Transition PlanHCBS Programs

Community Supports & Programs Commission

May 1, 2023

Here’s what you should know… The Center for Medicare and Medicaid Services,

known as CMS, has made changes to its requirements for home and community based services (HCBS).

The focus is on an individual’s quality of life and making sure they have support to be part of home and community life, be independent, make their own choices, and control the lives when they live in provider owned and controlled homes, day programs, and work environments.

May 1, 2023

Why the change?

• The new final rule, issued March 17, 2014, requires states to evaluate its HCBS settings to meet the new rule’s definition.

• CMS is concerned about the health and welfare of individuals who are receiving home and community based services in residential and day settings.

May 1, 2023

What does the Final Rule mean?

The new rule applies to all settings where an individual may receive HCBS services and looks at the quality of their life and access to and integration with the greater community

May 1, 2023

What does this mean for you?

The new HCBS Settings rule

• Focuses on services provided in a setting that is owned or operated by the community service provider.

• Requires that individuals who receive HCBS services have choices, freedom, support, and control over their environment similar to someone who is not disabled to the greatest extent possible in the least restrictive setting.

May 1, 2023

PROVIDER CONTROLLED SETTINGS MUST COMPLY WITH NEW RULES

Individuals will have:• Written agreements/lease• Freedom, support, control • Access to the community• Privacy and respect• Choice of activities, visitors • Access to competitive, integrated employment • Places to live and play that are accessible 

Check out the list of Consumer Rights & Freedoms at www.kdads.ks.gov

May 1, 2023

HCBS Program Participants must be assured…

• A lease or written agreement with– Protections comparable to landlord tenant laws– Protections for appeal of a discharge or eviction.

• Privacy and Control– Unrestricted access to food and visitors– A locked door to the participant’s unit

• Freedom and Choice – Ability to choose schedule and activities– Roommates, services and supports

Any limit or restriction supported by a specific assessed need, reviewed frequently, and be approved by the individual, parent or guardian

May 1, 2023

Who is affected?Those affected by the new rule include consumers receiving these specific HCBS services:

– Autism (Children who start serves prior to the age of six) – Frail Elderly (Adults 65 and older) – Intellectual Developmental Disabilities (Ages 5 and older)– Technology Assistance (Ages 0 – 21 years)– Traumatic Brain Injury (Ages 16 – 64 years) – Physical Disabilities (Ages 16 – 64 year)– Severe Emotional Disturbance (Ages 4 – 18 years)

Community Service Providers of various settings (licensed and unlicensed, daycare, residential, congregate, employment) for those HCBS services.

May 1, 2023

CMS requires a Plan in 120 days• Kansas will submit a transition plan for all of the

HCBS Programs (Autism, TA, IDD, FE, TBI, PD, and SED)

• CMS will review the plans and determine if the State has plans to bring all settings into compliance

•Timelines for benchmarks for compliance will be finalized by CMS and Kansas expects transitions to complete within 5 years.

May 1, 2023

Transition Plan

The initial plan is a draft of the State’s blueprint that incorporates initial feedback from CMS and outlines how the State will: Assess residential and nonresidential

settings Ensure compliance with the rules, and Transition individuals to compliant

settings, if necessary

May 1, 2023

Transition Plan (cont’d)

Assessing all HCBS settings – Residential and nonresidential settings– Provider Survey available online until June 30, 2014

Exploring alternative setting options – That complies with the Final Rule – That expand choices for individuals

Developing compliance strategies– Setting timelines and benchmark for quality assurance– Ensuring timely reviewing to maintain compliance

May 1, 2023

Over the next year:

• KDADS will evaluate settings to determine if providers comply with the new rule

• KDADs will seek public input and provide opportunities to hear what participants and providers have to say

• Create a plan with timelines and benchmarks to bring providers into compliance or transition individuals from non-compliant to compliant settings

May 1, 2023

Challenges for current providers?The new rule will mean challenges for current providers

• CMS MAY accept arguments that facilities can be operated “near” public or private institutional settings. – CMS will not allow residential or day settings to be located in the same

building as an institution, such as a nursing facility– Many wings of nursing homes have been converted to provide a lower

restricted residential environment

• CMS is looking at the quality and outcomes of a setting– Residential Supports for IDD may need to increase choices when an

individual chooses not to attend work or day supports

• CMS has not issued guidance on day and employment settings, like adult day care and sheltered workshops– Additional information will be provided when CMS releases guidance and

additional information sessions will be available

May 1, 2023

Also an opportunity…• The State can explore creative alternatives that

provide more options and independence– Shared Living models– Family Support models– Supported Employment models

• The rule allows, but does not require, a State to target multiple groups within a single waiver. – The rule gives States the flexibility to design a waiver to

meet the needs of multiple target groups as long as it can meet the unique needs of each person and there is equal access to all services.

May 1, 2023

What’s Online?Statewide PlanIndividual Program Summary of RulesConsumer Rights & FreedomsLink to Rule on CMS websiteProvider Survey

The Transition Plans are posted on the KDADS website at www.kdads.ks.gov

Public Comment Period Open until July 15, 2014

May 1, 2023

Public Comment SessionsWe will continue to seek public input, even after we submit the plan

for final CMS approval. 

Additional public comment sessions  (conference calls) are available during the Public Comment period.

For Consumers – Wednesday, July 2, 2014 from 12:00 to 1:00 p.m.

 

For Providers– Monday, June 23, 2014 from 11:00 to 12:00 p.m. – Tuesday, July 15, 2014 from 10:00 to 11:00 a.m.

 Conference Call Information:

Conference Number: 1-866-620-7326Conference Code 4283583031#

May 1, 2023

For more information…

For details and updates visit:http://www.kdads.ks.gov

Contact Aquila “Q” Jordan:Aquila.Jordan@kdads.ks.gov

May 1, 2023

OPEN FOR DISCUSSION:

IDEAS THOUGHTS, QUESTIONS?

Questions, Comments and InputBy Phone: 785-296-4986

By Email: HCBS-KS@KDADS.KS.GOV