The Centers for Medicare and Medicaid Services (CMS) issued a final rule effective March 17, 2014, that contains an outcome-oriented definition of home and community-based services (HCBS) settings. The purpose of the federal regulation, in part, is to ensure that people receive Medicaid HCBS in settings that are integrated in and support full access to the greater community. This includes opportunities to seek employment and work in competitive and integrated settings, engage in community life, control personal resources and receive services in the community to the same degree as people who do not receive HCBS. CMS expected that all states develop an HCBS statewide transition plan that provided 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.

The District maintains two HCBS waiver programs: the Elderly and persons with Physical Disabilities (EPD) Waiver, run by the District’s Department of Health Care Finance (DHCF), and the Intellectual and Developmental Disabilities (IDD) waiver, run by the District’s Department on Disability Services (DDS). The EPD waiver program is for the elderly and individuals with physical disabilities who are able to safely receive supportive services in a home and community-based setting. The IDD waiver program provides residential, day/vocational and other support services in the community for District residents with intellectual and developmental disabilities. The plan addresses service settings in these two waiver programs.

CMS requires that states resubmit a revised Statewide Transition Plan (STP) a year after original submission, and further requires that states seek input from the public in the development of this transition plan. DHCF and DDS submitted the District’s first version of the STP to CMS on March 17, 2015. Since then, the District has updated the plan annually and as required in response to public comment and CMS feedback.

On October 6, 2017, CMS granted DC initial and final approval of this Statewide Transition Plan. Please see https://dds.dc.gov/publication/cms-letter-dc-granting-initial-and-final-approval-statewide-transition-plan.

Most recently, on September 30, 2018, the District submitted an updated Statewide Transition Plan to CMS that includes the third set of a full year of site assessments for HCBS IDD and EPD waiver settings, as well as progress on our systemic changes. DC remains on track to achieve compliance with the HCBS Settings Rule by the original deadline of March 19, 2019.

DHCF and DDS appreciate all of the public feedback we have received, and in particular the ongoing work of the HCBS IDD Settings Advisory Group. If you are interested in participating in that group, please contact Erin Leveton at [email protected] or (202) 730-1754. To provide feedback on the EPD Waiver HCBS Settings plan, please contact Ieisha Gray at [email protected] or (202) 442-5818.

The September 30, 2018 HCBS Settings Statewide Transition Plan and attachments follow.