Medicaid program; home and community-based services--HCFA. Final rule.

This rule amends the interim final Medicaid regulations published on October 1, 1981 that implemented section 2176 of the Omnibus Budget Reconciliation Act of 1981. The regulations permit States to offer, under a Secretarial waiver, a wide array of home and community-based services that an individual may need to avoid institutionalization. These final regulations: Provide that certain facilities must meet standards, including those established under section 1616(e) of the Social Security Act, if waiver services are to be provided in the facilities, revise the equation that States must use to determine the cost-effectiveness of their waiver programs, clarify that these services are available, at a State's option, to both medically needy individuals and categorically needy individuals, provide that all recipients who are eligible under a special income level will have their post-eligibility income treated in a comparable manner, revise some aspects of the assurances and the documentation that States must provide in their waiver requests, revise the effective date of an approved waiver, established a federal financial participation (FFP) limit for expenditures for home and community-based services, and specify the hearings procedures that apply to waiver terminations.