CDCAN: SWEEPING CHANGES COMING FOR MANY MEDICAID HOME & COMMUNITY BASED WAIVER SERVICES ACROSS NATION AS STATES TAKE STEPS TO COMPLY WITH NEW REGULATIONS

STATE CAPITOL UPDATE:
SWEEPING CHANGES COMING FOR MANY MEDICAID HOME & COMMUNITY BASED WAIVER SERVICES ACROSS NATION AS STATES TAKE STEPS TO COMPLY WITH NEW REGULATIONS
–   DEPARTMENT OF HEALTH CARE SERVICES RELEASES FOR PUBLIC COMMENT PROPOSED 12 PAGE DRAFT STATE TRANSITION PLAN TO FEDS THAT OUTLINES HOW CALIFORNIA WILL IMPLEMENT NEW FEDERAL REGULATIONS IMPACTING ITS MEDICAID HOME AND COMMUNITY BASED WAIVER SERVICES
–  SCHEDULES TWO PUBLIC STAKEHOLDER CONFERENCE CALLS FOR PUBLIC ON DRAFT STATE TRANSITION PLAN FOR OCT 21 & DEC 2 FROM 10 AM TO 12 NOON
–  FURTHER STATEHOLDER MEETINGS ON INDIVIDUALS WAIVERS IMPACTING WAIVER SERVICES UNDER DEPARTMENTS OF AGING, DEVELOPMENTAL SERVICES, PUBLIC HEALTH TO BE SCHEDULED – IMPACT COULD BE ENORMOUS ESPECIALLY TO SITE BASED PROGRAMS & RESIDENTIAL SERVICES

 SACRAMENTO, CA [CDCAN LAST UPDATED 09/22/2014 – 05:30 AM] – Sweeping changes are coming across the nation including California for several Medicaid funded special programs, – known as “Home and Community Based Services Waivers” –  that will impact a wide range of long-time community-based services and programs serving hundreds of thousands of children and adults with disabilities – including developmental, mental health needs, with major steps being taken by the states in recent weeks to implement new federal regulations that became effective March 17, 2014. 
    The new federal regulations which redefine what home and community-based services are allowable for federal funding, combined with changes mandated by the federal Affordable Care Act, and implementation of the “Coordinated Care Initiative” in 8 counties that are shifting health care services and long term services and supports to Medi-Cal managed care plans, represent the biggest changes to California’s Medi-Cal program since it was established in 1965. 
    The new federal regulations include a requirement for the states to publicly release a statewide transition plan on how it will implement the federal regulations – and also require the states to involve the public in the process.  In general, states have five years (from the March 17, 2014 effective date of the federal regulations) to fully transition and comply with the new rules with their existing waivers – but must be in full compliance when submitting any new waivers or a proposed change in their existing Medicaid State Plan. 
    Medicaid waivers are programs that provide additional services to specific groups of individuals, limit services to specific geographic areas of the state, and provide medical coverage to individuals who may not otherwise be eligible under Medicaid rules.  California has a number of Medicaid waivers that fund a wide range of programs, services and supports for children and adults with disabilities (including developmental), mental health needs, the blind and seniors – including services funded through the 21 non-profit regional centers, In-Home Operations Waiver , Nursing Facility/Acute Hospital Waiver, Multipurpose Senior Services Program (MSSP) and more.
 
DEPARTMENT OF HEALTH CARE SERVICES RELEASES DRAFT STATE TRANSITION PLAN TO IMPLEMENT NEW REGULATIONS
    In California, the Department of Health Care Services, the agency that oversees State’s massive Medicaid program called “Medi-Cal”,  – the largest in the nation –  took an official step moving toward implementation, with the release for public comment of a “Draft Statewide Transition Plan” – required by the federal regulations – that includes outlining the overall statewide process, what state departments are involved and what specific waivers and services are impacted. 
    The Department of Health Care Services said it has been working with partner agencies, including the Department of Developmental Services (DDS), the California Department of Aging (CDA), the California Department of Public Health (CDPH), and others to develop the initial draft Statewide Transition Plan for public stakeholder input.  The State has been reviewing all impacted Medi-Cal waivers (1915(i) and 1915(c) Waiver services and provider-controlled residential settings) for compliance with the new federal requirements.      
    The department has scheduled public comments periods for its initial draft plan released September 19th and also a public comment period for a revised draft that will be released later in October, with also two public stakeholder conference calls scheduled to receive further comments and to answer questions.  The department indicated that a summary of stakeholder public comments and minutes from the two public stakeholder conferences calls will be posted on the department’s webpage with the revised drafts of the Statewide Transition Plan.
    The Department of Health Care Services, after receiving and reviewing public comments from its initial and revised draft plans, intends to submit the final version to the federal Centers on Medicare and Medicaid Services (CMS) by December 20, 2014.  The final Statewide Transition Plan will be posted on the department’s webpage (see below for link). 
    In addition to the specific stakeholder process for the Draft Statewide Transition Plan, the Department of Health Care Services, with the Departments of Aging, Developmental Services and Public Health,  indicated that there will be in the coming weeks and months, also individual Home and Community Based Services Waiver Transition Plans – such as a plan specific for the Home and Community Based for Developmental Services that fund the majority of regional center funded services and supports for children and adults with developmental disabilities  –  that will be drafted that will each have additional public stakeholder input processes.  No draft plans or specific dates for meetings or conference calls have yet been officially announced yet, but are expected soon.  Those additional specific plans for each waiver impacted – which require a public comment period – has to be submitted to the federal Centers for Medicare and Medicaid Services (CMS) by March 16, 2015.
 
WHAT ARE THE NEW FEDERAL REGULATIONS?
    [CDCAN Note:  Certain exceptions to some of the requirements, especially those regarding residential services could be permitted under the person centered planning process, though those specific exceptions, clarifications, and implementation questions (from both people receiving services and people providing them) should be addressed during the various waiver stakeholder process.  CDCAN will send out information as any new guidance or information regarding the new regulations from the Department of Health Care Services (or other departments) or from the Centers on Medicare and Medicaid Services (CMS) becomes available]. 
    The new federal regulations, which became effective March 17, 2014  specifies that service planning for participants in Medicaid Home and Community Based Services Waiver program must be developed through a person-centered planning process that addresses health and long-term services and support needs in a manner that reflects individual preferences and goals. The federal regulations require that the person-centered planning process is directed by the individual with long-term support needs, and may include a representative whom the individual has freely chosen and others chosen by the individual to contribute to the process. The rule describes the minimum requirements for person-centered plans developed through this process, including that the process results in a person-centered plan with individually identified goals and preferences.
    The federal regulations established new requirements for the qualities of settings that are eligible for reimbursement under the Medicaid Home and Community-Based Services Waivers that require home and community based settings that are based on the experience and outcomes of individuals under person center planning rather than physical or other characteristics of a particular setting.
Specifically, the federal regulations requires that all home and community-based settings must:
– Be integrated in and support full access to the greater community;
– Be selected by the individual from among setting options;
– Ensure individual rights of privacy, dignity and respect, and freedom from coercion and restraint;
– Optimize autonomy and independence in making life choices; and
– Facilitate choice regarding services and who provides them
    The federal regulations also include additional requirements for settings in where the community-based provider funded under a Medicaid Home and Community Services Waiver also owns or operates the residence of the individual who receives services under the waiver. In these settings, an individual who receives services under the waiver must:
– Have a lease or other legally enforceable agreement providing similar protections;
– Have privacy in their unit including lockable doors, choice of roommates and freedom to furnish or decorate the unit;
– Control his/her own schedule including access to food at any time;
– Be able to have visitors at any time; and
– Have a setting that is physically accessible.
    The federal regulations also defines other settings presumed to have institutional qualities that would not be in compliance with the home and community based services setting requirement, including any setting that has the effect, according to the Centers on Medicare and Medicaid Services of “…discouraging integration of individuals…from the broader community of individuals not receiving such services”.
    Should states decide to include any of these other settings in their Medicaid HCBS programs, CMS will exercise “heightened scrutiny,” meaning the state must demonstrate, via a process that includes public input, that the setting does not have the qualities of an institution and does have the qualities of a community based setting as defined and allowed in the new regulations. The federal regulations also clarifies that the home and community-based setting requirements apply to non-residential settings where home and community based services are delivered such as day programs and pre-vocational training settings.
    While the new federal regulations tightens requirements for the states it also includes changes to make it easier for states to access Medicaid funds for home and community-based care including giving the states the option to combine under a single waiver, coverage for several different populations currently covered under separate waivers.
 
HOW TO COMMENT ON THE DRAFT STATEWIDE TRANSITION PLAN
    FIRST PUBLIC COMMENT PERIOD: The Department of Health Care Services intends to receive and review public comments on the initial draft Statewide Transition Plan from September 19th through October 19, 2014, with a public stakeholder conference call scheduled for October 21, 2014 (Tuesday) from 10:00 AM to 12:00 noon to presumably to give a brief overview of next steps, answer questions and receive additional comments.  The call in number is: 888-829-8671  Participant passcode: 7335142
    SECOND PUBLIC COMMENT PERIOD:  The Department of Health Care Services indicated that it will then post on its webpage a revised version that will be released by October 27th, that will reflect changes and revisions including those from public comments received from the first public comment period.  Following the posting of the Revised Draft Statewide Transition Plan, the department will receive and review public comments on Revised Draft Statewide Transition Plan from October 27, 2014 through November 26, 2014.  That will be followed by a second public stakeholder call scheduled for December 2, 2014 (Tuesday) from 10:00 AM to 12:00 noon.  The call in number is: 888-829-8671  Participant passcode: 7335142
    WHERE TO SEND COMMENTS:  Submit all comments to: STP@dhcs.ca.gov
 
LINKS FOR MORE INFORMATION
WEBPAGE OF DEPARTMENT OF HEALTH CARE SERVICES HOME & COMMUNITY BASED SERVICES (HCBS) STATEWIDE TRANSITION PLAN:
http://www.dhcs.ca.gov/services/ltc/Pages/HCBSStatewideTransitionPlan.aspx
DRAFT STATE TRANSITION PLAN (SEPTEMBER 19, 2014) – PDF DOCUMENT COPY (12 PAGES) FROM DEPARTMENT OF HEALTH CARE SERVICES WEBPAGE:
http://www.dhcs.ca.gov/services/ltc/Documents/HCBS_Statewide_Transition_Plan_9-19-14.pdf
WEBPAGE OF CENTERS ON MEDICARE AND MEDICAID SERVICES HOME AND COMMUNITY BASE SERVICES:
http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Long-Term-Services-and-SupportS/Home-and-Community-Based-Services/Home-and-Community-Based-Services.html
ACTUAL FEDERAL REGULATION:
    Final Federal Regulations from Federal Register on Medicaid Home and Community Based Services Waiver (January 16, 2014)  – PDF Document Copy (93 Pages):
http://www.gpo.gov/fdsys/pkg/FR-2014-01-16/pdf/2014-00487.pdf
PRESENTATION, FACT SHEETS, Q&A, INFORMATIONAL BULLETINS FROM CMS:
    Presentation (Slides) by Centers on Medicare and Medicaid Services of the new regulations (January 29, 2014) – PDF Document Copy (59 pages):
http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Long-Term-Services-and-Supports/Home-and-Community-Based-Services/Downloads/Final-Rule-Slides-01292014.pdf
    Overview of the Final Rule (Fact Sheet) from Centers on Medicare and Medicaid Services (January 10, 2014) – PDF Document Copy (3 Pages):
http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Long-Term-Services-and-Supports/Home-and-Community-Based-Services/Downloads/final-rule-fact-sheet.pdf
    Fact Sheet: Summary of Key Provisions of the 1915(c) Home and Community-Based Services (HCBS) Waivers Final Rule (January 10, 2014) – PDF Document Copy (3 Pages):
http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Long-Term-Services-and-Supports/Home-and-Community-Based-Services/Downloads/1915c-Fact-Sheet.pdf
    Fact Sheet: Summary of Key Provisions of the Final Rule for 1915(i) Home and Community-Based Services (HCBS) State Plan Option (January 10, 2014) – PDF Document Copy (2 Pages):
http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Long-Term-Services-and-Supports/Home-and-Community-Based-Services/Downloads/1915i-fact-sheet.pdf
    Summary of Key Provisions of the Home and Community Based Services Settings from the Centers on Medicare and Medicaid Services (January 10, 2014) – PDF Document Copy (4 Pages):
http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Long-Term-Services-and-Supports/Home-and-Community-Based-Services/Downloads/HCBS-setting-fact-sheet.pdf
    Informational Bulletin on Final Rule by Centers on Medicare and Medicaid Services (January 10, 2014) – PDF Document Copy (53 Pages):
http://www.medicaid.gov/Federal-Policy-Guidance/Downloads/CIB-01-10-14.pdf
    Questions and Answers on the Final Rule from Centers on Medicare and Medicaid Services (January 10, 2014) – PDF Document Copy (5 Pages):
http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Long-Term-Services-and-Supports/Home-and-Community-Based-Services/Downloads/Final-Q-and-A.pdf
SETTINGS REQUIREMENTS, TOOLKITS & GUIDANCES FROM CMS:
    Document Showing Outline of Heightened Scrutiny Process by Centers on Medicare and Medicaid Services (no date) –  PDF Document Copy (1 Page):
http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Long-Term-Services-and-Supports/Home-and-Community-Based-Services/Downloads/Heightened-Scrutiny.pdf
    Graph of Steps To Compliance For HCBS Settings Requirements In A 1915(C) Waiver And 1915(I) State Plan Amendment (SPA) from Centers on Medicare and Medicaid Services (no date) – PDF Document Copy (1 Page):
http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Long-Term-Services-and-Supports/Home-and-Community-Based-Services/Downloads/HCBS-1915c-waiver-compliance-flowchart.pdf
    Statewide Transition Plan Toolkit for Alignment with the Home and Community-Based Services (HCBS) Final Regulation’s Setting Requirements (September 5, 2014) – from Centers on Medicare and Medicaid Services – PDF Document Copy (7 Pages):
http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Long-Term-Services-and-Supports/Statewide-Transition-Plan-Toolkit-.pdf
    Regulatory Requirements for Home and Community-Based Settings of those that comply and those settings that are excluded from Centers on Medicare and Medicaid Services -PDF Document Copy (3 Pages):
http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Long-Term-Services-and-Supports/Home-and-Community-Based-Services/Downloads/Requirements-for-Home-and-Community-Settings.pdf
    Additional Technical Guidance On Regulatory Language Regarding Settings That Isolate from Centers on Medicare and Medicaid Services – PDF Document Copy (3 Pages):
http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Long-Term-Services-and-Supports/Home-and-Community-Based-Services/Downloads/Settings-that-isolate.pdf
    Exploratory Questions to Assist States in Assessment of Residential Settings from Centers on Medicare and Medicaid Services – PDF Document Copy (6 Pages):
http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Long-Term-Services-and-Supports/Home-and-Community-Based-Services/Downloads/Exploratory-questions-re-settings-characteristics.pdf
Sign up for CDCAN alerts here: www.cdcan.us

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

  • LAAAC is managed by St. Barnabas Senior Services; Funded, in part, by Archstone Foundation.
  • St. Barnabas Senior Services

%d bloggers like this: