1. HCBS Community Settings Regulation: The Impact on SEMP and Prevocational Services NYS-APSE Annual Conference May 4, 2015 Presented by Ceylane Meyers-Ruff and Lynne Thibdeau

2. Intent of HCBS Regulation Align HCBS funding with civil rights protections under the Americans with Disabilities Act (ADA) Address concerns that HCBS funding is used for “institutional style” settings that “isolate” and lack opportunities for people to engage meaningfully in the community 2

3. Intent of HCBS Regulation Maximize opportunities to receive services in integrated settings, realize the benefits of community living and seek opportunities for employment in competitive integrated settings. Regulation is outcome oriented—focuses on nature and quality of individual experience in the setting and whether individuals have the “same degree of access” as others in the community. Final regulation applies to all settings, residential and non- residential. 3

4. January 2014- Final Regulation Issued March 2014- Final Regulation took Effect (but no guidance on non-residential settings) May 2014- Presented on the Regulation at the APSE Conference June-October 2014- Discussed the Regulation as part of the Pathway to Employment Trainings December 2014- Non Residential Guidance Issued by CMS 4

5. Settings that Isolate and are Presumed to have Institutional Qualities The setting is designed specifically for people with disabilities. The individuals in the setting are primarily or exclusively people with disabilities and on-site staff provides many services to them. Individuals in the setting have limited, if any interaction with the broader community. 5

6. Key Elements of HCBS Settings Regulation The setting is integrated in, and supports full access to, the greater community; Selected by the individual from among setting options; Ensures individual rights of privacy, dignity and respect and freedom from coercion and restraint; Optimizes autonomy and independence in making life choices; and Facilitates choice regarding services and who provides them. 6

7. Qualities of an HCBS Setting 1.The setting reflects the individual’s needs and preferences. 2.Individuals must have opportunities to make informed choices. 3.Informed choice must include opportunities to discover, explore and experience a variety of options. 4.Choices must include opportunities to combine more than one service in any given day or week. 7

8. Qualities of an HCBS Setting 5. There must be opportunities to review, update and change preferences and choices at least annually. 6. There must be sufficient supports to assist an individual in making informed choices and exercising autonomy to the greatest extent possible. 7. There must be opportunities for the individual to negotiate work schedules, break times, benefits, etc. same as people without disabilities. 8. Tasks and activities are comparable to tasks and activities for people who do not have disabilities. 8

9. Qualities of an HCBS Setting 9. Freedom of movement inside/outside setting- people are not restricted to one room or area. 10.Information about individuals kept private-i.e., no posting of schedules for medications, restricted diet, etc. 11. Access to meals/snacks at any time consistent with individuals in similar and/or same setting who do not receive HCBS. 9

10. Qualities of an HCBS Setting 12. The setting must be in a location that is accessible to other businesses, residences, restaurants, etc. to facilitate interaction with the public. 13. To the extent possible, the setting should be accessible by public transportation, para transit and other forms of transportation. Individuals with disabilities must have training and access to information about transportation options. 14. The setting cannot be co-located with a public or private institution, or located on the grounds of a public institution (hospital, nursing facilities, intermediate care facilities, or institutes for mental disease) 10

11. Impact on SEMP When we think about the way current SEMP services are provided, all of this is already happening. While much of the HCBS qualities are already in SEMP, we must make sure that it also happens in group employment (enclaves and mobile work crews). 11

12. Enclaves and Mobile Work Crews If individuals are enrolled in SEMP they must earn minimum wage. –Providers must either enroll individuals in Pre-voc or Increase their wage An individual can earn less than minimum wage but there must be a 14c Certificate from DOL authorizing the wage and the individual must be enrolled in Prevocational Services. OPWDD will be following the CMS 2011 bulletin which defines group employment. 12

13. Group Employment Employment services provided in regular business, industry and community settings for groups of 2-8 workers with disabilities. Examples include mobile crews and business based workgroups employing small groups of workers with disabilities in the community. Services must be provided in a manner that promotes integration into the workplace and interaction between participants and people without disabilities in those workplaces. The CMS definition of group employment and the qualities of an HCBS setting are the standard for enclaves and mobile work crews. 13

14. Impact on Prevocational Services There is a significant impact on prevocational services If prevocational services are happening in the community, many of the HCBS qualities will be met. For site based pre-voc changes will be needed. The specific impact on workshops will be discussed at the May 8 th Integrated Employment Conference being convened in Albany by Acting Commissioner Delaney. 14

15. Questions 15

16. Contact Information Ceylane Meyers-Ruff ceylane.meyersruff@opwdd.ny.gov Lynne Thibdeau lynne.thibdeau@opwdd.ny.gov 16