Home and Community Based Settings – 42 CFR 441.301(c)(6) Division of Senior and Disabilities Services

Background – How did we get here? SDS began reviewing settings self assessments submitted by providers in 2016 SDS focused primarily on a representative sample which included residential and non-residential settings SDS worked simultaneously to build new programs under the Senate Bill 74 initiative: Community First Choice(CFC) and Individualized Supports Waiver(ISW) Provider Certification and Compliance completed the assessment and review process and began the Remediation phase for ISW providers in October 2017, Sample group providers in January 2018, and Non-sample group providers in March 2018.

Who Needs to be Settings Compliant? Existing settings must be compliant by March of 2019 Any new programs, such as ISW and CFC, must demonstrate compliance before offering any new waiver service or billing Medicaid. Under the Settings Final Rule, all Medicaid-funded services must be provided in settings that exhibit home and community-based characteristics and do not isolate recipients. All HCBS Waiver providers are subject to a setting assessment and must become settings compliant.

Which providers are currently under review? Providers for ISW have been through the reviews and remediation steps and 82 of 83 providers have achieved full compliance. (1) needed additional time to remediate. Focus is now on all other types of providers. Streamlined process was implemented with ISW and proved very successful!

What is Compliance? Compliance with the Settings Final Rule requires changing the way some services are provided. Individuals have certain rights guaranteed to them when receiving services funded by Medicaid. Compliance simply means your setting is fully in alignment with setting rules. SDS Provider Certification and Compliance Unit works with you and makes final determination.  

What is Remediation? “Remediation” is the process of curing a finding. “Finding” is an identified practice that does not currently meet the conditions in the rule.   “Remediation Plan” contains these items: Identified cure for each finding Target date the cure will be completed Person(s) responsible for the actions in the plan Type of evidence provided to demonstrate compliance Target date evidence of cure will be provided

2018, or begin decertification. Settings Remediation Process Flow Chart For Providers SDS issues Remediation Notice(s) to Providers. Each unique setting as identified by a site key will receive a notice. Notices to be issued on March 28, 2018 for Non-Residential and Family Habilitation Services and April 11, 2018 for all Residential services. Provider reviews notice(s) and submits Remediation Plan(s) for each Non-Residential or Family Habilitation setting identified to SDS by April 25, 2018; and for each Residential setting identified by SDS by May 10, 2018. SDS reviews plan(s), issues decision(s), and notifies the Non- residential and Family Habilitation providers by May 9, 2018 and Residential providers by May 22, 2018. Remediation Plan Approved Remediation Plan Denied All providers submit proof of remediation completion to SDS on or before June 29, 2018 with required evidence stated in approved plan. Provider reviews comments and submits revised plan(s) for approval. Due date of revised plan(s) will be no longer than 10 days from date of notice. SDS approves proof of remediation and issues to provider Notice of Finding of Compliance for each unique setting on or before July 13, 2018. SDS reviews proof of remediation and finds it inadequate. Provider receives Notice of Non- compliance on July 13, 2018. Provider will submit required proof no later than July 27, 2018, or begin decertification. SDS reviews revised plan(s) and issues decision within 10 days of receipt of completed plan(s). Revised Plan Approved Revised Plan Denied Provider submits proof of remediation completion to SDS no later than June 29, 2018 with required evidence stated in approved plan(s). If revised plan(s) is denied by SDS, provider will meet with SDS to determine resolution. Provider may submit proof of remediation completion to SDS on or before June 29, 2018 with required evidence. SDS issues to provider Notice of Finding of Compliance for each unique setting on or before July 13, 2018. Guidance to Settings Compliance Remediation Flow Chart 02/20/18

Alaska HCBS Settings Website Refer to our resource pages for letter and remediation examples! http://dhss.alaska.gov/dsds/Pages/transitionPlanHCBS/resources.aspx http://dhss.alaska.gov/dsds/Pages/transitionPlanHCBS/HCBStransition.aspx

Questions? Please contact: Summer Wheeler, Provider Certification and Compliance Unit (907) 269- 3728 For specific questions regarding your site visit or setting review Craig Baxter, Residential Licensing Program Manager (907) 334-2492 For questions regarding licensing Jean Findley, Policy Unit Lynne Keilman-Cruz, Chief of Quality (907) 465-3186 (907)269-5606 For questions regarding the Transition Plan For Feedback or Questions about overall process