FAMILY CARE HOME AND COMMUNITY-BASED SETTINGS TRANSITION PLAN
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1 FAMILY CARE HOME AND COMMUNITY-BASED SETTINGS TRANSITION PLAN Submitted to CMS: October 2, 2014 Purpose The Department of Health and Human Services Centers for Medicare and Medicaid Services (CMS) published regulations in the Federal Register on January 16, 2014, effective March 17, 2014, which, among other things, changed the definition of home and community-based services settings for 1915(c) and (i) Medicaid Home and Community-Based Services (HCBS) Waivers. These new rules allow for a transition plan of up to five years for full compliance. The new rules also require that, at the time HCBS Waiver renewals are submitted to CMS, the State of Wisconsin must also develop and submit a transition plan identifying how the HCBS Waivers will be brought into compliance with the new outcome-oriented definition of home and community-based services settings. The federal regulations are 42 CFR (c)(4)-(6). More information can be found on the CMS website. WISCONSIN S HOME AND COMMUNITY-BASED SETTINGS TRANSITION PLAN ACTIVITY DESCRIPTION TARGET START DATE TARGET END DATE Public Notice & Input Stakeholder Meeting State will hold stakeholder meeting to announce C waiver renewal July 30, 2014 July 30, 2014 and transition plan. State will indicate where C waiver renewal application and transition plan can be found on State s website and the 30 day public input process. Website Posting State will post C waiver renewal application and transition plan on July 30, 2014 September 2, 2014 website for 30 days for public comment. Newspaper Notice State will post notice of C waiver renewal and transition plan in major newspapers. Notice will indicate where C waiver renewal application and transition plan can be found on website and the 30 day public input process. July 30, 2014 July 30, 2014 Public Comment 30 day public comment period July 30, 2014 September 2, 2014 C Waiver Renewal and Transition Plan State Analysis of Public Comment September 3, 2014 September 23, 2014 State will analyze public comments and revise application and transition plan based on that analysis. 1
2 Revised Transition Plan Posting State will post revised transition plan on website for public October 2, 2014 October 2, 2014 information. Submission to CMS for Approval State submits the C Waiver Renewal Application and HCBS Transition Plan to CMS. October 2, 2014 October 2, 2014 Preliminary Assessment Preliminary Assessment of HCB Services State will conduct a state-directed preliminary assessment of existing HCB services for compliance with HCBS characteristics (Yes, No, or Needs Provider Self-Assessment Verified by MCO/State). State will consider any services provided in the waiver participant s own or family home as home and community-based. For residential settings, preliminary assessment will be based upon a cross walk of the State s existing certification and regulatory requirements with the CMS regulations and guidance. Dependent upon approval of transition plan by CMS December 31, 2014 For day and vocational supports, preliminary assessment will be based on forthcoming guidance from CMS, to determine whether each site in which day and vocational supports are provided is consistent with the characteristics of a home and communitybased setting. Distribute Preliminary Assessment to State will share preliminary assessment with stakeholders for Stakeholders input. Review of Stakeholder Input of State will review stakeholder input and make adjustments as Preliminary Assessment necessary. Provider Self-Assessment/MCO & State Validation Development Preliminary Provider State will develop a provider self-assessment tool to compile Self-Assessment Tool baseline information on individual HCBS settings compliance. Distribute Preliminary Provider Self- State will share preliminary self-assessment tool with Assessment Tool to Stakeholders Review of Stakeholder Input of Preliminary Provider Self-Assessment Tool Implementation - Provider Self- stakeholders for input. State will review stakeholder input and make adjustments as necessary. State will implement the provider self-assessment tool to compile baseline information on individual HCBS settings compliance. MCOs will be responsible for distributing and collecting the tool. Dependent upon CMS guidance for nonresidential settings Dependent upon date of CMS guidance January 1, 2015 February 27, 2015 March 2, 2015 March 31, 2015 August 11, 2014 November 12, 2014 November 26, 2014 December 26, 2014 January 1, 2015 January 30, 2015 February 9, 2015 May 11,
3 MCO Quality Control - Provider Self- MCO will conduct a review on a representative sample of settings to evaluate validity of provider self-assessments. The MCO will use a stratified representative sample so that all settings types are included. MCO will report results to the State. This review will May 25, 2015 November 25, 2015 State Quality Control - Provider Self- Analysis of Provider Self- Distribute Analysis of Provider Self- to Providers, MCOs and Stakeholders include on-site visits. State will conduct a review on a representative sample of MCOs quality control to evaluate validity of provider on-site surveys/self-assessments. The state will use a stratified representative sample so that all settings types are included. This review will include on-site visits. Analyze the results of the on-site survey assessment (after verification) to identify specific issues and challenges that will need to be addressed through the 5-year transition period. All providers must be in compliance by March 17, If not, then MCOs will not be allowed to contract with providers that are out of compliance. December 9, 2015 April 11, 2016 April 25, 2016 May 25, 2016 June 8, 2016 June 8, 2016 Provider Remediation Non-Compliant Provider Who Wish to Come Into Compliance Will Submit a Compliance Plan to MCO for Approval MCO Quality Control - MCOs Evaluate Whether Non-Compliant Providers Are Now Compliant State Quality Control Evaluation of Non-Compliant Providers Member Transitions Member Transitions to HCB Compliant Settings Plan must identify action steps and dates to come into compliance for all items identified as non-compliant on the Provider-Self Assessment Analysis. Compliance Plan may not extend beyond March 11, MCOs will conduct on-site visits of all non-compliant providers using the Provider Self-Assessment Analysis to determine if noncompliant providers are now in compliance. State will conduct on-site visits using a representative sample of MCOs quality control to evaluate validity of remediation compliance assessments. This review will include on-site visits. When necessary, the state will work with MCOs to ensure that members are transitioned to providers meeting HCBS setting requirements. Members will be given, at minimum, a 30-day notice pursuant to the DHS-MCO contract. However, the Department anticipates being able to identify non-compliant providers early in the process and expects the MCO to start the relocation process as appropriate. Members will have a choice of June 9, 2016 September 9, 2016 March 12, 2018 September 10, 2018 September 24, 2018 December 31, 2018 MCOs and the State will know which noncompliant providers are not willing to come into compliance as of September 9, MCOs and the State will March 17,
4 alternative providers through a person-centered planning process. Transition of the members will be comprehensively tracked to ensure successful placement and continuity of service. know which of the remaining non-compliant providers remain noncompliant no later than December 31, Efforts will be made to transition members to compliant settings as soon as it is evident that a setting will remain noncompliant. Participant Survey Participant Survey Analysis State will analyze requirements for annual MCO member survey January 1, 2016 June 1, 2016 for inclusion of questions regarding HCBS settings. Participant Survey Development & State will modify and implement participant survey requirements June 2, 2016 January 1, 2017 Implementation Participant Survey Quality Control Regulations Wisconsin Administrative Code & Statutes analysis Wisconsin Administrative Code & Statutes implementation Contract DHS-MCO Contract Revisions Analysis DHS-MCO Contract - Development & Implementation dependent on analysis. State will monitor participant survey results to flag member experience that is not consistent with assuring control over choices and settings with community access. State will conduct necessary follow-up with MCOs. Activity will occur annually. State will analyze programmatic rules for compliance with HCBS final regulations. If necessary, State will work to revise programmatic rules to reflect final regulations on HCBS setting requirements. State will analyze current contract for compliance with new HCBS waiver regulations. State will amend contract to comply with new HCBS waiver regulations. Activity will occur annually. Contract will incorporate HCBS setting thresholds and will prohibit new providers/sites that have an institutional or isolating quality while presenting deadlines for current providers to come into compliance. Contract will incorporate other new requirements defined in the rule. January 1, 2017 March 17, 2019 January 1, 2015 December 31, 2015 January 1, 2016 December 31, 2018 January 1, 2015 June 1, 2015 June 2, 2016 March 17,
5 Member Handbooks Member Handbooks Analysis State will analyze member handbook for compliance with new January 1, 2016 June 1, 2016 HCBS waiver regulations. Member Handbooks Development & Implementation State will amend member handbook to comply with new HCBS waiver regulations. Activity will occur annually. June 2, 2016 March 17,
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