As part of INARF’s continuing commitment to ensuring members are informed, we have compiled updates on key issues and activities in which the INARF Board of Directors, Governmental Affairs Committee, and Staff have been engaged in on your behalf. Have a question or want to share your perspective on the issues below? Please contact Kim Opsahl for assistance. Have an issue or concern that is impacting your business that is not listed in this update? Please let us know by clicking here. Rate Restoration – SGL Update: Last week, INARF received an update from the Office of Medicaid Policy and Planning that the State Plan Amendment (SPA) required to restore Supervised Group Living and ICF/DD Rates will be submitted to the Centers for Medicare and Medicaid Services (CMS) on August 21st. Once submitted, CMS has up to 90 days to either approve the SPA or "stop the clock" by submitting formal questions. Upon approval by CMS, providers will be notified via IHCP Bulletin, restored rates will be published, and mass adjustments will begin to retro-actively apply the restored rates to July 1, 2015. INARF will continue to work with OMPP to receive updates on the Medicaid State Plan review process and will advise members as more information is available. Waiver Re-Write and Amendments: The first month of Daily Rate implementation is underway. Per guidance issued by the Division, participants who will be served under the daily rate methodology should have the opportunity to meet with their teams within the next 30 days post implementation to evaluate individuals’ service needs and determine the most appropriate service delivery approach going forward. Following this review, if the team is recommending that the daily rate is not appropriate in meeting the individual's unique support needs, it is imperative that the BRQ submitted to support this recommendation clearly demonstrate evidence of the team meeting, dialogue, and decision-making. Within the next few weeks, we anticipate Documentation Standards for the Daily Rate will be published. CIH Waiver Transformation / Waiver Rate Reform 4.0 As reported last month, the Division of Disability and Rehabilitative Services is embarking on an effort to redesign residential services for individuals on the Community Integration and Habilitation Waiver. To this end, the Division announced forums for self-advocates, families, and providers to be held in September. The forums are intended to gather input on what is working well and thoughts on what residential supports and services people want to help them in achieving their desired outcomes and goals. As a part of this announcement, the Division published a dedicated webpage to share information and resources related to the CIH Waiver Transformation. In addition to information about the forums, the page includes links to the “Planning Indiana’s Future” presentation held earlier this summer. In the future, the page will include questions to consider for the forums, updates on transformation activities, and proposals under consideration. As new information is added, INARF will advise members accordingly. INARF’s workgroup exploring the idea of a cost based approach to traditional supported living will be meeting within the next few weeks. The group will continue to discuss and model methodologies for achieving this approach, as well as to identify values and features that are critical to any successful approach. HCBS Settings Rule Transition Plan The assessment phase of the Division’s HCBS Settings Rule Transition Plan is underway. Beginning on July 1st, Case Managers were tasked with completing the Individual Experience Survey with all CIH and FS Waiver participants. Case Managers received training on the survey tool and an FAQ document has been shared. The survey includes 25 questions and should take 10-20 minutes to complete. The questions are focused on assessing not where individuals are living, but rather how they are living. Surveys are to be completed by the end of 2015. In related news, our partners at ANCOR recently reported that the Centers for Medicare and Medicaid Services has updated its home and community based services (HCBS) website to include a matrix of HCBS Statewide Transition Plans. The table includes information on all 50 states and the District of Columbia, and provides updated information on available documents on each state relating to Statewide Transition Plans. While no plans have yet received official approval by CMS, the matrix is helpful in that it includes "Clarifications and/or Modifications required for Initial Approval" (CMIA), which sets forth additional actions that must be taken by states affected in order to receive approval. Wellness Coordination: INARF continues to work with the Division to clarify guidance / instruction to providers on Wellness Coordination requirements. During the Community Supports Section meeting scheduled for August 20 in conjunction with the Quarterly Professional Interest Section meeting, we will share feedback from members who have recently been through Wellness Coordination audits and provide updates on the recommendations submitted in June. Day/Employment Services: On July 1st the Vocational Rehabilitation Services Hybrid Model was implemented. Information and resources regarding the changes, including new forms, have been posted to the Bureau’s website. Of note, the Hourly Billing Mileage Worksheet was recently removed from the website for updates. Once it is reposted, we will advise members accordingly. The VR Rate Reform Work Group is meeting in late August to begin post-implementation monitoring and analysis. In order to gather broad feedback, INARF will be sending out a survey seeking input on experience with the VR Employment Services Model implementation, to date. Should you have questions as implementation moves forward, please forward them to VRProvider@fssa.in.gov. If you have issues or concerns that you believe the VR Rate Reform Work Group should address, please send them to Kim Opsahl at firstname.lastname@example.org. Family Support Waiver and EPSDT Services During the approval process for the Family Support Waiver (FSW), CMS advised that the State need to make greater assurances that certain waiver services available to children under the age of 21 were being used only to supplement not replace services the State is obligated to provide under the EPSDT (Early Periodic Screening Diagnosis and Treatment) Program. As a condition of approval, the State agreed to make these changes; including taking immediate action to make necessary adjustments to its State Medicaid Plan and the FSW to ensure children received services through the appropriate source. The Division is waiting for guidance from CMS to clarify which services need to be addressed; they are also working to understand the potential fiscal impact of shifting services currently provided under the FSW to EPSDT Program. FSSA / DDRS Litigation: FSSA and the Division are engaged in litigation on three key areas – the use of the Level of Care Screening Instrument (LOCSI), the policy of moving individuals from the Aged & Disabled Waiver to the Family Support Waiver, and concerns with the Objective Based Allocation Program. • On the LOCSI litigation, the State has entered a settlement agreement which will result in the selection and implementation of a new level of care screening tool. • On the A&D Waiver policy litigation, the District Court recently entered an order finding in favor of the State. The plaintiffs in these cases have filed an appeal with the Seventh Circuit. • On the OBA litigation, the plaintiffs have filed their response to the State’s motion to decertify the class. They have also filed a motion to exclude or limit the State’s expert testimony. The State has subsequently filed their response to this motion. The final pretrial conference is scheduled for December 28, 2015. Group Home Advocacy Update: INARF’s Group Home Advisory Work Group met with BDDS Director Cathy Robinson and Director of Institutional Services Cindy Carter in July to discuss issues related to the vacancy / referral process and general communication / collaboration / coordination at the local level. The discussion was very productive with commitments to gather additional information about the concerns raised and reconvene for further discussion in early September. Since that meeting, the Bureau has included a description of Group Home services on the BDDS Services Offered webpage. The ESN Work Group will be meeting with the Division in September to continue discussions to finalize recommendations on policies governing referrals, visits, admissions, meeting responsibilities, and discharges and are awaiting final approval. The first meeting of INARF’s Future of Group Home workgroup will be later this month. The group’s purpose is to begin a broader systems discussion on the role of the group home program moving forward and how INARF and the Division can partner to support that role. Recently, the Indiana State Department of Health (ISDH) provided guidance concerning the responsibility for damage to a Medicaid ICF/DD group home that was caused by a client. The consumer in question had a history of aggressive behavior including destruction of property and had a Behavior Support Plan (BSP) that indicated that the consumer would be required to pay for some of the cost for any damage they caused. In this case, there was minor drywall damage to the group home. The ISDH stated that resident funds could be used for restitution as long as the behavior was covered in the BSP and the resident understands the reason for the restitution was that their actions have consequences. ISDH also indicated that the IDT should determine the amount that the resident has to pay, if the resident does not have a lot of money. The BSP restitution requirement also has to be approved by the facility’s HRC and consent has to be obtained. Many thanks to INARF’s Medicaid Consultant Bradley & Associates for sharing this information. If you have any questions, please do not hesitate to contact Tracy Mitchell (email@example.com) or Dan Gaafar (firstname.lastname@example.org) at Bradley & Associates 317-237-5500. No Wrong Door Initiative With support from an Administration for Community Living planning grant, the Division of Aging is developing a three-year implementation plan to transform state long term services and supports access programs and functions into a “no wrong door” system for all populations and all payers. The Division of Aging is hosting forums throughout the state to talk about the initiative and gather feedback. The forums will be held through September. Copies of the presentation are available on the No Wrong Door webpage. House Enrolled Act No. 1391 House Enrolled Act (HEA) No. 1391, passed during the 2014 legislative session, charges the Office of the Secretary of the Family and Social Services Administration (FSSA), in conjunction with the State Department of Health, and the Office of Management and Budget, with providing a written report to the general assembly before October 1, 2015 regarding the following topics:. 1) a review of all current long-term care services available in Indiana, including regulated and unregulated methods of service delivery; 2) an analysis of past policies implemented in Indiana, and other states’ approaches to serving individuals in a home and community-based setting and in an institutional care setting more efficiently and cost-effectively through the use of emerging technologies, including telemedicine and remote patient monitoring; 3) an analysis of demographic trends by payer sources, and demand and utilization of long-term care services options statewide, and by county or other geographic setting; 4) an analysis of program and policy options for long-term care services where demand exceeds current capacity for providing the services; 5) a review of Medicaid reimbursement for skilled nursing facility care, and a determination concerning whether: (A) the reimbursement methodology should be modified to reflect current and future care models, and (B) incentives should be included in reimbursement for quality care and quality outcomes. 6) an analysis of past policies in Indiana and other states’ approaches to manage construction of additional skilled nursing facilities, including certificates of need and moratoria. The analysis must include the following: (A) The costs and benefits to Indiana’s budget and the Medicaid program in whether or not additional skilled nursing facilities are built, including the impact on Medicaid utilization for skilled nursing services; and (B) the impact of additional skilled nursing facilities on the availability and cost of capital for the renovation and new construction of skilled nursing facilities, residential care facilities, assisted living facilities, and other senior housing options. Last week, INARF staff attended a regional forum regarding HEA 1391 in Vincennes, Indiana. Representatives from the FSSA Division of Aging presented a brief overview of information to be included in the report. Stakeholders provided comments on the information from the presentation. Attendees also identified other concerns that should be addressed in the report, including clarification of the moratorium legislation from the 2015 legislative session, collaboration between state agencies, fragmentation of funding sources for services related to aging, the necessity of advanced care planning, and limitations to person-centered planning due to restrictions from private insurance companies. INARF members are encouraged to review the draft report and provide feedback on any concerns with the issues that are addressed by e-mailing Sarah Chestnut at email@example.com. U.S. Department of Labor Overtime Rules: INARF staff are drafting written comments to the proposed DOL Overtime Rule. It is anticipated these comments will be shared with members within the next week, so that members can develop and submit comments, as well. INARF staff also continues to participate in ANCOR’s workgroup tasked with formulating comments to the Department of Labor's recently published overtime rules. As published, the proposed rule will more than double the salary level under which virtually all workers qualify for overtime pay whenever they work more than 40 hours in any given week. That threshold, now $23,660, [would] rise to $50,440.