Fed Regist. 1992 Jun 30;57(126):29142-60.
This interim final rule amends current Medicaid regulations to permit States to offer, under a Secretarial waiver, a wide array of home and community-based services to individuals age 65 or older who are determined, but for the provision of these services, to be likely to require the level of care furnished in a skilled nursing facility (SNF) or intermediate care facility (ICF) (nursing facility (NF) effective October 1, 1990). The rule allows Federal payment for these and other long term care services, up to an amount specified in section 1915(d)(5)(B) of the Social Security Act, subject to HCFA's approval of the States' requests for waivers and certain assurances made by the States. Once granted, waivers are in effect for 3 years, unless terminated by the State with notice to the Secretary, and are renewable for periods of 5 years. Periodic evaluation, assessment, and review of the care furnished under the waivers is required. This rule implements section 4102 of the Omnibus Budget Reconciliation Act of 1987, as modified by section 411(k) of the Medicare Catastrophic Coverage Act of 1988, section 8432 of the Technical and Miscellaneous Revenue Act of 1988, and section 4741(b) of the Omnibus Budget Reconciliation Act of 1990. This rule is being issued in final and, for the most part, without a delay in the effective date for the reasons explained in section IV, "Waiver of Proposed Rulemaking and Delay in the Effective Date."
本暂行最终规则修订了现行医疗补助法规，允许各州在获得部长豁免的情况下，向65岁及以上的个人提供一系列广泛的居家和社区服务。这些个人若不提供这些服务，很可能需要在专业护理机构（SNF）或中级护理机构（ICF）（1990年10月1日起为护理机构（NF））接受护理。该规则允许联邦政府为这些及其他长期护理服务提供资金，最高金额为《社会保障法》第1915(d)(5)(B)节规定的数额，但需获得医疗保健财务管理局（HCFA）对各州豁免申请的批准以及各州作出的某些保证。豁免一旦获批，有效期为3年，除非州政府通知部长后终止，且可每5年续签一次。需要对根据豁免提供的护理进行定期评估、评定和审查。本规则实施了经1988年《医疗保险灾难性保险法》第411(k)节、1988年《技术和杂项收入法》第8432节以及1990年《综合预算协调法》第4741(b)节修订的1987年《综合预算协调法》第4102节。本规则已最终发布，并且在很大程度上没有延迟生效日期，原因见第四节“放弃制定规则提议和延迟生效日期”中的解释。
