Division of ACF / Assisted Living Surveillance Home and Community Based Services (HCBS) Settings Rule Valerie A. Deetz, Director

Training Objectives Provide overview of the HCBS Final Rule Discuss HCBS Settings requirements Completion and Submission of the Assisted Living Program (ALP) Self-Assessment Tool Define next steps & compliance expectations All lines will be muted during the webinar. To ask a question, please use the chat function.

Current ALP Environment There are currently 131 licensed Assisted Living Programs (ALPs) throughout New York State. 29 60 24 18

Overview HCBS Final Rule

HCBS Settings Requirements Final rule promulgated in 2014 with expected date of full compliance by March 17, 2019. DOH will: Issue HCBS Self-Assessment Conduct on-site visits Provide ongoing education, training & respond to inquiries Develop a person-centered care planning tool Identify facilities who may be under “Heightened Scrutiny” Implement a Statewide Transition Plan (CMS approval required) Requires appropriate home and community based setting for Medicaid waiver programs including 1915 (C), 1915 (i) and the 1115 waiver which will include services provided by NYS ALPs

Goals of the HCBS Settings Requirements The home and community-based services setting requirements establish an outcome-oriented definition focusing on the nature & quality of individuals’ experiences. The rule further maximizes opportunities for individuals to have access to the benefits of community living & the opportunity to receive services in the most integrated setting by: Ensuring an individual’s rights of privacy, dignity, respect, & freedom from coercion and restraint Optimizing individual initiative, autonomy, & independence in making life choices Facilitating individual choice regarding services & supports, and who provides them Supporting integration in & access to the greater community

Key Provisions: Home and Community Based Services Overview Continued Once the program makes the Managed Long Term Care (MLTC) transition, ALPs will be required to comply with the Home and Community-Based Services (HCBS) Final Rule. Key Provisions: Regulates appropriate home & community-based settings for residential and non-residential Medicaid waiver programs (1915[c], 1915[i], 1915 [k] and 1115): Aligns policies & procedures for individuals in need of home and community- based services across disability populations using three distinct Medicaid funded authorities (1915[c], 1915[i], 1915 [k]) Establishes new person-centered planning and conflict of interest requirements Establishes public notice process for substantive changes in services or rates, new effective dates, new CMS monitoring and compliance tools.

Per CFR 440.180(b), HCBS waiver services include: Case management services, Homemaker services, Home health aide services, Personal care services, Adult day health services, Habilitation services, Respite care services, Day treatment services, and Other services requested by the agency and approved by CMS as cost effective and necessary to avoid institutionalization

HCBS Settings Requirements

HCBS Settings Requirements Provides opportunities to seek employment & work in competitive integrated settings, engage in community life, & control personal resources; Ensures the individual receives services in the community to the same degree of access as individuals not receiving Medicaid home & community-based services; Is selected by the individual from among setting options, including non-disability specific settings & an option for a private unit in a residential setting; Person-centered service plans document the options based on the individual’s needs, preferences & for residential settings, the individual’s resources

HCBS Settings Requirements Additional Requirements for Provider Owned & Controlled (Any setting where the provider of HCBS also owns & operates an individuals residential service) Specific unit/dwelling is owned, rented, or occupied under legally enforceable agreement; Same responsibilities/protections from eviction as all tenants under landlord tenant law of state, county, city or other designated entity; If tenant laws do not apply, state ensures lease, residency agreement or other written agreement is in place providing protections to address eviction processes & appeals comparable to those provided under the jurisdiction’s landlord tenant law; Each individual has privacy in their sleeping or living unit; • Units have lockable entrance doors, with the individual and appropriate staff having keys to doors as needed; • Individuals sharing units have a choice of roommates;

HCBS Setting Requirements Additional Requirements for Provider Owned & Controlled Settings continued: • Individuals have the freedom to furnish and decorate their sleeping or living units within the lease or other agreement; • Individuals have freedom and support to control their schedules and activities and have access to food any time; • Individuals may have visitors at any time; and • Setting is physically accessible to the individual

Completing the HCBS Settings Self-Assessment Tool

HCBS Settings Self- Assessment Tool • Dear Administrator Letter 16-15 issued July 5, 2016 • 2016 ALP HCBS Self-Assessment due to DOH by 5 PM July 29th (via HCS). Results will be analyzed and shared Six (6) Domains to Evaluate: General, Resident Rooms, Resident Freedom w/in the Facility, Integration w/the Greater Community, Resident Rights & Facility Operations Questions regarding the HCBS Self-Assessment can be addressed to ACFHCBS@health.ny.gov

HCBS Settings Self-Assessment Tool Copy (Arial Regular)

HCBS Settings Self-Assessment Tool Copy (Arial Regular)

HCBS Settings Self-Assessment Tool Copy (Arial Regular)

HCBS Settings Self-Assessment Tool Copy (Arial Regular)

QUESTIONS?

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