HCBS IDD Waiver Transition Plan SelfAssessments Initial Remediation

HCBS IDD Waiver Transition Plan: Self-Assessments & Initial Remediation Provider Leadership, April 23, 2015

Goals for Today ² Understand how to conduct Provider Self-Assessments, as required by the HCBS IDD Waiver Transition Plan. ² Update on the state self-assessment process and initial steps towards remediation. ² Learn about upcoming changes to the Medicaid waiver regulations.

HCBS Settings Rule ØTitle: Medicaid Program; State Plan Home and Community-Based Services, 5 -Year Period for Waivers, Provider Payment Reassignment, and Home and Community-Based Setting Requirements for Community First Choice (Section 1915(k) of the Act) and Home and Community-Based Services (HCBS) Waivers (Section 1915(c) of the Act) or “The Settings Rule” ØPublished in the Federal Register on 01/16/2014 ØEffective March 17, 2014 Øwww. hcbsadvocacy. org 3

HCBS Waiver Transition Plan New federal outcome-oriented definition of home and community-based services (HCBS) settings. We must modify service settings within a little less than 4 years to meet new HCBS rules to ensure continued flow of Medicaid funding. • Integration with the community: The setting must support full access by the person to the greater community, “including opportunities to seek employment and work in competitive integrated settings, engage in community life, control personal resources, and receive services in the community, to the same degree of access as [people] not receiving Medicaid HCBS. ” • Choice: People must have a choice among setting options, including settings that are not disability-specific. • Rights: The setting must ensure people’s rights to privacy, dignity and respect, and freedom from coercion and restraint. • Independence: The setting must optimize a person’s ability to make life choices, including choices related to daily activities, the physical environment, and with whom to interact.

HCBS Waiver Transition Plan Ø All states must develop an HCBS transition plan, that provides a comprehensive assessment of potential gaps in compliance with the new regulation, as well as strategies, timelines, and milestones for becoming compliant with the rule’s requirements. Ø DDS submitted its Statewide Transition Plan on March 17, 2015 and is working with stakeholders on our state self-assessment. Ø Providers will be conducting self-assessments and writing transition plans for their own organizations. Ø Self-assessments are due July 1, 2015 Ø Transition Plans are due September 1, 2015 Ø Service coordinators will also be talking to every person who receives HCBS services about their experiences to inform our assessment. Ø Starting June 1 and ongoing.

Provider Self-Assessments Ø Developed with the HCBS Settings Advisory Group, TA from Support Development Associates (PCT), and in accordance with CMS Guidance Ø CMS HCBS Basic Element Review Tool for Statewide Transition Plans Ø CMS Exploratory Questions to Assist States in Assessment of Settings Ø Available on-line at: http: //dds. dc. gov/page/waiver-amendment-info. Will be in MCIS, in the Provider Tab. Ø Requires an honest and critical self-assessment. DDS and CMS do not expect that our settings will be in full compliance with the rule today. We need to understand: Ø Where we are now (our baseline); Ø What capacity building and TA would be helpful; and Ø What we, as a system, need to do next to reach compliance by March 17, 2019.

Provider Self-Assessments Ø Who: All active residential, day and vocational services providers with HCBS Settings Ø What: One self-assessment for each day and residential service you provide – systems level self-assessment; not setting-by-setting. Ø Team: Must include a cross section of their organization, including at least one executive, middle manager, and direct support professional, in addition to people supported and their family members. Providers are encouraged to include advocates and other stakeholder in their self-assessment process. Ø Description: Include a description of their self-assessment process.

Provider Self-Assessments # Indicator CMS Recommended Assessment Question Prevalence in Provider Setting (Select 1 -6, above ) Provide name and hyperlink, if available, for specific evidence of compliance. If no specific evidence is available, please indicate that. (a) The home ensures a person’s rights of privacy, dignity, respect and freedom from coercion and restraint. Comments & Feedback: Please use this section to help us identify systemic support and barriers to achieving compliance with the HCBS Settings Rule; areas in which training, technical assistance and capacity building would be helpful; explanations, if needed, of your selfassessment score; etc. The following PCR question(s) may be helpful in responding to this section: CQ. 2 - Is the person’s right to privacy acknowledged and practiced? (for 1 & 4 below) CQ. 3 – Is the person and/or their representative aware of actions they can take if they feel they have been treated unfairly, have concerns or are displeased with the services being provided? (for 2 below) CQ. 25 – Is the person and/or their representative able to communicate and/or demonstrate their rights as a consumer of waiver services? ( for 2 below) OO. CQ. 20 - Does the provider ensure proper handling of all consumer records including security, confidentiality, and retention in accordance with DDS and federal policies (for 3 below) 1 People are provided personal care assistance in private, as appropriate. 2 Information is provided to people on how to make an anonymous complaint. 3 People’s health and other personal information (e. g. , mealtime protocols, therapy schedules) are kept private.

Provider Self-Assessments Scoring: 1. Our policy or practices restrict or impede the opportunity for this to occur. 2. Our policy or practices do not prevent this, but in practice may limit this, therefore this statement is true only for a few of the people we support. 3. This is true for approximately half of the people we support, at least some of the time. 4. Our policy neither supports nor hinders this, but, in practice encourages this indicator, therefore, this indicator is true for many of the people we support. 5. Our policy supports this and yes for many of the people we support. 6. N/A = not applicable. (For example, the question asks about choice of meals and no meals are provided in this setting. )

State Self-Assessment Work with HCBS Settings Advisory Group to review and make recommendations for remediation, where needed, on: Ø All HCBS waiver service definitions and provider requirements. (Completed) Ø All regulations governing HCBS. (Completed) Ø DDS/DDA Provider Certification Review (PCR) process. (In progress) Ø DOH licensing requirements and regulations. Ø All relevant DDS/DDA policies, procedures, and protocols, including Quality Management practices and tools. (In progress) Ø Provider training requirements. (In progress) Ø Human Care Agreements and rate methodologies. (In progress) Ø Information systems. (Not started)

Draft Changes to General Provisions 1938 HOME AND COMMUNITY BASED SETTING REQUIREMENTS 1938. 1 All Supported Living, Supported Living with Transportation, Host Home, Respite Daily, Residential Habilitation, Day Habilitation, Small Group Day Habilitation, Individualized Day Supports, Supported Employment, Small Group Supported Employment and Employment Readiness settings must: Ø be chosen by the person; Ø ensure people’s right to privacy, dignity, and respect, and freedom from coercion and restraint; Ø be physically accessible to the person and allow the person access to all common areas; Ø support the person’s community integration and inclusion, including relationship-building and maintenance, support for self-determination and self-advocacy, and opportunities for employment and meaningful non-work activities in the community; Ø provide information on individual rights; and Ø allow visitors at any time, with any exception based on the person’s assessed need and justified in his or her person-centered plan.

Draft Changes to General Provisions 1938 HOME AND COMMUNITY BASED SETTING REQUIREMENTS 1938. 2 All Supported Living, Supported Living with Transportation, Host Home, Residential Habilitation, and Respite Daily, settings must: Ø Be integrated in the community and support access to the greater community; Ø Provide opportunities for the person to engage in community life; Ø Allow full access to the greater community; Ø Be leased in the names of the people who are being supported. If this is not possible, then the provider must ensure that each person has a legally enforceable residency agreement or other written agreement that, at a minimum, provides the same responsibilities and protections from eviction that tenants have under relevant landlord/tenant law. This applies equally to leased and provider owned properties.

Draft Changes to General Provisions 1938 HOME AND COMMUNITY BASED SETTING REQUIREMENTS 1938. 2(e) All Supported Living, Supported Living with Transportation, Host Home, Residential Habilitation, and Respite Daily, settings must: Ø Develop and adhere to policies which ensure that each person receiving services has the right to the following: Ø Privacy in his or her personal space, including entrances that are lockable by the person (with staff having keys as needed); Ø Freedom to furnish and decorate his or her personal space (with the exception of Respite Daily); Ø Control over his or her personal funds and bank accounts; Ø Privacy for telephone calls, texts and/or emails; and Ø Access to food at any time.

Draft Changes to General Provisions 1938 HOME AND COMMUNITY BASED SETTING REQUIREMENTS 1938. 3 Any deviations from the requirements in § 1938. 2(e) must be supported by a specific assessed need, justified in the person’s personcentered Individualized Support Plan, and reviewed and approved as a restriction by the Provider’s Human Rights Committee.

Draft Changes to General Provisions 1911 INDIVIDUAL RIGHTS (New Additions) Each Waiver provider shall develop and adhere to policies which ensure that each person receiving services has the right to the following: Ø Be informed orally and in writing of the following: Ø Complaint and referral procedures including how to file an anonymous complaint; Ø How to report an allegation of abuse, neglect and exploitation; Ø For people receiving residential supports, the person’s rights as a tenant, and information about how to relocate and request new housing.

Draft Changes to General Provisions New Provider Requirements (1904. 4) Ø Complete mandatory training in Person-Centered Thinking, Supported Decision-Making, Supporting Community Integration, and any other topics as determined by DDS. Ø Develop and implement a continuous quality assurance and improvement system, that includes person-centered thinking, community integration, and compliance with the HCBS Settings Rule, to evaluate the effectiveness of services provided.

Draft Changes to General Provisions 1907 INDIVIDUAL SUPPORT PLAN (ISP) (Changes) Ø The ISP is the plan that identifies the supports and services to be provided to the person and the evaluation of the person’s progress on an on-going basis to assure that the person’s needs and desired outcomes are being met, based on what is important to and for the person, specifically including identifying the person’s interest in employment, identifying goals for community integration and inclusion, and determining the most integrated setting available to meet the person’s needs. Ø The ISP shall be developed by the person and his or her support team using Person-Centered Thinking and Discovery tools and skills.

Draft Changes to Day/ Voc Regs Ø Ban payment of stipends for attendance or participation at day or vocational programs. Ø Require development of PPP & JS/CPPP. Ø Emphasis on community integration. Ø Day Habilitation must include activities to support community integration and inclusion. These must occur in the community in groups not to exceed 4 participants and must be based on people’s interests and preferences as reflected in their Individualized Support Plan and Person -Centered Thinking and Discovery tools. Ø Employment Readiness must include community-based employment preparation experiences that are related to the person’s employment goals.

DDS Budget Hearing Ø Ø Wednesday, April 29, 2015 10: 00 AM John A. Wilson Building Room 500