Update on CMS Expectations for State Transition Plans

The CCC has created an STP Mini-toolkit as a quick reference guide after almost 2 years of HCBS Final Rule implementation. This information is an extension of that toolkit:

The Center for Medicare & Medicaid Services (CMS) and NORC, the contractor helping implement the Final Rule and review State Transition Plan’s, hold monthly webinars called SOTA (State Operations and Technical Assistance) calls to advise Medicaid directors about completing their STP. CCC participates in these calls and will continue to report on relevant issues. We have made a specific request to CMS to publish all the questions and answers from every call, and they have indicated they are working to address that concern. Below are CCC observations from the last two calls.

Nov. 4, 2015 – HCBS Settings, Excluded Settings, and Heightened Scrutiny Process [Download]

The content stayed consistent with the Final Rule and Guidance, but for the first time specifically addressed private homes as settings:

  • A state may presume that an individual’s private home or relative’s home where the individual resides meets the home and community-based settings requirements.
  • However, it is still the state’s responsibility to ensure that individuals living in a private home or a relative’s home have opportunities for full access to the greater community.
  • If the state presumes that private homes meet the settings requirements, the state needs to confirm that the homes were not purchased or established in a manner that isolates the individual from the community of individuals not receiving Medicaid-funded home and community-based services. For example, did a group of families purchase an isolated property solely for their family members with disabilities using waiver services?

Dec. 9, 2015 – Systemic and Site-Specific Assessments and Remediation  [Download]

The most significant aspects of CMS’ expectations about the STP process revealed in this webinar were “deadlines” when CMS expects certain milestones of the STPs to be completed by all states.

  • CMS expects states to submit an amended STP with their systemic assessment results [regulations, licensing requirements, survey assessment results, etc.] no later than March 31, 2016. This includes posting the amended STP for public comment and including the states’ responses to that public comment.
  • CMS expects states to complete their site-specific assessments no later than July 31, 2016. States are required to post these results for public comment and submit results to CMS no later than Sept. 30, 2016.
  • CMS differentiated a “modified” STP from an “amended” STP. A Modified STP is one that includes additional data in support of or expanding on existing content in the STP without making any substantive changes. An Amended STP is one that includes determinations from systemic and site-specific assessments, includes remedial actions or changes to milestones, or contains changes substantive enough to warrant public comment.
  • Desiree asked what should be the possible state responses if public comment disagrees with the state list of non-compliant settings. CMS responded that it will depend on the nature of the comments, the evidence presented in support of the comments, and the weight of the comments.
  • Mark asked if a person living in a setting believes the setting fulfills the requirements of HCBS, but the state reviewer makes a contrary assessment, whose view will prevail? CMS responded that a person’s individual choice will not overrule whether the state determines that a setting has the qualities of an institution or whether it meets the HCBS settings requirements.

Please continue to educate your advocates about these issues using the CCC developed materials as their voices will be of utmost importance when public comment periods open in your state. Check the CCC website regularly to see if your state public comment period is open!

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