Home and CommunityBased Services HCBS Settings Rule Lisa

Home- and Community-Based Services (HCBS) Settings Rule Lisa Mills, Ph. D. , Econ. Sys and Representatives from the DHHS Office of Aging and Disability Services January 29, 2020

Federal HCBS Settings Rule What is the federal HCBS Settings Rule? • In January 2014, the federal Centers for Medicare & Medicaid Services (CMS) released a new rule regarding home- and community-based services (HCBS), which took effect March 17, 2014. • The rule requires that people who receive those home- and community-based services and supports funded through Medicaid must receive those services and supports in settings that meet specific standards. • States have been given until March 17, 2022 to ensure their HCBS systems and settings are in full compliance with the rule. For more info: http: //www. maine. gov/dhhs/oads/hcbs/requirements. shtml Maine Department of Health and Human Services 2

Federal HCBS Settings Rule (cont. ) Why did CMS issue the federal HCBS Settings Rule? • To ensure people receiving HCBS have full access to benefits of community living and the opportunity to receive services in the most integrated setting. • To enhance the quality of HCBS and provide rights protections to participants. For more info: https: //www. medicaid. gov/medicaid/home-community-basedservices/guidance/home-community-based-services-final-regulation/index. html http: //www. maine. gov/dhhs/oads/hcbs/requirements. shtml Maine Department of Health and Human Services 3

What is Validation? State must determine compliance of existing HCBS settings. Step One: Providers complete self -assessments for each setting Step Two: (required by CMS) state “validates” the provider selfassessment data Validation determines how compliant an existing setting is, and what must be done to bring that setting into full compliance in time for the March 17, 2022 deadline. Maine Department of Health and Human Services 4

HCBS Provider Validation Process Provider Self. Assessment Validation of the Self -Assessment Responses On-Site Reviews, Individual Experience Assessments, and/or Desk Reviews Notification to Providers and Implementation of Remediation Notification of Final Determination Ongoing Compliance Monitoring of Settings Maine Department of Health and Human Services 5

Update on Provider Self-Assessment Process Residential Settings Non-Residential Settings • Shared Living (Related Provider) • Community Supports • Shared Living (Unrelated • Clubhouse Provider) • Work Supports-Group • Group Homes (2 -6 ppl) • Family-Centered Homes Total Settings = 2, 076 Total Settings = 183 Submitted Self-Assessments = 2, 059 Submitted Self-Assessments = 181 Submission Rate = 99. 2% Submission Rate – 98. 9% EXTENDED Deadline for Late Submissions: Dec. 13, 2019 Non-Submission: Intensive Validation by DHHS Maine Department of Health and Human Services 6

How Does Maine Plan to Validate Provider Self. Assessments? 1 st Method: On-Site Visits Up to 644 settings will receive On-Site Visits (30% of all settings) • 3 Non-Residential setting types (100% will get on-site) Community Supports, Work Supports-Group & Clubhouse • 4 Residential setting types (24% will get on-site) 13% Group Homes (1 -2 person) 38% Group Homes (3 -5 person) 100% Group Homes (6+ person) 10% Family Centered Homes 10% Shared Living-Related Family Member 35% Shared Living-Unrelated Provider *Proportional selection of settings/region given total number of each setting type in each region. Random selection done in way that ensured maximum number of distinct providers included. Maine Department of Health and Human Services 7

Plan for On-Site Visits Contract in place with Disability Rights Maine (DRM) to conduct on-site validation Econ. Sys and DRM worked together to create validation tools and validator training. DRM has recruited a team of validators. They are training them, which includes coaching and mentoring in doing validation on-sites. On-site validation visits will occur on a rolling basis, between February 2020 and October 2020 If a provider has multiple settings selected for on-site validation, only the first validation visit will request/review agency policies, etc. Maine Department of Health and Human Services 8

Plan for On-Site Visits (2) Policy/Document Review for a setting, if first for a specific provider agency Will request documents be sent in advance so this review can be done in advance of visit. Additional on-site documentation review followed by conversational interviews with some of the individuals receiving HCBS in the setting. Interview with setting manager; staff person who can speak on behalf of provider. Touring the setting, inside and outside. Observation of private living areas only with permission of individuals. (Private Space Needed) Maine Department of Health and Human Services Interviews with staff working in the setting. Touring of local area in which setting is located. Discussion of next steps and timeframes with provider before departing. 9

How Does Maine Plan to Validate Provider Self. Assessments? (cont. ) 2 nd Method: Individual Experience Assessment (IEA) Survey • All residential settings that do not receive an on-site visit • Support Coordinator/Care Coordinator/Case Manager conducts in-person IEA in the setting with each member (and guardian if one appointed) receiving services in the setting • Information will be compared with Provider Self-Assessment to determine current compliance with any areas of partial or noncompliance that need to be addressed • If concerns about lack of alignment between Provider Self-Assessment and IEAs, either on-site visit or desk review will also be used Maine Department of Health and Human Services 10

How Does Maine Plan to Validate Provider Self. Assessments? (cont. ) 3 rd Method: Desk Level Reviews • Provider will be contacted to submit information and documentation to support answers in Self-Assessment • OADS has identified staff who will conduct Desk Level Reviews • Econ. Sys is developing desk review process and procedures (CMS recommended Wyoming’s approach) • Desk Reviews will occur on a rolling basis, between February 2020 and October 2020 • Settings selected for Desk Level Reviews based on discrepancies identified between the Provider Self-Assessment and results of Individual Experience Assessments Maine Department of Health and Human Services 11

Proposed Plan: After Validation • Providers will receive the results of a setting validation within 30 days of the validation process being completed for that setting • Based on the setting validation results, each setting with areas of partial or noncompliance with be required to have a setting-specific Transition-to. Compliance Plan. DHHS/Econ. Sys will provide a plan and template for providers to use • After they receive their settings’ validation results, providers will have 30 days to submit an approvable Transition-to-Compliance Plan for the setting. State and/or Econ. Sys staff will be available to answer questions and provide technical assistance to providers as they develop these Transition-to. Compliance Plans Maine Department of Health and Human Services 12

Proposed Plan: After Validation (cont. ) • All Transition-to-Compliance Plans must be fully implemented (all action steps completed) by October 31, 2021. The state and Econ. Sys will monitor provider progress on implementation of their Transition-to-Compliance Plans to ensure the October 31, 2021 deadline is met. • If any setting does not meet the October 31, 2021 deadline, the state is required to ensure safe and orderly transitions of individuals wishing to continue to receive HCBS to compliant settings so that these relocations are completed in the person-centered manner by no later than March 17, 2022. Maine Department of Health and Human Services 13

Information for HCBS Providers • OADS HCBS webpage: http: //www. maine. gov/dhhs/oads/hcbs/index. shtml • Econ. Sys’ Maine HCBS Compliance Portal: https: //maine. hcbscompliance. com • Econ. Sys Training & Resources: https: //maine. hcbscompliance. com/training_materials • Monthly HCBS informational meetings will be held the last Wednesday of the month from 11 a. m. to 12 p. m. Next meeting scheduled for February 26, 2020. • Please share future meeting HCBS topics with us through the HCBS. DHHS mailbox: HCBS. DHHS@maine. gov Maine Department of Health and Human Services 14

Questions? Please feel free to submit questions to: HCBS. DHHS@maine. gov Maine Department of Health and Human Services 15