1. Home and Community Based Services Federal Rules Revision to Statewide Transition Plan
Dana Williamson, Director
Texas Health and Human Services Commission
January 10, 2017

2. Purpose
Provide background on the rules for Home and Community Based Services (HCBS) settings
Provide information on the revised statewide transition plan (STP)
Provide updates on status of implementation and timelines
Answer questions

3. HCBS Settings These rules apply to: 1915(c) waivers
Community Living Assistance and Support Services (CLASS)
Deaf Blind with Multiple Disabilities (DBMD)
Home and Community-based Services (HCS)
Medically Dependent Children Program (MDCP)
Texas Home Living (TxHmL)
Youth Empowerment Services (YES)
1915(i) state plan services
Community First Choice (1915(k) state plan services))
HCBS State of Texas Access Reform (STAR+PLUS) Waiver (1115 demonstration waiver)

4. HCBS Settings
These rules are intended to make sure individuals receive services in settings that are integrated in and support full access to the community.
These rules give people the opportunity to:
Seek employment in competitive and integrated settings
Take part in the community
Be in control of personal resources
Get the same access to services as those not receiving HCBS
With the context of this rule, settings are the various places where waiver services are provided to an individual.
An integrated setting is one that enables individuals with disabilities to interact with non-disabled persons to the fullest extent possible.

5. Key Aspects of Compliance
Settings owned and controlled by providers:
Legally enforceable lease agreements
Privacy/Respect
Private access to phone
Private medical records
Choice of clothing
If individual does not need staff assistance--toileting and grooming activities are private
Locks on bedroom door if requested
Choice of roommates
Choice regarding daily activities—independent of group activities if desired

6. Key Aspects of Compliance
Support for access to public transportation to facilitate community integration and autonomy
Support for competitive employment or volunteer activities if desired
Residences are completely accessible to individuals with disabilities who live at the residence

7. HCBS Transition Plan
States were required to send transition plans to the Centers for Medicare & Medicaid Services (CMS) detailing how they would review their programs and achieve compliance with the rules by March 2019.
Transition plan requirements include:
Internal and external review of existing settings to see if rules and policies support regulations and whether individuals experiences match policy
Strategies and a plan for remediation
Public and stakeholder input into the assessment and remediation strategies

8. Status of Texas’ HCBS STP
Texas submitted a plan to CMS in December 2014 and a revised version in March 2015.
Texas received initial feedback from CMS in September 2015 and submitted a revised version in February 2016.
Texas received feedback from CMS in June 2016 and submitted a revised version in November 2016.
These submissions are to gain initial approval of the STP.
While pending approval, work continues and the agency is in the assessment period of the plan.

9. STP Timeline Systemic/Internal Assessment – completed in December 2015
External Assessment – provider, participant and service coordinator surveys are completed. The analysis of survey results is ongoing.
Identify any need for additional remedial action and milestones – Spring & Summer 2017
Remediation Timeline Milestones -anticipated completion date 2018
Next slide contains more detail on the remediation/timeline milestones

10. Remediation Timeline Milestones
Proposed Completion Dates:
May 2017
Seek legislative funding during 2017 state legislative session to implement regulations
September-June 2017
Amend waivers to include HCBS regulations and any needed rate adjustments
Amend program rules Texas Administrative Code; Augment contract monitoring tools already in place
March 2018
Revise waiver policy manuals to include HCBS regulations
Ongoing
Develop educational webinars for 1915(c) providers about HCBS federal regulations

11. Submitting Feedback on Amended STP in Summer 2017
HHSC will update the STP in the summer of 2017.
Will include more substantive changes based on results of external assessments.
The 2017 STP updates will be posted for the full 30 days to allow for public comment and inclusion of comments in the update.
The posting will be on the HHSC website on the following webpage:

12. Community Day Habilitation Programs
Based on the HCBS final rule, day habilitation is a service state staff have identified as non-compliant with the new HCBS settings regulation.
CMS guidance indicates settings in which only individuals with disabilities congregate is not considered integrated into the community.
HHSC believes additional funding will be needed to restructure how day activity services are delivered to ensure compliance with new settings provisions.

13. Legislative Appropriations Request 85th Legislative Session
Legislative Appropriations Request (LAR)
Texas Health and Human Services Commission Fiscal Years Legislative Appropriations Request, 4.A. Exceptional Item Request Schedule, 85th Regular Session, Agency Submission, Version 1, Item Priority 40 
Posted on the Texas HHS Website:

14. LAR Methodology
Adds new service-community integration for individuals in their own home or family home
Limit community integration to 15 hours per week at $16.44 an hour
Funding included to make 3 and 4 bed homes a 24 hour rate
No additional funds added to the host home rate
Residential providers will be responsible for individualized community integration

15. Day Habilitation Compliance Option
HHSC is working with a stakeholder group consisting of provider associations, advocates and persons receiving services to identify areas of concern and possible revisions to the LAR as submitted.

16. Day Habilitation Compliance Option
HHSC proposes to move forward with the following options:
Restructure day habilitation as a waiver service to ensure compliance with community integration.
Explore other options for ensuring access to community integration in addition to restructuring day habilitation.
hourly service aimed at community integration; and
other supports needed to help individuals access the community and work towards educational and employment goals .

17. HCBS Resources CMS HCBS webpage HHS HCBS webpage
HHS HCBS webpage
1915(c) Statewide Transition Plan webpage
YES 1915(c) Waiver webpage

18. Ongoing Feedback
Please submit any additional questions or feedback on this topic to: