- 1 Continued advocacy upon implementing your Statewide Transition Plan is needed!
- 1.0.1 Does the State Transition Plan affect me?
- 1.0.2 Background – History of HCBS Waivers
- 1.0.3 What is changing about HCBS waivers?
- 1.0.4 What is a Statewide Transition Plan (STP)?
- 1.0.5 What can I do to help my state and ensure policy does not limit support options?
- 1.0.6 What should I look for when assessing and providing comment on the Statewide Transition Plan?
- 1.0.7 What else can I do besides submit public comment?
- 1.0.8 Where Can I Find More Information?
Continued advocacy upon implementing your Statewide Transition Plan is needed!
Does the State Transition Plan affect me?
If you are receiving waiver services, or intend to use waiver services, you may be affected by the implementation of the HCBS Final Rule in your state. The settings in which you are supported will be subject to scrutiny to ensure compliance with new regulations.
Results could include:
(1) the closing of a housing, employment or day program
(2) a requirement that you find an alternative program and/or living situation
(3) being forced to find an alternative funding source for your program (other than Medicaid) and/or
(4) changes to the operations or programs in which you participate.
Background – History of HCBS Waivers
The U.S. government authorized the “Medicaid 1915(c) Home and Community-Based Services (HCBS) Waiver program” in 1981. Prior to this, beneficiaries could only receive comprehensive long-term care in institutional settings. This law allows states flexibility to offer different types of support services to individuals with disabilities in their own home or other settings in the community. States are in charge of creating different waivers to meet the needs of their citizens, the term ‘HCBS waiver’ is the broad term that encompasses all of the different waivers available in states.
What is changing about HCBS waivers?
In January 2014, the Center for Medicaid Services (CMS) issued new regulations defining HCBS settings, in other words, where waiver recipients can use their supports. The new regulations use outcome-oriented characteristics and define HCBS settings as guided by the consumer’s person-centered service plan (PCP). This is a huge step forward as policy is intended to ensure more individualized supports based on the needs, choices, and experiences of individuals with disabilities.
Every state was charged by CMS with drafting and revising a State Transition Plan (STP) that assessed their state policy and HCBS settings in response to these new regulations. This STP was to describe steps your state would take to comply with these new federal CMS regulations by March 2019. This is the opportunity to open the doors to more quality, person-centered life options, BUT it can also create barriers to certain opportunities! For more information about how these regulations can open or close doors in your state, see the CCC HCBS Policy Brief and its accompanying FAQ.
What is a Statewide Transition Plan (STP)?
The Statewide Transition Plan is the document describing how states will assess and remedy their compliance with the new HCBS regulation requirements, and then provide this written description to CMS. The state will also assess individual settings/types of settings to further document their compliance.
States must make a list of settings that are and are not in compliance. Some settings may be labeled as “isolating” or “institutional.” You can give feedback on whether you agree with the results of your state as this list must be available for 30 days of public comment.
Every state is sharing and asking for public comment on their STP draft at different times, and your states public comment may be open right now! Visit the HCBS Advocacy website for information about your state and check it regularly to make sure you do not miss your public comment period.
What can I do to help my state and ensure policy does not limit support options?
According to these new federal CMS regulations, your state has an obligation to seek and revise their policy based on public comment – that includes YOUR voice!
Your state MUST release drafts of important changes as proposed by the STP for public comment for AT LEAST 30 days. Additionally, they MUST have another option of collecting public feedback which may include an in-person forum. Once they receive feedback, they are suppose to revise these portions of their STP based on public comment. You can view the latest communication and whether you state has initial or final approval here. Find your State Agency website here.
Use the CCC Guidance for Implementing State Transition Plans as a resource.
What should I look for when assessing and providing comment on the Statewide Transition Plan?
Though the federal regulations regarding HCBS services have already been finalized, stakeholders can provide input into both the process for implementing their state’s STP as well as ensuring that their state follows the guidelines and intent of the outcome-oriented federal regulations established by CMS.
Every state’s STP will be different, but here are some suggestions based on feedback from members of the Coalition for Community Choice:
- Does the STP include many opportunities for feedback throughout the process from a variety of stakeholders, including individuals with disabilities and their families from an array of settings choices? Share your willingness to be part of any stakeholder committees.
- Will your state publically post stakeholders comments, their summary of public comments and final draft of STP revisions that will be sent to CMS? Doing so will ensure transparency and accountability to stakeholders.
- Are assessment tools reviewed by stakeholders before being implemented? The STP and all surveys developed should focus on a “quality of life” analysis rather than on narrow characteristics such as size, geographic locations or other physical characteristics.
- Is criteria described in outcome-oriented terms? Criteria that is not based on individuals experience, and therefore not following the intent of the new CMS regulations, must not be included as it may limit options. For example, statements such as “Only 4 HCBS recipients can be served in a setting,” “Residential settings can not provide employment or day programming,” and “Settings are limited to …” are not based on quality of life of waiver recipients. A setting should not be evaluated on its own without examining the individuals being served and their person-centered plans. “Appropriate” means different things to different individuals and the settings must be evaluated through that lens.
- STP should examine the merits and compliance of each setting on its own without lumping any settings into a generic category. For example, states can not assume “all” congregate settings, farmsteads, gated communities, disability-specific housing or clustered group settings are the same and, therefore, automatically non-HCBS settings.
- Is educating the public about the importance of the Person-Centered Plan (PCP) and facilitation requirements listed as a priority in your states STP? The PCP is crucial for the future as it will ensure recipients are receiving individualized supports and life opportunities and are being supported in a home and community of their choice.
Generally, you want to make sure your state is not adding further restrictions or regulations beyond the federal requirements for HCBS settings. See this CMS Fact Sheet to learn what the new federal HCBS regulations require: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Long-Term-Services-and-Supports/Home-and-Community-Based-Services/Downloads/Requirements-for-Home-and-Community-Settings.pdf
What else can I do besides submit public comment?
- Attend public forums of state leaders and tell them your concerns! It is imperative that they hear directly from waiver recipients, their families, and providers about how their state is addressing the needs of those with I/DD. Share with them the CCC Guidance on Implementing State Transition Plans.
- Tell us your concerns during your advocacy efforts as we can offer these instances as examples to federal leaders. For example:
- Do you feel as if your state leaders are listening to your public comment?
- What have your state leaders stated about being unable to meet your requests?
- Did the state widely disseminate information about the new regulations and public comment periods?
- Is information in plain language that self-advocates with intellectual disabilities can understand and therefore facilitate their input?
- Was your public forum well-attended by a diverse population with various perspectives?
- Share your public comment with others in the CCC as an example.
- Join the CCC to stay updated and receive more action alerts.
- Pass this information and CCC along to your friends, families, organizations and other organizations.
- LIKE, follow, and share news on our CCC Facebook page.
Where Can I Find More Information?
CCC members can request technical assistance or examples of letters other members have submitted. Contact Desiree Kameka, CCC National Coordinator: DKameka@Madisonhouseautism.org
Final CMS 2249-F/2296-F Regulations in Federal Register (Note: the first 70 pages is discussion in response to the rounds of national public comment periods over several years during the development of these new regulations)
CMS HCBS Compliance Toolkit (official guidance) sent to states about the State Transition Plan: https://www.medicaid.gov/medicaid/hcbs/guidance/settings/index.html
HCBS Advocacy website with the list of state by state links and national resources: http://hcbsadvocacy.org/
Official CMS HCBS Webpage: https://www.medicaid.gov/medicaid/hcbs/index.html