HCBS Provider Monthly Meeting June 30 2021 HCBS

HCBS Provider Monthly Meeting June 30, 2021

HCBS Compliance Initiative Update: Heidi Bechard, OADS Heightened Scrutiny Setting Reviews/Timelines: Shannon Webb, Econ. Sys and Heidi Bechard, OADS Agenda Evidentiary Packages, Timelines, Public Comment Period: Shannon Webb, Econ. Sys and Heidi Bechard, OADS Questions & Answers

OADS HCBS Trainings and Resources Webpage: HCBS Resources (recent additions) https: //www. maine. gov/dhhs/oads/aboutus/initiatives/hcbs/training-and-resources Maine HCBS Provider Manual 2021 Dr. Angela Amado Community Connections and Relationships Building Series-recorded trainings and resource materials

Additional Resources available on the OADS Webpage Providers: Resources and Training https: //www. maine. gov/dhhs/oads/providers/adults-withintellectual-disability-and-autism/resources-training Current Person-Centered Plan Manual Introduction and Action Notes Knowledge Check (power point and video) Additional links to Work, Community and Assistive Technology Resources and Trainings are identified on this page Providers: Employment Services and Information for Providers https: //www. maine. gov/dhhs/oads/providers/employmentservices

HCBS Resources on the HCBS Compliance Portal As a reminder, the following resources are available on the HCBS Compliance Portal – Trainings and Resources tab: https: //maine. hcbscompliance. com/training_materials Sample Policies for Residential and Non-Residential Settings: Transportation Independence and Personal Secure Storage Employment First and Integrated Employment Managing and Storing Personal Financial Resources Behavioral Support Modification and Management and HCBS Modifications Minimum Remediation Guides for Residential Settings: Shared Living or Related Caregiver Residential Settings and All Other Residential Settings Evidence of Remediation – Guidance Tool for Residential Providers Positive Personal Profile – Developing a Positive Personal Profile

HCBS Compliance Initiative Update Residential Setting Validations and Setting Findings Reports: Remain on target to be issued to providers (with self-assessments submitted to the HCBS Compliance Portal in November 2019) by 7/31/21. Community Support Setting Validations: DRM will have completed on-site CS validation visits by the end of this week (for CS settings that submitted selfassessments in the HCBS Compliance portal in November 2019). Many of these setting findings reports have been issued. Remainder will be issued by 7/31/21.

Findings Reports & Proposed TTCPs April 14 May 12 June 9 1, 039 1, 187 1, 321 # Providers uploaded a proposed TTCP to the portal 877 1, 013 1, 106 1, 236 # Providers has not uploaded a proposed TTCP to the portal yet 162 174 215 276 190 184 291 141 1, 229 1, 371 1, 612 1, 643 # Findings Reports (FRs) sent to Providers # In the Works Total June 30 1, 502

Transition to Compliance Plans (TTCP) Approved / Sent to Providers April 14 May 12 506 731 June 9 812 June 30 904 Accepted 371 599 706 786 Not Accepted Yet 135 132 106 118 Not yet accepted Overdue 89 85 89 82 Not yet accepted - Not overdue 46 47 17 36

CMS Definition of Settings Presumed Not to be Home and Community. Based • Category I: Settings in a publicly or privately operated facility that provides inpatient institutional treatment; • Category II: Settings in a building on the grounds of, or adjacent to, a public institution; • Category III: Settings with the effect of isolating individuals receiving Medicaid home and community-based services from the broader community of individuals not receiving Medicaid home and community-based services.

Identification of Heightened Scrutiny Settings The Department used the following March 2019 CMS guidance during each setting’s validation to determine whether the setting has isolating qualities: Does the setting otherwise have the effect of isolating individuals receiving Medicaid-funded HCBS from the broader community, including the broader community of individuals not receiving Medicaid-funded HCBS? Due to model used for service provision, do individuals have limited opportunities – as compared to individuals living in the same community that do not receive HCBS - for interaction in and with the broader community, including interactions with individuals not receiving Medicaid HCBS? Does the setting restrict and/or limit individuals’ choices to receive services provided by the setting outside of the setting or to engage in activities outside of the setting? Is the setting physically located separate and apart from the broader local community? Note: Physical location alone does not make a setting isolating.

Heightened Scrutiny Settings Identified Total Number Identified to Date Feb 2021 Mar 2021 Apr 2021 54 80 94 May June 1, 2021 June 30, 2021 112 150 123

Heightened Scrutiny Settings To Date: 6/30/21 Type of Setting # Determined Isolating 6+ Gr Home 12 3 -5 Gr Home 23 1 -2 Gr Home 33 FCH 4 SL-Unrelated 16 SL-Related Family Member 7 Community Supports 47 Work Supports-Group 1 Closing 7 TOTAL 150

How the CMS Extension Impacted Maine’s Heightened Scrutiny Settings • Due to COVID, CMS extended the deadline for states to be in full compliance by 1 year to 3/17/2023 • CMS also extended the deadline for HS settings to fully comply (avoiding state/federal level HS review) by 1 year from 7/1/20 to 7/1/21 • This is a CMS deadline for HS settings in all states that can’t be changed • Prior to the CMS extension for COVID, the timeframes did not allow any HS Settings the opportunity to avoid the state/federal level HS review. • The state previously expected all HS settings would need to go through the state/federal level HS review.

How the CMS Extension Impacted Maine’s Final Date For all Settings to be in Full Compliance • With the CMS extension, the state did change the final deadline for all settings (including HS settings not fully compliant by 7/1/21) to be fully compliant from 10/31/21 to 7/31/22. • This change allows all providers more time to remediate their settings. • This change was also made to reflect completion of Validations is delayed to 6/30/21, due to COVID, which means finishing issuance of all Findings Reports is delayed to 7/31/21 due to COVID.

Heightened Scrutiny Settings Trying to Remediate by 7/1/21 • Progress Updates and Evidence of Remediation must be submitted by COB 7/1/21 • Updates or Evidence submitted after COB 7/1/21 will not be accepted • Settings will be notified by 7/31/21 if they have or have not reached full compliance

Settings Unable to Reach Full Compliance by 7/1/21 • Settings that have not reached full compliance will receive the Evidentiary Package (EP) template and instructions with their notice • EP must be submitted within 60 -days of the notice. If revisions are needed, provider will be notified and have 30 days to submit a revised EP. • Remediation should continue. Next Progress Update will be due in 6 months (semi-annual reporting). • You will receive feedback on your Progress Update within 30 days.

Evidentiary Package Template The CMS approved EP Template is available for review on the HCBS Compliance Portal Trainings and Resources Tab located at: https: //maine. hcbscompliance. com/trainin g_materials

• All HS settings must have draft EPs submitted by 10/31/2021. Evidentiary Packages and 30 -day Public Comment Period • The state must review/approve and post the EPs for public comment with its Final Statewide Transition Plan. • All EPs must be ready for posting by 1/31/2022. • Public Comment Period will occur between 2/28/2022 and 3/31/2022. • EPs will be sent to CMS after they are posted for public comment with Final Statewide Transition Plan.

Technical Assistance Once the Department receives CMS approval to utilize FMAP funds we look forward to sharing information regarding Technical Assistance for providers working towards full compliance with the federal HCBS Settings rule requirements.

Beginning July 30, 2021 Setting Updates by Close of Business on the 30 th of Every Month to Diane. Haberman@maine. gov and Heidi. Bechard@maine. gov , to include the following information: New settings with associated NPI+3 numbers Inactive settings with associated NPI+3 numbers Settings that have moved to a new location including old and new NPI+3 numbers Settings that have closed with associated NPI+3 numbers

Questions and Answers