1. HCBS Community Rule & Delaware’s Transition Plan JULY 22, 2015

2. Delaware’s HCBS Programs Delaware provides home and community-based services (HCBS) through four programs: 1 Division of Developmental Disabilities Services (DDDS) 1915(c) Waiver Alternative to institutional placement. Available to individuals 12 and over with intellectual and developmental disabilities. Diamond State Health Plan (DSHP) 1115 Waiver Provides HCBS to eligible individuals through a mandated managed care delivery system, in addition to acute care services such as physician and nursing services. Available to those who would otherwise receive care in a nursing facility. Pathways to Employment Program Designed for individuals age 14-25 with disabilities who want to work. PROMISE Program Provides enhanced behavioral health services and supports for those who have severe and persistent mental illness and/or a substance abuse disorder and who require HCBS to live and work in integrated settings. Available to individuals age 18 and over.

3. Delaware Transition Plan “101” Delaware submitted its HCBS Statewide Transition Plan to CMS on March 17, 2015. Delaware’s HCBS Statewide Transition Plan outlines our steps to: –Assess the current landscape of State policies, laws and regulations at all levels against the Community Rule; –Assess HCBS provider services and settings against the Community Rule (through feedback from providers and participants); –Develop and implement strategies to remediate non-compliant situations; and –Demonstrate full compliance with the Community Rule by March 17, 2019. 2

4. Transition Plan Timeline Delaware’s Transition Plan will be implemented in six phases over the next four years: State Survey Codes, regulations, training materials, etc. Provider Survey Pilot Survey HCBS Policy and Settings Survey Look-Behind Member Survey HCBS Settings/Services Survey MCO Survey HCBS Policy/Procedures/ Trainings Survey 3

5. Unique Characteristics of Delaware’s Transition Plan We are using a robust array of data sources to assess compliance at all levels of our HCBS system. Stakeholder groups are providing input on the implementation of the Transition Plan: –Governor’s Advisory Council to DDDS. –Governor’s Commission on Community-Based Alternatives for Individuals with Disabilities. –Ad-hoc Cross-Agency Oversight Body. Delaware is leveraging its External Quality Review Organization (EQRO) to assist with survey development. We are providing multiple avenues for stakeholders to learn about the Transition Plan and provide input, including through our website: http://dhss.delaware.gov/dhss/dmma/hcbs_trans_plan.html http://dhss.delaware.gov/dhss/dmma/hcbs_trans_plan.html 4

6. DD-Specific Surveys DDDS has actively involved a diverse group of stakeholders in developing the DD-specific surveys 5 Stakeholders… Self-advocates Families Parents Providers Attorneys specializing in disability law Advocacy organizations such as DD Council Formed two workgroups… Residential services and day services Each co- chaired by a self-advocate That held approximately six meetings… Where they reviewed CMS requirements and surveys from other state programs To produce… Recommended survey questions That they will present to the Governor’s Advisory Council to DDDS.

7. Our Next Steps Delaware is moving forward with implementing our Transition Plan, including: –Assessing State policies, regulations, codes, etc. –Developing surveys for MCOs and HCBS participants and providers. –Training State staff and MCOs. –Developing guidance on tenant rights. –Continued engagement with stakeholders on Delaware’s Transition Plan progress. Visit our Transition Plan website for more information: http://dhss.delaware.gov/dhss/dmma/hcbs_trans_plan.html http://dhss.delaware.gov/dhss/dmma/hcbs_trans_plan.html 6