NACDD: Making Sense of LTSS Policy. Rachel Patterson

Implementation of the HCBS Settings Rule: Resources for Advocates

Rachel Patterson

Association of University Centers on Disabilities

July 8, 2014

What Counts as a Home or Community-

Based Setting?

HCBS Rule: The Key Points

1. Setting is integrated in the community

2. People have self-determination

3. Additional protections for provider-owned

4. Everyone has a Person-Centered Plan

5. Some settings presumed not HCBS

HCBS Rule: Other provisions

• Improved Enforcement of waiver provisions• Caregiver assessment in 1915(i)• Heightened scrutiny for settings that isolate• Documentation of compliance in person-centered plan

• What about non-residential services?

Key Dates

• Published: January 16, 2014• Effective: March 17, 2014• Transition Plans Due: March 17, 2015

Unless states submit a waiver renewal or amendment before March 17, 2015, then:• States must submit a Transition Plan for the services in that waiver with the submission

• 120 days later submit a Transition Plan for their remaining HCBS system

HCBS Rule: Transition Plan

• 2 public notices• 30 day public comment period on full transition plan

• Modify the plan in response to comments• Save comments and submit summary to CMS

• Plan can be up to 5 years in length

Transition Plans: What we’ve seen so far

• Strict timelines• Assessment plans and Plans to write a Transition Plan

• Lack of detail

Stakeholder Engagement:

This is where you come in!

Stakeholder Engagement

• Did the state post the full transition plan?• Did the state modify the plan based on comments?

• Are the comments publically available?

Tools on HCBSadvocacy.org

HCBSadvocacy.org

Tips for Advocates

• Learn About the Rule• Spread the Word• Get Involved

• Public Comment• Stakeholder Committees• Town halls

• Advocate• Improved Stakeholder Engagement

Tips for Advocates

• Work in coalition• Olmstead coalitions or task forces• Protection & Advocacy• DD Council• University Centers• Area Agencies on Aging• Mental Health America or NAMI local• Centers for Independent Living• AARP local chapter

Tips for Advocates

• Build on Existing Reform Work in the State• Olmstead Settlements• Medicaid reform

• 1115 waivers• Managed Care• Community First Choice Option• Balancing Incentive Program • 1915(i) HCBS State Plan Amendments

Leverage these and other opportunities for increased stakeholder engagement