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HCBS Settings Final Rule

HCBS Settings Final Rule. September 2014 MaryAnn Mood. Home and Community-Based Services (HCBS) Settings Final Rule. The Centers for Medicare and Medicaid (CMS) issued this final rule on January 16, 2014

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HCBS Settings Final Rule

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  1. HCBS Settings Final Rule September 2014 MaryAnn Mood

  2. Home and Community-Based Services (HCBS) Settings Final Rule • The Centers for Medicare and Medicaid (CMS) issued this final rule on January 16, 2014 • The final rule lists many items HCBS providers must comply with to receive Medicaid payment under federal HCBS waivers • The new items relate more to outcomes, making sure individuals are getting the most out of community living and are getting services in integrated settings

  3. The New HCBS Rule Impacts • Participants receiving home and community-based (HCB) services • Medicaid providers providing HCB services • People involved in developing HCB service plans • Non–residential settings where HCB services are provided • Residential settings where participants receiving HCB services live • How HCB service plans are developed • The documentation HCB service plans must contain

  4. HCBS Waiver Changes under 1915(c) • States may combine the three current waiver groups into one single waiver • Traits of HCBS settings are outlined • Rules for person-centered plans of care • Public input requirements for changes in services or rates

  5. HCBS Setting Requirements The final rule establishes: • Qualities of HCBS settings • Settings that are not HCBS • Settings that are presumed not to be HCBS • State compliance and transition requirements

  6. The Final Rule Excludes the Following Settings • Nursing facilities • Institutions for mental disease • Intermediate care facilities for individuals with intellectual disabilities • Hospitals (CMS, 2014)

  7. Settings Presumed to Have Institutional Qualities • Settings in a publicly or privately owned facility providing inpatient treatment • Settings on the grounds of, or very close to, a public institution • Settings that separate individuals receiving HCBS from the community Note: States that use these settings will be subject to the heightened scrutiny process (CMS, 2014).

  8. HCBS Final Rule Applies to Residential and Non-Residential Settings All HCBS settings: • Are integrated in and support full access to the community • Support seeking employment in integrated settings • Are picked by the individual from among different options • Protect individual rights of privacy, respect, and freedom from bullying and restraint • Increase freedom and independence in making life choices • Support choice in picking services and providers

  9. Items Specific to Provider-Owned or Controlled Residential HCBS settings • Individuals must have all of the following: • A lease or other similar legal document • The ability to lock their doors, choose their roommates, and decorate their unit • Control of their own schedule, including having food and visitors at any time • In addition: • The setting must be physically accessible • Any changes to above rules must be due to a specific need and explained in the person-centered service plan (CMS, 2014).

  10. Discussion • Any questions about how the rule applies to residential settings?

  11. Non-Residential Settings CMS has given instructions for residential settings, but states are still waiting for instructions on non-residential settings.

  12. The Person-Centered Plan • Led by the individual • Reflects cultural needs and uses language that is easy to understand • Discusses the individual’s eligibility for services

  13. Waivers that Serve Children • Taking decision-making power away from the parents/guardians is not the intent of the rule • Person-centered planning should be used for age-appropriate modifications • Unlikely that CMS will allow specific waivers to not follow rules due to the age of the participants

  14. Transition Plans Each state must turn in a transition plan to CMS showing how its HCBS settings comply with the new rule

  15. Maryland’s Public Comment • E-mail address: dhmh.hcbssetting.maryland.gov • Mailing address: DHMH 201 W. Preston Street Baltimore, MD, 21201 Attn: Rebecca VanAmburg

  16. Maryland’s Progress • Work plan • Timeline to develop the final transition plan • Determining topic areas to be discussed in the final transition plan • Gathering baseline data

  17. Surveys • Who? • Providers • Participants and caregivers • Survey Monkey link: • Case managers • Will help guide next steps

  18. Questions and Comments Your input is needed and valued!

  19. About The Hilltop Institute The Hilltop Institute at UMBC is a non-partisan health research organization—with an expertise in Medicaid and in improving publicly financed health care systems—dedicated to advancing the health and wellbeing of vulnerable populations. Hilltop conducts research, analysis, and evaluations on behalf of government agencies, foundations, and nonprofit organizations at the national, state, and local levels. Hilltop is committed to addressing complex issues through informed, objective, and innovative research and analysis. www.hilltopinstitute.org

  20. Contact Information MaryAnn Mood Policy Analyst The Hilltop Institute University of Maryland, Baltimore County (UMBC) 410.455.6395 mamood@hilltop.umbc.edu

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