NACDD: Making Sense of LTSS Policy. Rachel Patterson
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This document provides resources for advocates regarding implementation of the Home and Community Based Settings (HCBS) Rule. It outlines the key points of the rule, including that settings must be integrated in the community and ensure participant self-determination. It discusses state transition plan requirements, opportunities for stakeholder engagement, and tips advocates can use to get involved in the process and help ensure full compliance with the rule. Key dates outlined include the rule's effective date of March 2014 and the March 2015 deadline for states to submit transition plans.
NACDD: Making Sense of LTSS Policy. Rachel Patterson
- 1. Implementation of the HCBS Settings Rule: Resources for Advocates Rachel Patterson Association of University Centers on Disabilities July 8, 2014
- 2. What Counts as a Home or Community- Based Setting?
- 3. HCBS Rule: The Key Points 1. Setting is integrated in the community 2. People have self-determination 3. Additional protections for provider-owned 4. Everyone has a Person-Centered Plan 5. Some settings presumed not HCBS
- 4. HCBS Rule: Other provisions • Improved Enforcement of waiver provisions • Caregiver assessment in 1915(i) • Heightened scrutiny for settings that isolate • Documentation of compliance in person- centered plan • What about non-residential services?
- 5. Key Dates • Published: January 16, 2014 • Effective: March 17, 2014 • Transition Plans Due: March 17, 2015 Unless states submit a waiver renewal or amendment before March 17, 2015, then: • States must submit a Transition Plan for the services in that waiver with the submission • 120 days later submit a Transition Plan for their remaining HCBS system
- 6. HCBS Rule: Transition Plan • 2 public notices • 30 day public comment period on full transition plan • Modify the plan in response to comments • Save comments and submit summary to CMS • Plan can be up to 5 years in length
- 7. Transition Plans: What we’ve seen so far • Strict timelines • Assessment plans and Plans to write a Transition Plan • Lack of detail Stakeholder Engagement: This is where you come in!
- 8. Stakeholder Engagement • Did the state post the full transition plan? • Did the state modify the plan based on comments? • Are the comments publically available? Tools on HCBSadvocacy.org
- 13. Tips for Advocates • Learn About the Rule • Spread the Word • Get Involved • Public Comment • Stakeholder Committees • Town halls • Advocate • Improved Stakeholder Engagement
- 14. Tips for Advocates • Work in coalition • Olmstead coalitions or task forces • Protection & Advocacy • DD Council • University Centers • Area Agencies on Aging • Mental Health America or NAMI local • Centers for Independent Living • AARP local chapter
- 15. Tips for Advocates • Build on Existing Reform Work in the State • Olmstead Settlements • Medicaid reform • 1115 waivers • Managed Care • Community First Choice Option • Balancing Incentive Program • 1915(i) HCBS State Plan Amendments Leverage these and other opportunities for increased stakeholder engagement
Editor's Notes
- #3: Sea change in how we think about this and how we regulate it. Not just “not an institution” as defined in Medicaid law, but experience of people living there.
- #4: Integrated and facilitates access to greater community; selected by individual, Privacy, dignity, respect, autonomy, independence Provider owned: Lease, privacy, lockable doors, furnish or decorate, food, visitors, accessibility. Person-centered plan – rules on plan and process, including self-determination Settings that may have been funded with HCBS dollars as not officially institutions but that have the quality of isolating people
- #5: Heightened scrutiny for settings that isolate – stakeholder engagement, need to hear from people who live there. Two ways to look at it – from the person/plan or from the setting. Both need to be in compliance.
- #7: Full Transition Plan 441.301(c)(6)(iii)(B)
- #8: Stakeholder engagement: Is it the full transition plan? Did state modify the plan in fidelity to the comments?
- #10: Share screen: State Resources, Click on Iowa Back to home page: Key Dates and Deadlines Resources to Share Learn About the New Rules – only from Federal Government. Links directly to their resources. HCBS in the news – send us your news stories. National Resources – issue briefs and other ways to learn, and tools for advocacy. DD network partners advocacy checklist and crosswalk of rule and CMS guidance. Will be updated when CMS issues new guidance. Will help you understand the stuff Erik talked about. Count 30 or 120 days. Reiterate Resources to Share – or corrections! (have gotten corrections from state Medicaid agencies)
- #12: Resources from advocates and the federal government
- #14: States that Eric mentioned – you can advocate that those plans aren’t enough and that there needs to be more comment – the P&A did this in PA
- #16: Areas where states are already doing work. They should also include stakeholder engagement. Make sure they’re talking about the rule.