1. The Home and Community Base Services (HCBS) Rule: Transition Plan Update ARRM Business and Finance Forum November 18, 2015 1

2. Presenter Heidi Hamilton Heidi.Hamilton@state.mn.us (651) 431-2443 2

3. Objectives Participants will understand the HCBS rule requirements for services and settings Participants will understand CMS qualities and standards used to assess settings Participants will understand the provider self- assessment 3

4. HCBS Rule: Background The Centers for Medicare and Medicaid (CMS) issued new federal rules governing Medicaid HCBS in January 2014. Requires all state to complete a transition plan Each state must be in full compliance by March 17, 2019 The home and community-based services rule aims to: Ensure an individual’s rights of privacy, dignity, respect, and freedom from coercion and restraint Optimize individual initiative, autonomy, and independence in making life choices and Facilitate individual choice regarding services and supports, and who provides them 4

5. HCBS Rule Requirements: Qualities Ensures the person receives services in the community to the same degree of access as people not receiving HCBS Is integrated in and supports access to the greater community Is selected by the person from among setting options, including non-disability specific settings and an option for a private unit in a residential setting. Provides opportunities to seek employment and work in competitive integrated settings, engage in community life, and control personal resources 5

6. HCBS Setting Requirements: Not HCBS As defined by CMS, settings that are not home and community-based are: A nursing facility An institution for mental disease An intermediate care facility for individuals with developmental disabilities (ICF/DD) and Hospitals 6

7. HCBS Setting Requirements: Presumed Not to Be HCBS As defined by CMS, settings that are “presumed” not to be home and community-based are: Settings in a publicly or privately-owned facility providing inpatient treatment Settings on the grounds of, or adjacent to, a public institution Settings with the effect of isolating individuals receiving Medicaid HCBS from the broader community of individuals not receiving Medicaid HCBS 7

8. Setting Assessment and Review What are states required to do? Transition Plan(s) States must assure that residential and non- residential settings currently have the qualities of HCBS. Verify ongoing compliance 8

9. Regulatory Review: Analysis The state’s assessment of the extent to which its standards, rules, regulations, or other requirements comply with the HCBS rule requirements. Regulatory requirements governing non‐residential services, including employment and day services Regulatory requirements governing any home and community based services, provider qualifications and settings Person-centered planning requirements 9

10. Setting Identification and Provider Self- Assessment Setting Identification DHS used data from the Olmstead report that identified potentially segregated settings. CMS guidance Data from self-assessment Develop compliance thresholds Assists the state to determine measurable criteria by which HCBS settings will be evaluated. 10

11. Qualities and Concept Areas of the Provider Self-Assessment Physical location Autonomy Choice Rights, Dignity, Respect and Privacy Community Integration Physical Accessibility Employment 11

12. 12 What DHS learned from the self- assessment Determine efforts and strategies to help providers transition into compliance Evaluate providers’ willingness to make changes to comply with the rule Accomplish the requirement to complete a statewide assessment

13. Next steps Operationalize HCBS quality criteria Further define qualities Develop tools for providers Review evidence for compliance Seek necessary legal authority State statute/rule Waiver plan amendments Establish evaluation criteria for settings that may have the effect of isolating a person from the broader community 13

14. HCBS transition Website: www.mn.gov/dhs/hcbs- transitionwww.mn.gov/dhs/hcbs- transition HCBS transition e-mail: hcbs.settings@state.mn.ushcbs.settings@state.mn.us 14 Resources