Upcoming changes to Medicaid’s Home and Community Based Services (HCBS) Regulations

transcript

Upcoming changes to Medicaid’s Home and Community Based Services (HCBS)

Regulations

By Roberta Newton & Michelle Rojas Soto January 29, 2015

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About Michelle Rojas Soto

Moderator USC UCEDD Director of Community Education, Information Dissemination and Technical Assistance mrojassoto@chla.usc.edu www.uscucedd.org

The USC University Center of Excellence in Developmental Disabilities at Children’s Hospital Los Angeles (USC UCEDD) is one of 67 centers around the country. Our mission is to provide leadership in strengthening family-centered, culturally-competent services and systems for the benefit of individuals with, or at risk for, developmental, behavioral and/or special health care needs and their families in partnership with those who utilize the services.

About Roberta Newton

Presenter Manager, Los Angeles Regional Office State Council on Developmental Disabilities Roberta.Newton@scdd.ca.gov http://www.scdd.ca.gov/areaboard10.htm

The State Council on Developmental Disabilities is established by state and federal law to ensure that individuals with developmental disabilities and their families participate in the planning, design and receipt of the services and supports they need which promote increased independence, productivity, inclusion and self-determination. The Council supports 13 regional offices that provide advocacy assistance, training, monitoring and public information.

Overview

What is CMS and HCBS?

Why is CMS and HCBS important

for DD families?

What changes will take effect and when?

How will the mandated changes impact

families?

Next steps

What is CMS and

Why is HCBS important for DD families?

What changes will take effect

and when?

How will the mandated

changes impact families?

Next steps

• CMS – Centers for Medicare & Medicaid Services • HCBS – Home and Community Based Services • HCBS includes the wide variety of services that people use to support them

in the community: o Personal care attendants o Supported living services o Transportation, etc.

• With a few exceptions, nearly all the services offered by your regional center are HCBS.

Why do CMS and HCBS matter?

Why is HCBS

important for DD

families?

and when?

Next steps

• CMS are a major source of funding for the developmental disability service system. About 50% of regional centers’ budgets comes from CMS.

• When CMS announced changes to their rules, states paid close attention. States know they may need to make changes to their services so that CMS will continue to pay for those services.

• It is important for people who receive HCBS to also pay attention to the new rules because your services could change as a result.

• HCBS include not only regional center services but some services provided by the Departments of Health Care and Aging.

How will HCBS change?

Next steps

• The purpose of the new rule is to make sure that HCBS services provide real opportunities to work, live, and socialize in the community.

• Five Standards Integration into the community Individual Choice Individual Rights Autonomy Choice Regarding Services and Providers

More Info: http://autisticadvocacy.org/wp-content/uploads/2014/09/Guide-for-Advocates-and-Families.pdf

How will HCBS change?

Next steps

• People must have the right to choose what services they receive and from whom, through a person-centered planning process.

• Service settings that are institutional in nature, that keep people segregated from their community, will probably not qualify for CMS funding. However, the new rule does not explicitly target any specific service categories for elimination.

• At this point , states are expected to begin assessing the various service settings to determine which may not comply with the new standards.

How will families be impacted?

and when?

How will the mandated changes impact

families?

Next steps

• States must encourage service recipients, advocates, and stakeholders to participate in assessing HCBS.

• Teams will visit and/or survey locations where services are delivered.

• Emphasis on “person-centered planning”. The regional center Individual Program Planning (IPP) process will probably change too.

• Some services or service categories may be eliminated.

• What is almost certain to change is how services look, how they operate and what rules they follow. For example, there will likely be the requirement that regional centers and providers document that a service was freely chosen from among an array of choices.

Where do we go from here?

and when?

Next steps

• By March 17, 2015, each state has to submit a “Transition Plan” to CMS that lays out the process they will follow for assessing their services and ensuring full compliance.

• California submitted its Transition Plan in December 2014. It includes an implementation timeline for education and outreach, assessments and appeals.

• It is expected that CMS will reject the initial plan and require the state to develop a more robust, detailed plan with greater stakeholder involvement.

• States are required to come into full compliance with the new rules by March 17, 2019.

and when?

Next steps

• Review the state’s Transition Plan, track changes and new developments, and volunteer to participate in the ongoing evaluation process:

http://www.dhcs.ca.gov/services/ltc/Pages/HCBSStatewideTransitionPlan.aspx

This web site was established by the Department of Health Care Services (DHCS) because they are the lead agency for all HCBS waivers.

• Review the timeline: http://www.dhcs.ca.gov/services/ltc/Documents/STPTimeline19Dec14.pdf

• Submit comments: STP@dhcs.ca.gov

and when?

Next steps

• DDS will develop a transition plan and timeline specifically for the developmental disabilities service system. The DDS HCBS Advisory Group is in the process of being established and will begin its work in February 2015.

• Track progress and provide input:

http://www.dds.ca.gov/HCBS/index.cfm

• Additional HCBS Information:

http://hcbsadvocacy.org/

http://tash.org/wp-content/uploads/2015/01/Joint-Statement-by-HCBS.pdf

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Upcoming changes to Medicaid’s Home and Community Based Services (HCBS) Regulations

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