HCBS Settings Rule Attestation Process April 2017 What
HCBS Settings Rule Attestation Process April 2017
What is the Settings Rule? • The settings rule was released by CMS in January 2014 • Full compliance by States is required by March 17, 2019 • Minnesota submitted an initial, statewide transition plan in January of 2015 • Only a few states have an approved plan by CMS at present • Due to timelines to reach compliance, MN is proceeding as if our plan is approved. • Essentially, the Settings Rule has defined characteristics of a HCBS setting, and asks providers who are reimbursed through HCBS waivers demonstrate that they are, indeed a HCBS setting and not an institution.
Minnesota Transition Plan • Minnesota in stage 2 of 5 -step approval process for its Transition Plan with CMS. • Transition Plan must include minimal federal requirements; but states have flexibility in how they apply more stringent standards. • A revised Transition Plan was released Oct. 3 with DHS taking public comments until Nov. 3, 2016. • The revised MN State Transition Plan was submitted in December and has yet to be approved.
Who is Impacted by the HCBS Settings Rule? All residential and non-residential settings funded through Medicaid as part of HCBS: Adult Day Services Group Homes Assisted Living/HWS Including Memory Care Employment Services The HCBS Settings Rule DOES NOT apply to providers who only serve private pay residents or clients in their settings, or who are not enrolled HCBS providers.
Primary Areas of Concern Settings Presumed to be Institutional in Nature Heightened Scrutiny Process Changes to the State Plan Ability to Serve Medicaid Beneficiaries
Institutional in Nature Publicly or Privately Owned Facilities that Provide Inpatient Treatment Settings on the Ground of or Adjacent to a Public Institution Settings that have effect of isolating Medicaid-funded Individuals from Broader Community example Housing with Services in wing of a nursing home; Adult Day program within same building as hospital or nursing home. --- “a setting that shares an address or common wall with an institution. ” Housing with Services or Adult Day program attached to or next door to publicly-owned hospital or nursing home. --- “city, county, state, tribal, or federal institutions. ” Settings designed for people with disabilities or for people with a certain type of disability. ---a more extensive review of settings with 25% or more people with disabilities under age 55
Compliance Process • DHS will assess providers for compliance with the HCBS Settings Rule using a 3 -step process: Assessment Validation Remediation
Step 1: Initial Assessment • Providers will submit an Attestation. • Attestation is 20 questions for Customized Living and 12 for ADS, designed to: – Identify settings presumed not to be HCBS due to institutional proximity or having the effects of isolating. – Report status of compliance and provide supporting evidence. • Attestation administered to 5700 settings electronically. • Timeline: April 2017
Step 2: Validation • DHS will conduct audits of provider-submitted supporting documentation of a sample of submissions (1, 119 approx. ) determined by: – Setting type – On-site visits and outreach – Person’s experience assessments.
Step 3: Remediation • Settings determined not to be HCBS (“institutional in nature”) will have the opportunity undergo a Heightened Scrutiny process. – to show their setting does not have characteristics of an institution and has qualities of HCBS setting. – DHS will evaluate each setting to determine if there is enough evidence for it to overcome presumption of not being HCBS, which includes one-onone outreach and/or an on-site visit.
Heightened Scrutiny Decision • If DHS believes a setting is HCBS, they submit an evidentiary packet to CMS who will make the final determination. This process includes a public comment period. • If setting is unable to take necessary steps to comply with HCBS requirements, DHS will implement relocation protocols.
Ability To Serve If provider does not comply with new rule, they will not be certified as a Medicaid HCBS provider, but can continue to serve private pay individuals.
DHS Timeline 2016 • Set standards, criteria and expectations. • Establish process for compliance. • Develops provider attestation. • Holds public comment period. • Submits revised plan. 2017 2018 -2020 • Implements provider attestation, validation, and remediation processes. • Proposes changes to state law and federal waiver plans to reach alignment. • Develops tools/resources and provides technical assistance. • Determines which settings will be submitted to CMS for heightened scrutiny. (2018) • Establish process to verify compliance. (2018) • Verifies compliance (2018 -2020)
Proposed Changes to 144 D in 2017 Legislative Session • Require right to have and use a lock on unit/apartment door; • Require choice of roommate when sharing an apartment; • Require freedom to furnish/decorate bedroom/apartment; • Require freedom and support to access food at any time. Restricted access to food must be documented in the person’s support plan; and • Require right to choose who visits and when they visit, unless otherwise specified in person’s support plan or lease agreement.
What You Should Do ASSESS ENGAGE COMPLY • Measure your setting against the new requirements • Gather or identify needed info & supporting documentation – see guidebook for assistance • Complete Attestation form • Read Advantage for ongoing updates. • Attend DHS Webinar • Prepare any missing supporting documentation • Participate in Leading. Age MN Technical Assistance Calls • Use resources provided by DHS • Get in compliance and prepare for heightened scrutiny.
Resources • Leading. Age Minnesota Web Site – Go to Provider Resources Page – Click on HCBS Settings Rule • CMS Toolkit: What You Should Know, Settings Presumed to be Institutional & Heightened Scrutiny Process • Links to DHS HCBS Settings Rule information • Additional material will be added, including information on heightened scrutiny as well as tools and resources to prepare for and verify compliance
Resources Registration Information Register using Train Link: you must have a Unique Key to register and receive credit for training. • Go to Train. Link • Select Continuing Care Learning Center • Select Sign On in the upper right hand corner • Enter your Unique Key • Select Upcoming Classes/Class Registration • Select All DSD Classes • Search “HCBS Waiver Provider Attestation”’ • Locate the desired session date • Select the Class • Select Enroll in this class and follow the registration instructions. Note: This is the same webinar on both dates, you only need to register for one of the two sessions. You can find the Web. Ex link and phone number in the “Delivery Method/Handouts” link when you register for the session.
DHS Contact Information There are three ways to send DHS your questions, provide your feedback or request a paper copy of the statewide transition plan: • Email hcbs. settings@state. mn. us • Call 651 -4300 • Mail Minnesota Department of Human Services, Disability Services Division, Attention: HCBS Rule Transition Plan, P. O. Box 64967, St. Paul, MN 55164 -0967 Providers: Sign up to receive Provider Updates and other MHCP notices in your email account.
What do I need to do next? Complete the attestation process to demonstrate that you meet the new requirements or to indicate that you need more time or assistance. Through the attestation process you will provide documentation that shows how you are meeting—or how you plan to meet—the new setting requirements.
What is included in the DHS toolkit? • A cover letter • Guidebook – a guidebook to completing the attestation process that has been customized to your setting (either customized living or adult day) • Frequently asked questions (FAQs)
To start the process, follow these steps: Read through the toolkit and gather your information, such as documentation, license number, etc. Log in to the online attestation form: https: //edocs. dhs. state. mn. us/lfserver/Secure/DHS-7176 -ENG Upload your documentation and submit your initial attestation by April 30, 2017. For each requirement, you will indicate whether you: - Currently meet the requirement, or - Do not yet meet the requirement but are working to come into compliance by Sept. 1, 2017. - Update your attestation, if needed, by Sept. 1, 2017
Navigating the Form • To log in to the attestation form for the first time, select “New attestation” and then enter your license (ADS) or HFID number (CL). If you have more than one location, you may start a new attestation based on an existing completed attestation. • Once you are logged in to the online attestation form, navigate page-by-page using the “Previous” and “Next” buttons located in the upper, left-hand side of the page. You can also skip to a specific section of the form by using the dropdown menu located between the previous and next buttons. • You can save and exit the form at any time, using the “Save & Exit” button located in the upper right-hand corner of the form.
Log-in Process If you are not able to proceed to the next page once you have entered your license or HFID: • Recheck your license / HFID number or look up your number online. • Make sure you are using the HFID number that is associated with the housing with services registration, NOT your comprehensive home care license. This number can be found on the housing with services registration certificate for the site. • If you are still unable to enter a valid number, please email hcbs. settings@state. mn. us. Use the subject line: “sign in number for attestation needed. ” Include your provider name, the setting address, city, state, zip code, phone number and the provider service type at the setting.
Information Needed for Attestation • NPI/ UMPI number: Provide the 10 -digit National Provider Identifier (NPI) or your Unique Minnesota Provider Identifier (UMPI) number you use to enroll with Minnesota Health Care Programs. • Name of setting: For customized living, use the name associated with the Housing with Services Registration. • Physical address of setting: Use the street address where the waiver services are provided. Do not use the address of a headquarters building or business office.
Current tenants/clients How many people currently (on the date you complete this attestation) are receiving HCBS services at this setting? Enter the number of people that receive services by each funding type. Enter “ 0” if you do not provide services to people of the described funding type. The field for the number of total people in the setting will auto populate. a) ____ Number of older adults with services funded by HCBS waivers (EW, AC) b) ____ Number of people with services funded by HCBS disability waivers (CADI, DD, CAC, BI) c) ____ Number of people with other payer sources d) ____ Number of total people in the setting
Indicating your intention Do you intend to meet the HCBS requirements at this setting? If you plan on meeting all of the HCBS setting requirements, even if you aren’t compliant at the time of the attestation, choose yes here. • □ Yes • □ No, I want to opt out and no longer be a HCBS provider. I understand I will need to work with the county /lead agency and DHS to develop transition plans for people currently served to transition by March 2019.
The Attestation Questions 1 -7 Customized Living Only Questions 8 -20 CL and ADS Remember as you respond, that you may not have all of the supporting documentation today, but you can indicate that you will have it by September 1. Check your guidebook as you move through the Attestation for guidance on the requirement, what you need to do to comply and how to show you are doing so. Don’t Panic!
1. 2. 3. 4. 5. 6. 7. Attestation Questions & Federal Related Requirement Lease Agreement – Setting has a lease agreement providing protections to address eviction and appeals Lockable door – Each person has privacy in sleeping or living unit including a lockable door Roommates – The setting facilitates that a person who shares a bedroom is with a roommate of their choice Decorations – Setting provides freedom to furnish & decorate their living unit Daily Schedule – Setting provides freedom and support to control their daily schedule including access to food at any time Visitors – Setting allows people to have visitors at any time Accessibility – The setting is physically accessible to the individual
Attestation Questions & Federal Related Requirement 8. Employment – Setting provides opportunities for people to seek employment and work in competitive integrated settings 9. Community Life – Setting provides people opportunities to access and engage in community life 10. Control of Money – Setting supports the person’s control of personal resources (their money) 11. Privacy – The setting ensures people’s right to privacy 12. Dignity and Respect – Setting ensures people’s dignity and respect 13. No Coercion/restraint – Setting ensures freedom from coercion and restraint 14. Independent choices – Setting optimized individual initiative, autonomy, and independence in making life choices, including daily schedule and with whom to interact
Attestation Questions 15 -20. Setting Information 15 – Setting is “in” 16 – Setting is “adjacent” 17 – Setting may be isolating 18 – Multiple Homes located on same street/adjoining property 19 – Settings that provide multiple activities onsite 20 – settings that may be isolating: disability waivers only
Supporting Documentation • The attestation requires supporting documentation. The setting type guide book will help you gather the needed documentation. For many questions you will be demonstrating how you inform clients and also, how you inform or achieve compliance through staff. • Tip: When you attach your documents at the end of the form, you should then select the “Submit Attestation” button. If you select “Save & Exit, ” your attachments will NOT be saved. • For most of the questions in the attestation form, you will be selecting the type of document you will attach to demonstrate that you meet the requirement. Select the button in front of this document type and then indicate the page number or range of numbers that demonstrate that you meet the requirement.
Supporting Documentation You may need to include more than one document type to demonstrate that you meet the new requirements. For example, you may have two different policies that show you meet the requirement. In these cases, you have two options. • You may either combine the two documents into one, and indicate the page numbers for both. Or, • You can use the “Other” document type to indicate the second document and the relevant page numbers.
For Customized Living • • • Blank copy of a lease Recipient rights form or statement of recipient rights Staff orientation or annual training records Policy / procedure document(s) Reasonable accommodation policy Blank recipient care plan
For ADS • Recipient rights form: Statement of Participant Rights • Sample monthly plan for daily activities • Form that informs people on how opportunities and supports will be provided so they are fully included in their community. • Staff orientation or annual training record Adult day service providers may also submit these documents, if applicable: • Policy and/or procedure that outlines management of personal funds- if provider has money management duties • Document titled “Question 18 - Adjoining Settings” to describe shared programming • Document titled “Question 20 - Community Participation”
Save or Submit • Saving the attestation will not save any of your attachments. • If you submit your attestation, your uploaded documents will be saved and you can sign back in to edit your submission at a later date.
Name of person completing the Attestation • contact person, • title, and • phone number Enter the name of the person responsible for compliance. DHS will use this information when sending out additional information and/or communication. It is understood that this may be a different person than the one actually submitting the attestation.
Email address • When completing the attestation form online, an email address must be used. • The email associated with the attestation will allow you to log back in to each attestation. • DHS will also send communication to this email regarding any questions specific to this setting/ site. • You may use the same email for your attestation for other settings, but it must be paired with a unique licensing or HFID number, which will differentiate the setting attestations from each other. • Tip: note your email address and license number or HFID for future reference.
Submit attestation or Save and Exit • All areas need to be marked as compliant by September 1, 2017. • If you are unable to make necessary changes to meet requirements and would like to request a hardship extension, please complete an HCBS Provider Attestation Hardship Request, DHS-7176 A (PDF) form and submit as an attached document to the attestation. • Select one: – □ Submit Attestation – □ Save & Exit ALERT: If you have uploaded attachments, they will not be saved if you select this. Use this option so you can sign back in and edit your submission later.
After the Attestation • If you anticipate needing more time for compliance beyond September 1, an extension form can be submitted by August. • Clients may have questions as they are receiving letters about the process from DHS. • A “person’s experience” survey will be conducted annually • Site visits from DHS to those “presumed not to be HCBS” • An “evidentiary package” will be prepared for submission to CMS – a public comment period is an opportunity to garner support from clients and community
For More Information on the Settings Rule… Bobbie Guidry Vice President of Housing and Community Services 651. 603. 3508 bguidry@leadingagemn. org
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