June 24 2015 HCBS Settings Rule Title Medicaid Program State Plan Home and CommunityBased Services 5Year Period for Waivers Provider Payment Reassignment and Home and CommunityBased Setting Requirements for Community First Choice Section 1915k of the Act and Home and CommunityBas ID: 707137
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Home and Community Based Services Settings Rule
June 24, 2015Slide2
HCBS Settings RuleTitle: Medicaid Program; State Plan Home and Community-Based Services, 5-Year Period for Waivers, Provider Payment Reassignment, and Home and Community-Based Setting Requirements for Community First Choice (Section 1915(k) of the Act) and Home and Community-Based Services (HCBS) Waivers (Section 1915(c) of the Act) or “The Settings
Rule”Published in the Federal Register on 01/16/2014
Effective
March 17,
2014www.hcbsadvocacy.org http://dds.dc.gov/page/waiver-amendment-information
2Slide3
HCBS Settings RuleDescribes traits of HCBS settings
. (Our focus today.)Establishes guidelines for person-centered plans of care. Adds public input requirements for changes in services or rate.
Allows states to group waiver populations together.
3Slide4
HCBS Settings Rule – Intent To ensure that people receiving long-term services and supports through home and community-based service (HCBS) programs are actually community-based, with full access to the benefits of community living and the opportunity to receive services in the most integrated setting
appropriate.Focus on:
Integration
with the
communityChoiceRightsIndependence4Slide5
Standards for all HCBS SettingsIntegration with the community
The setting must support full access by the person to the greater community, “including opportunities to seek employment and work in competitive integrated settings, engage in community life, control personal resources, and receive services in the community, to the same degree of access as [people] not receiving Medicaid HCBS.” 5Slide6
CMS Exploratory Questions: IntegrationIs the person aware of or have access to materials to become aware of activities occurring outside the HCBS setting?
Does the person shop, attend religious services, schedule appointments, have lunch with family and friends in the community, as the person chooses?
Are people moving about inside and outside the setting, as opposed to sitting by the front door?
Do people in the setting have access to public transportation?
Does the person have a checking or savings account or other means to control his or her funds?6Slide7
Standards for all HCBS SettingsChoice
People must have a choice among setting options, including settings that are not disability-specific.CMS Exploratory Question: Can the person identify other providers who render the services he or she receives?
7Slide8
Standards for all HCBS SettingsRights
The setting must ensure people’s rights to privacy, dignity and respect, and freedom from coercion and restraint.8Slide9
CMS Exploratory Questions: Rights
Does staff talk to other staff about the person as if the person was not present or within earshot of other people living in the setting?Does staff address people in the manner in which the person would like to be addressed as opposed to routinely addressing people as “hon” or “sweetie”?Do people in the setting have different haircuts/ styles and color?
Are people prohibited from engaging in legal activities?
Is health information about people kept private?
Are people’s schedules for PT, OT, medications, diet, etc. posted in a general area for all to view?9Slide10
Standards for all HCBS SettingsIndependence
The setting must optimize a person’s ability to make life choices, including choices related to daily activities, the physical environment, and with whom to interact. Similarly, the setting must facilitate choice regarding services and supports and who provides them.
10Slide11
CMS Exploratory Questions: IndependenceDoes the person’s schedule vary from other people’s in the same setting?
Does the person work in an integrated community setting?Does the person regularly participate in meaningful non-work activities in the community for the period of time the person desires. Is individual choice facilitated in a manner that leaves the person feeling empowered to make decisions?
11Slide12
Standards for Residential HCBS Settings
People must have:Landlord-tenant protections.Lockable doors.Choice of roommates.
Freedom to furnish and decorate their unit.
Control of their own schedule.
Access to food anytime.Visitors anytime.Physical accessibility.Any change to the above rules must be due to a specific need and explained in the person-centered plan.
12Slide13
CMS Exploratory Questions: ResidentialCan the person request an alternative meal if desired?
Is the person required to sit at an assigned seat in a dining area?Does the person have access to such things as a tv, radio, and leisure activities that interest him or her and can he or she schedule such activities at his or her convenience?
Does the person know he or she can request a change in roommate?
Does the person have a lease or written residency agreement?
Can the person close and lock his or her bedroom door? Bathroom door? Does the person have full access to typical facilities in a home such as a kitchen with cooking facilities, dining area, laundry and comfortable seating in the shared areas?13Slide14
Settings That Are Not HCBS
Nursing facilitiesInstitutions for mental diseases (IMD)
Intermediate
care
facilities for individuals with intellectual disabilities (ICF/IID)Hospitals14Slide15
Settings That Are PresumedNot HCBS
Settings in a publicly or privately-owned facility providing inpatient treatment.Settings on grounds of, or adjacent to, a public institution.Settings with the effect of isolating individuals from the broader community
of individuals not receiving Medicaid HCBS.
15Slide16
HCBS Waiver Transition PlanWe must modify service settings within a little less than 4 years to meet new HCBS rules to ensure continued flow of Medicaid funding.
All states must develop an HCBS transition plan, that provides a comprehensive assessment of potential gaps in compliance with the new regulation, as well as strategies, timelines, and milestones for becoming compliant with the rule’s requirements.
DDS submitted its Statewide Transition Plan on March 17, 2015 and is working with stakeholders on our state self-assessment.
Providers will be conducting self-assessments and writing transition plans for their own organizations.
Service coordinators will also be talking to every person who receives HCBS services about their experiences to inform our assessment. Slide17
State Self-AssessmentWork with HCBS Settings Advisory Group to review and make recommendations for remediation, where needed, on:
All HCBS waiver service definitions and provider requirements. (Completed)
All regulations governing HCBS
.
(Completed) DDS/DDA Provider Certification Review (PCR) process. (In progress)DOH licensing requirements and regulations.
All relevant DDS/DDA policies, procedures, and protocols, including Quality Management practices and tools.
(In progress)
Provider training requirements. (In progress)
Human
Care Agreements and rate
methodologies. (
In progress)
Information
systems
. (Not started)Slide18
Draft Changes to General Provisions 1938
Home and Community Based Setting Requirements1938.1 All Supported Living, Supported Living with Transportation, Host Home, Respite Daily, Residential Habilitation, Day Habilitation, Small Group Day Habilitation, Individualized Day Supports, Supported Employment, Small Group Supported Employment and Employment Readiness settings must:
be chosen by the person;
ensure people’s right to privacy, dignity, and respect, and freedom from coercion and restraint;
be physically accessible to the person and allow the person access to all common areas; support the person’s community integration and inclusion, including relationship-building and maintenance, support for self-determination and self-advocacy, and opportunities for employment and meaningful non-work activities in the community; provide information on individual rights; and
allow visitors at any time, with any exception based on the person’s assessed need and justified in his or her person-centered plan.Slide19
Draft Changes to General Provisions 1938
Home and Community Based Setting Requirements1938.2 All Supported Living, Supported Living with Transportation, Host Home, Residential Habilitation, and Respite Daily, settings must:
Be
integrated in the community and support access to the greater community;
Provide opportunities for the person to engage in community life;Allow full access to the greater community;
Be
leased in the names of the people who are being supported. If this is not possible, then the provider must ensure that each person has a legally enforceable residency agreement or other written agreement that, at a minimum, provides the same responsibilities and protections from eviction that tenants have under relevant landlord/tenant law. This applies equally to leased and provider owned properties
.Slide20
Draft Changes to General Provisions1938 Home
and Community Based Setting Requirements1938.2(e) All Supported Living, Supported Living with Transportation, Host Home, Residential Habilitation, and Respite Daily, settings must:
Develop
and adhere to policies which ensure that each person receiving services has the right to the following
:Privacy in his or her personal space, including entrances that are lockable by the person (with staff having keys as needed);Freedom to furnish and decorate his or her personal space (with the exception of Respite Daily);
Control
over his or her personal funds and bank accounts;
Privacy
for telephone calls, texts and/or emails; and
Access
to food at any time.Slide21
Draft Changes to General Provisions1938
Home and Community Based Setting Requirements1938.3 Any deviations from the requirements in § 1938.2(e) must be supported by a specific assessed need, justified in the person’s person-centered Individualized Support Plan, and reviewed and approved as a restriction by the Provider’s Human Rights Committee. Slide22
Draft Changes to General Provisions 1911 INDIVIDUAL RIGHTS (New Additions)
Each Waiver provider shall develop and adhere to policies which ensure that each person receiving services has the right to the following:
Be
informed orally and in writing of the following:Complaint and referral procedures including how to file an anonymous complaint; How
to report an allegation of abuse, neglect and exploitation;
For
people receiving residential supports, the person’s rights as a tenant, and information about how to relocate and request new housing.Slide23
Draft Changes to General Provisions
New Provider Requirements (1904.4)Complete mandatory training in Person-Centered Thinking, Supported Decision-Making, Supporting Community Integration, and any other topics as determined by DDS.
Develop
and implement a continuous quality assurance and improvement system, that includes person-centered thinking, community integration, and compliance with the HCBS Settings Rule, to evaluate the effectiveness of services
provided. Slide24
Draft Changes to General Provisions INDIVIDUAL
SUPPORT PLAN (ISP) (Changes)The ISP is the plan that identifies the supports and services to be provided to the person and the evaluation of the person’s progress on an on-going basis to assure that the person’s needs and desired outcomes are being met, based on what is important to and for the person, specifically including identifying the person’s interest in employment, identifying goals for community integration and inclusion, and determining the most integrated setting available to meet the person’s needs.
The
ISP shall be developed by the person and his or her support team using Person-Centered Thinking and Discovery tools and skills.Slide25
Draft Changes to Day/ Voc Regs
Ban payment of stipends for attendance
or participation at
day or vocational programs.
Require development of PPP & JS/CPPP.Emphasis on community integration.Day Habilitation must include activities
to support community integration and inclusion. These must occur in the community in groups not to exceed 4 participants and must be based on people’s interests and preferences as reflected in their Individualized Support Plan and Person-Centered Thinking and Discovery
tools.
Employment Readiness must include community-based
employment preparation experiences that are related to the person’s employment goals. Slide26
Person Centered ApproachRequired by the HCBS Settings Rule.
… grounded in demonstrating respect for the dignity of all involved…seek to discover, understand and clearly describe the unique characteristics of the person, so that the person:
Has
positive control over the life he/she desires and finds
satisfying;Is recognized and valued for their contributions to their communities (past, current and potential)
; and
Is
supported in a web of relationships, both natural and paid, within
the desired community/neighborhood
Copyright SDA LLC Slide27
Important To & Important ForImportant To What is important to a person includes what results in feeling satisfied, content, comforted, fulfilled, and happy.
RelationshipsStatus and controlRituals & routinesRhythm or pace of life Things to do and places to go
Things
to have
Important ForWhat others see as necessary to help the person Be valuedBe a contributing member of their communityIssues of healthPrevention & Treatment of illness/medical conditionsPromotion of wellness
Issues of
safety & well
being (physical and emotional) Slide28
Important
to
Important
for
Health & Safety Dictate Lifestyle
Copyright SDA LLC Slide29
Person Centered Thinking
Important
to
Important
for
Copyright SDA LLC
How health and well being fits into the desired life – not either/or, but
both/and.Slide30
Person Centered ThinkingTraining for Attorneys and GuardiansJuly 16, 2015Facilitated by: Michael Smull
Time: 2:00pm – 4:30pmLocation: Conference Room 2B (HR Suite) To register please contact Fikicia Guy and Erica Gross in the DDS Training Departmentdds.providertraining@dc.gov Slide31
Integrated Approach to Health
TechnologyWii FitTimerTV: music videos
Personal Strengths
Likes fruits and veggies
Enjoys looking goodLoves being outsideRelationshipBasedSister helps with medical decisions.
Roommate to go on walks with.
Eligibility Specific
Nutrition
Fitness
Dental
Nursing (HCMP)
Staffing supports
Community Based
Senior center
Health clinic
Paved path in the parkSlide32
For More InformationErin LevetonState Office of Disability AdministrationDC Department on Disability Services(202) 730-1754Erin.Leveton@dc.gov