Wednesday, March 25, 2015
The Centers for Medicare and Medicaid Services (CMS) issued a final rule effective March 17, 2014, that contains a new, 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 expects all states to develop an HCBS statewide transition plan that provides 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. CMS further requires that states seek input from the public in the development of this transition plan.
The District maintains two HCBS waiver programs: the Elderly and Persons with 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 of 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.
Below is the District of Columbia’s Statewide Transition Plan for the HCBS waiver services. (The IDD Waiver-specific details are located in Appendix 1, page 13, and are incorporated by reference to this Statewide Transition Plan.) To assist in the development of the plan, DHCF formed a HCBS Stakeholder Subgroup: Transition Plan, which was comprised of individuals from the DC Senior Advisory Coalition; VMT Home Health Agency; Lisner Louise Dickson Hurt Home; DC Long-Term Care Ombudsman Legal Counsel for the Elderly; Premium Select Home Care, Inc; District of Columbia Health Care Association; DC Office on Aging; DC Department of Health; DC DDS; and KBC Nursing Agency & Home Health Care Inc.
This group met weekly January-February of 2015 and served as a mechanism for DHCF to receive feedback and input from stakeholders. Once the plan was drafted, DHCF posted the plan in its entirety on the Department of Health Care Finance (DHCF) website at www.dhcf.dc.gov on February 5, 2015, and at the same time, published a notice on our website announcing a period of public comment. The plan and notice of the public comment period were further disseminated to over 60 people connected to DHCF’s HCBS Stakeholder Group, to the Medical Care Advisory Committee list-serve of over 50 individuals and organizations and shared via the DC Developmental Disabilities Council (DDC) community list-serv, which includes over 500 recipients. Approximately two-thirds of the recipients are from the community side (i.e., District residents with disabilities, family members, activists, and representatives from community-based & non-governmental organizations). The plan and public notice of the comment period were also published in the District of Columbia Register on February 13, 2015, and then re-posted on DHCF’s website February 23, 2015. The public comment period ran from February 5 to March 13, 2015.
DHCF also hosted a public forum at the DC Department of Health Care Finance at 441 4th St, NW, Washington DC, 20001 on Thursday, February 26, 2015, at 4 pm in the Main Street conference room (North Building, 10th floor), at which time DHCF explained the transition plan and received oral or written comments. Notice of the public forum was posted on DHCF’s website and was disseminated via email to individuals and stakeholder organizations. DHCF reviewed all comments and incorporated appropriate suggestions, as appropriate. DHCF has summarized the changes made to the transition plan in response to the public comment, and will post the summary of public comments and responses on its website by March 20, 2015.
This revised version of the Transition Plan, dated March 16, 2015, reflects the public comments received during the public comment period and continuing guidance from CMS. Changes are largely focused on including more details on dates for key activities within the Transition Plan; including metrics around the number of individuals and settings impacted by the Rule; details on DHCF’s heightened scrutiny process; and added opportunities for training on the Rule. The revised Plan will be posted, in its entirety, on the DHCF website by March 20, 2015.
DHCF appreciates all of the public feedback we received and the ongoing work of our HCBS Stakeholder Subgroup: Transition Plan. If you are interested in participating in this group, please contact Trina Dutta at [email protected] or (202) 719-6632.