective August 31, 2021. Identified in the District’s partially approved plan was the Direct Care Worker Vaccination Incentive Initiative. Under this initiative, the District aims to reimburse HCBS providers for the reasonable costs incurred, beginning December 2020 forward, to incentivize direct care workers to receive the COVID-19 vaccine. The District will provide a one-time payment to HCBS providers for the costs associated with successfully encouraging staff to get vaccinated via implementation of an incentive structure. More information on the District’s planned implementation of the Direct Care Worker Vaccination Incentive Initiative is available at https://dhcf.dc.gov/node/1561131.

September 1, 2021 Update: The District has received partial approval of its Initial Narrative and Spending Plan effective August 31, 2021. The partial approval letter is posted below and available for review. The District will respond to CMS outstanding questions on proposed initiatives in order to receive full approval. Please continue to monitor this website for updates on implementation.

July 13, 2021 Update: The District’s ARPA Section 9817 Initial Narrative and Spending Plan is posted below and is available review. The plan was submitted to the Centers for Medicare and Medicaid Services for review and approval on July 12, 2021.

July 8, 2021 Update: The District’s draft ARPA Section 9817 Initial Narrative and Spending Plan is posted below and is available for review.

Background

The American Rescue Plan Act (ARPA) of 2021 was signed into law on March 11, 2021. Section 9817 of ARPA provides states with a temporary ten (10) percentage point increase to the federal medical assistance percentage (FMAP) for Medicaid Home and Community-Based Services (HCBS). States must use funds equivalent to the amount of federal funds attributable to the increased FMAP to implement activities that enhance, expand, or strengthen Medicaid HCBS.

HCBS is defined broadly in the statute and guidance to include traditional HCBS services (home health, 1915c waivers, 1915i services, etc.) and services provided under the rehabilitative services option (ASARS, MHRS), regardless of whether those services are delivered under managed care or approved under a Section 1115 demonstration program.  Federal guidance also makes clear that Section 9817 creates an opportunity for reinvestment of local savings to draw additional enhanced FMAP.

The District must its submit a spending plan and narrative that describe planned enhancement activities to the Centers for Medicare and Medicaid Services (CMS) for review by July 12, 2021.

Additional Information is available in the attached presentation.

Guiding Principles

In its planning, the District must consider the impact on local budget of any initiatives, the long-term sustainability of initiatives funded, and equity of enhancement activities across HCBS programs. In this process DHCF, along with its District partners at the Department of Behavioral Health (DBH) and the Department on Disability Services (DDS), is guided by a few core principles as it considers efforts to enhance Medicaid HCBS, including:

  • Coordinating across provider types and building out equally for any one-time infrastructure initiatives, especially in areas where HCBS providers uptake has lagged;
  • Building on existing work and efforts to be more inclusive of HCBS providers; and
  • Minimizing or eliminating existing gaps in the HCBS service delivery system.

Public Engagement

Stakeholders interested in submitting written comments, recommendations, or suggestions may email them to Eugene Simms, Special Assistant, Office of the Director, at [email protected]. The District will also be holding virtual meetings to facilitate stakeholder engagement.