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Presentation (PDF) Open in new window CMS HCBS Final Rule Deep Dive Background o Released on January 16, 2014 o Has been in the works for 3 years o Over 2000 comments submitted o Became effective March 17, 2014 Main Components o Defines & describes Home & Community Based Settings o Requirements for Person-Centered-Planning o Allows states to combine waivers o Allows a 5 year renewal cycle o Permits payments to some 3rd parties Community-Based Definition o Is integrated and supports full access to the community, to the same degree as individuals not receiving HCBS o Ensures the individual receives services in the community to the same degree of access as individuals not receiving HCBS o Provides opportunities to seek employment and work in competitive integrated settings, engage in community life, & control personal resources o Is selected by the individual from among setting options, including non-disability specific settings & an option for a private unit in a residential setting o Ensures right to privacy, dignity & respect, & freedom from coercion & restraint o Person-centered service plans document the options based on individual needs & preferences, residential settings, the individual’s resources o Optimizes autonomy & independence in making life choices o Facilitates individual choice regarding services & supports, & who provides them And……… Applies to ALL HCBS Services How do we get there? o States must create a transition plan within 120 days of first waiver submission o Must have a 30 days comment period (ended 8/7) o Must identify areas of compliance/non-compliance o "Heightened Scrutiny" o Awaiting guidance for non-residential The Toolkit o Contains: o Q&A Document o “Settings that Isolate” (Red Flags) o Exploratory Questions o Compliance Flowchart Red Flags: o Designed specifically for people with disabilities o The individuals in the setting are primarily or exclusively people with disabilities & on-site staff provides many services to them o The setting is designed to provide people with disabilities multiple types of services & activities on-site o People in the setting have limited, if any, interaction with the broader community o Settings that use/authorize interventions/restrictions that are used in institutional settings o Multiple settings co-located & operationally related (i.e., operated & controlled by the same provider) that congregate a large number of people with disabilities together & provide for significant shared programming & staff, such that the people’s ability to interact with the broader community is limited Was the setting chosen by the individual? o Choice offered of available options? o Was individual given opportunities to visit other settings? o Does the setting reflect the individual’s needs and preferences? o Can the individual identify other providers? o Does the individual express satisfaction with their provider? o Does the individual know how & whom to make a request for a new provider? Does the individual have full access to the community? o Are the HCBS recipients living/receiving services in a separate part of the setting than people not receiving HCBS services? o Is the setting around other residences, retail businesses? o Is the community traffic pattern consistent (people do not cross the street to avoid the setting)? o Are visitors present? Restricted to specific times? Posted visiting times? o Is there evidence that visitors are regularly there? o Is there a restricted visitor’s area? Indiana’s Transition Plan o Well thought out & detailed o Utilizes NCI as a basis to determine compliance o Five Phase Plan o Comment period is now closed 5 Phases of the Indiana Transition Plan o NCI data utilized to identify potential areas of concern o Survey sent to providers to gather information on areas that may be out of compliance with HCBS definition o Compliance data will be shared with stakeholders & feedback obtained o An inventory will be developed, listing areas of compliance & non-compliance o Action plans will be developed to bring Indiana into compliance Day Services o No offical guidance yet from CMS on facility-based services o INARF monitoring, working with DDRS