1. Home & Community-Based Services Regulations: Where the States are Now, Where they Should Go Moving Forward July 22, 2015

2. Quick Review-HCBS Regulations CMS issued regulations effective March 17, 2014 Most states had until March 17, 2015 to submit a transition plan to CMS Plan for compliance by March 17, 2019 Up to 5 years of transition  5 years of advocacy engagement Applies to 1915(c) waivers and 1915(i) and 1915(k) state plan options Requires all home and community-based services (HCBS) be provided in community-based settings NACDD-July 22, 20152

3. Quick Review-HCBS Regulations REMEMBER! Intent of the regulations is to improve HCBS participants’ community integration and experiences Goal is not to shut down settings, but to ensure that HCBS funds are used in settings that are truly community-based Focus is supposed to be on the HCBS participant’s experience!! NACDD-July 22, 20153

4. Where are we now? Plans submitted State timeline examples Review of rules Assessments of settings Revised transition plans Compliance dates Public input is important at all of these milestones! NACDD-July 22, 20154

5. Transition Plan Trends Plans to plan v. full initial plan Systemic review v. minimum compliance Ongoing compliance Reliance on biased results Participant v. provider focus Stakeholder involvement NACDD-July 22, 20155

6. The Work Ahead Build strategy for education, public comment Changes in rules, policies and waivers Engagement in setting assessments Process Results Compliance plans Ongoing compliance Stakeholder committees NACDD-July 22, 20156

7. 7 Questions? Elizabeth Edwards edwards@healthlaw.org

8. Washington DC OfficeLos Angeles OfficeNorth Carolina Office 1444 I Street NW, Suite 1105 Washington, DC 20005 ph: (202) 289-7661 fx: (202) 289-7724 nhelpdc@healthlaw.org 3701 Wilshire Blvd, Suite #750 Los Angeles, CA 90010 ph: (310) 204-6010 fx: (213) 368-0774 nhelp@healthlaw.org 101 East Weaver Street, Suite G-7 Carrboro, NC 27510 ph: (919) 968-6308 fx: (919) 968-8855 nhelpnc@healthlaw.org www.healthlaw.org THANK YOU

9. Quick Review-Institutional Settings Excluded settings: NF, IMD, ICF-ID/DD, hospitals Presumed to have institutional qualities: Facilities that provide inpatient treatment Settings on the ground of, or immediately adjacent to, a public institution Settings that have the effect of isolating individuals receiving HCBS from the broader community of individuals not receiving HCBS NACDD-July 22, 20159

10. Quick Review-Community Settings All HCB settings must: be integrated in and support full access to the greater community be selected by the individual from among setting options; ensure individual rights of privacy, dignity and respect, and freedom from coercion and restraint; optimize autonomy and independence in making life choices; & facilitate choice regarding services and who provides them Provider owned or controlled settings have additional obligations Any modification of these conditions must be supported by a specific assessed need and justified in the PCP NACDD-July 22, 201510