Home and CommunityBased Services Settings Final Rule Update

Home and Community-Based Services Settings Final Rule Update August 08, 2017 Virginia Brown, Director Bureau of Policy and Regulatory Management

Background • CMS published the final rule amending regulations contained in 42 CFR 441. 301 on January 16, 2014 • The rule supports enhanced quality in Home and Community. Based Services (HCBS) programs and adds protections for individuals receiving services. • In addition, this rule reflects CMS’ intent to ensure that individuals receiving services and supports through Medicaid’s HCBS programs have full access to the benefits of community living and are able to receive services in the most integrated setting. • On May 9, 2017, CMS extended the transition period for compliance to March 17, 2022 2

HCBS Settings Requirements The final rule establishes: • Mandatory requirements for the qualities of home and community-based settings including discretion for the Secretary to determine other appropriate qualities • Settings that are not home and community-based • Settings presumed not to be home and communitybased • State compliance and transition requirements 3

Transition Plans • The transition plan is the document in which states determine their compliance with the regulatory requirements for home and community-based settings and describe to CMS how they will comply with the new requirements. • Statewide Plan vs. Waiver Specific Plan – Both are required. – Waiver specific plans are incorporated in the Statewide Transition Plan as appendices. – DHS’ Statewide transition Plan was initially approved by CMS on August 30, 2016. 4

Provider Assessment OLTL HCBS Final Rule Provider Self-Survey • The Home and Community-Based Services (HCBS) Provider Self. Survey served as a starting point that was used to develop the assessment process for the HCBS Settings Final Rule monitoring. • The final report on the survey’s outcome was issued in August 2015. OLTL’s Current Focus • OLTL is focusing on monitoring individual provider sites that are enrolled to provide: – Residential Habilitation – Structured Day Habilitation – Pre-Vocational/Employment Services • 96% of the on-site monitoring visits for these services have been completed. 5

Assessment Procedure Current Procedure • Using the assessment tool for each provider site: o The OLTL Bureau of Policy and Regulatory Management reviews the provider’s submitted documentation, including policies and procedures for the site(s) being monitored. o The OLTL Quality Management Efficiency Teams (QMETs) conduct on-site monitoring assessments for the site(s) being monitored. • A cross-bureau panel reviews information in the assessment tool for site compliance with the HCBS Settings Final Rule. • The panel makes a recommendation to the OLTL executive staff whether: o Site is Compliant; or o Site is Non-Compliant: Ø Issue a Statement of Findings requiring a Corrective Action Plan from the provider; or Ø Recommend site to be submitted for Heightened Scrutiny; or Ø Terminate provider from providing waiver services at that specific location. 6

Non-Compliant Sites Corrective Action Plan: • The Provider will be issued a statement of findings outlining issues at the site that are not in compliance with the HCBS Settings Final Rule. • The Provider will submit a Corrective Action Plan (CAP) detailing the steps they will take to come into compliance, including the proposed timeframe for completion of the site’s CAP. • The OLTL HCBS Settings Final Rule Panel will either approve the CAP or request revisions to the CAP. • OLTL will follow up with providers to ensure CAP completion, which could include an additional on-site monitoring visit. • Once verified compliant, OLTL will issue a letter of compliance with the HCBS Settings Final Rule to the provider. 7 11/22/2020

Non-Compliant Sites Heightened Scrutiny: • If a site has an area of non-compliance that the provider cannot rectify, such as the physical location, but the OLTL determines the overall setting is home and community based, the OLTL, with provider agreement, may submit the setting to CMS for Heightened Scrutiny. Termination: • If a site cannot, or will not, come into compliance, the provider will be terminated from providing HCBS at that site and the waiver participants will have the option of relocating to a compliant site or remain at the site and stop receiving HCBS. 8 11/22/2020

Heightened Scrutiny • Sites that are going to be submitted for Heightened Scrutiny will have their Heightened Scrutiny package available for public comment. • The Heightened Scrutiny requirements and processes are currently under development. 9

Adult Day Centers • Currently, the OLTL is coordinating with the Department of Aging to determine HCBS Settings Final Rule compliance for Adult Day Centers including those in or on the grounds of Institutional Settings. 10

Moving Forward Ensuring HCBS Settings Final Rule Compliance after Community Health. Choices Implementation For the Community Health. Choices (CHC) Waiver: • The CHC-Managed Care Organizations (MCOs) will take over the Final Rule monitoring, ensuring that each site will be assessed every two years. • The CHC-MCOs will report their findings back to the OLTL. For the Omnibus Budget Reconciliation Act (OBRA) Waiver: • The OLTL will continue to monitor the OBRA sites for compliance every two years. 11 11/22/2020

CMS Engagement Ø Meeting held with CMS and representatives from other states on July 26, 2017. Ø CMS believes that states are not in disagreement with the rule and is looking for feedback from states on the following areas: § what kinds of guidance and operational procedures are needed § How to make the heightened scrutiny process more efficient § The types of settings states are concerned may not be able to comply and the criteria that is causing those concerns Ø Discussion centered around settings that isolate and the heightened scrutiny process. 12

Questions? 11/22/2020 13

Website Links • OLTL Waiver Amendment, Renewals and Accompanying HCBS Transition Plans – http: //www. dhs. pa. gov/learnaboutdhs/dhsorganization/officeoflongte rmliving/oltlwaiverinfo/index. htm • OLTL HCBS Final Rule Provider Self-Survey Outcome Report – http: //www. dhs. pa. gov/cs/groups/webcontent/documents/document/ c_209460. pdf • HCBS Settings CMS Final Rule Statewide Transition Plan Website – http: //www. dhs. pa. gov/citizens/hcbswaiver/ • HCBS Settings CMS Final Rule Statewide Transition Plan – http: //www. dhs. pa. gov/cs/groups/webcontent/documents/document/ c_220667. pdf 14