HCBS Setting Transition Plans
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1 HCBS Setting Transition Plans NCI Annual Meeting August 12, 2015 Presented by Erica Hendricks, HSRI Policy Associate Content from: HCBS Transition Plans AAIDD National Conference 2015 Valerie J. Bradley, HSRI President Elizabeth Pell, HSRI Policy Associate Human Services Research Institute
2 2 New HCBS Setting Requirements Purpose: Ensure people receiving long-term services and supports through Medicaid home and community based services (HCBS) programs have full access to the benefits of community living and opportunities to receive services in the most integrated setting appropriate Cross HCBS populations and service settings Rule published January 16, Effective March 17, States had 1 year to submit Statewide HCBS Setting Transition Plans. States have 5 years to be in compliance.
3 3 Outline CMS Transition Plan Review Process State Transition Plan Examples
4 4 CMS Transition Plan Review Contributing to review: Administration on Community Living Office of Civil Rights Department of Justice Perspectives: Bring knowledge of Olmstead or other investigations pertaining to specific settings Provide additional input on overall Plan strategy Identify external stakeholder concerns
5 5 Initial Review CMS Review Process 1. Verify public notice & comment periods 2. Results of public comment, systemic review of regulation & policies, site specific assessment, remediation plan both systemic & site specific (activity & dates), monitoring compliance into future CMS & Federal Partner Review 1. Systemic assessment of settings; present summary of results by type (ALF, group home, etc.), how validate 2. Detailed remediation plan
6 6 Statewide Transition Plans: CMS Review Status 0 plans approved so far 46 plans submitted by 3/17 (5 states to submit) 11 states have received communication fron CMS 20 substantive reviews underway 4 states invoked heightened scrutiny reviews
7 7 CMS Next Review Steps Beginning in June, CMS plan for communication with states: State has not completed a Setting Assessment -- CMS will review milestones for reasonableness, and will review again once assessment is complete. Public input will be required again after states have completed assessment of current settings. CMS will review assessments as well as public input on those assessments. State has completed Setting Assessment -- CMS final approval is contingent upon completion of the assessment process, identification of setting types, identification of a specific remediation strategy, inclusion of adequate benchmarks/milestone progress and public input on a final revised plan that incorporates assessment findings.
8 8 CMS Communication with States Heightened scrutiny reviews Results of systemic assessments Validation of site specific assessments and provider surveys More specificity for remediation AK, CO, GA, HI, IL, KY, NV, OH, TN, WV, WY
9 9 Transition Plans Using NCI California Connecticut Delaware Indiana Louisiana Maryland Massachussetts Mississippi New Jersey New York South Dakota Texas Washington Washington, DC
10 10 How Do Transition Plans Use NCI? Less Detail Don t indicate how the data will be used Standard processes will be considered for modification to ensure ongoing compliance, such as utilizing available data, such as the National Core Indicators (NCI) More Detail Refer to specific NCI indicators Crosswalk between assurances and data sources Indicate how and when NCI data will be used
11 11 Common Transition Plan Elements State Transition Activity State agencies review regulations, standards, policy & procedures, waiver service definitions, provider qualifications, quality monitoring Provider self-assessment of settings Validation of provider self assessment Identification of settings in compliance, not in compliance, & heightened scrutiny Remediation plan Present or absent in most plans Present Present Present Absent; self assmt data not collected or not analyzed Specificity absent
12 12 Examples from State Transition Plans
13 13 New Jersey Recipient & Stakeholder Engagement Presentations for consumers and other stakeholders developed to inform public about the HCBS rule. YouTube video and slides from these presentations were uploaded to the state HCBS website. Created webpage with a state mailbox for comments Setting Assessment Extensive regulatory crosswalk between state regulations and HCBS rule
14 14 New Jersey Crosswalk: DD Waiver Day Services (Excerpt) Section C: Person-Centered Planning Federal Rule CMS Guidance Compliance Documentation Citation/ Proof/ Verification (c)(1) Does the setting allow an individual, or a person chosen by the individual, to take an active role in the development and updating of the individual s personcentered plan? Individual and/or their chosen representative are a member of the IDT Individual participation is mandated by policy and procedure Division Circular #35 Service Plan Division Circular #35 Service Plan Rights Document Chapter 23: Service Plan
15 15 South Dakota Recipient & Stakeholder Engagement State staff conducted validation surveys and also interviewed individuals and guardians to validate provider selfassessment. Webinars for providers and stakeholders were conducted to explain the HCBS rule and the provider self assessment In-person community conversations were held Social media (Facebook & Twitter feed) was used to inform about plan, how to view and comment
16 16 South Dakota DD Waiver Residential Service Setting Assessment CHOICES WAIVER
17 17 South Dakota Setting Analysis Identified 59 heightened scrutiny settings, none ID/DD waivers Remediation Strategies - Using CMS 86% HCBS Quality Assurance threshold Continuous quality improvement monitoring will use the Systemic Monitoring and Reporting Technology (SMART), NCI and CQL s POMs Plan identifies expectations laid out in rule, actions steps to bring the state into compliance, designates a responsible agency and a target completion date. (Transition Plan has a very clear remediation chart!)
18 18 Tennessee Recipient & Stakeholder Engagement Materials for consumers and family members developed with input from provider and advocacy organizations Settings Assessment + Recipient Engagement Individual Experience Assessment required to be completed by case managers interviewing every individual on caseload Remediation Strategies Providers required to submit a transition plan to state describing how they will come into compliance with the rule
19 19 Settings Assessment Massachusetts State developed ID/DD transition plans for work, day, & residential settings Recipient & Stakeholder Engagement Stakeholder workgroup formed to monitor plan implementation that includes advocacy organizations, families, providers, self advocacy organizations Remediation Policy adopted to ensure that any future approved settings meet the HCBS rule
20 20 Challenges Identified in Massachusetts 2100 homes in compliance except for locks & leases. How to deal with locks on bedroom doors where bedroom is means to exit home? Behavior management plan regulations need to be changed to support positive behavioral approaches 14 providers (58 settings) presumed not to be in compliance. Each provider required to have a detailed transition plan Workgroup established to facilitate financial, real estate, and programmatic considerations (such as reverse integration)
21 21 References & Information 1. CMS HCBS website: HCBS Final Regulations, Fact Sheets, Settings that Isolate, Transition Plan Compliance toolkit, & Statewide Transition Plans: 2. CMS mailbox for ongoing Q&A & comments: 3. National Core Indicators website: 4. New Jersey s Residential & Community Based Setting crosswalk: 5. HCBS Advocacy website, tracks HCBS setting transition plans: 6. Massachusetts rule: 7. Tennessee s individual interview instrument:
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