Draft Transition Plan For Home And Community Based Settings

Draft Transition Plan for Homeand Community Based SettingsIn Response toCenters for Medicare and Medicaid ServicesFinal Rules1

Purpose of this WebinarA final federal rule, published in January 2014,created requirements for home and communitybased settings in Medicaid programs.To review Washington state’s draft transitionplan regarding the new HCBS rules2

Intent of Final RuleTo ensure that individuals receiving long-termservices and support have full access to benefitsof community living and the opportunity toreceive services in the most integrated settingappropriateWashington State fully supports the intent of theHCBS s/3

Characteristics of HCBS Settings Integration in the greater community; Choice among settings, and regarding servicesand supports and who provides them; Freedom to furnish or decorate their sleeping orliving unit, control their schedule, have accessto food at any time, and have visitors of theirchoice at any time;4

Characteristics of HCBS Settings Protections from eviction and an appealsprocess comparable to those provided underlandlord tenant law; Independence in making life choices regardingdaily activities, physical environment, and withwhom to interact; and Privacy in their sleeping or living unit, includingthe ability to lock their door and choose theirroommate.5

What is a Transition Plan?Required by CMSAssesses the state’s compliance with the newHCBS rulesAddresses how the state will come into andmaintain compliance with the new requirementsWashington state’s draft transition plan was posted for public commenteffective December 12, 20146

How Was the Transition Plan Developed?Reviewed our state’s laws, rules, and policies inrelation to the new requirementsAssessed our compliance with the requirementsGathered public input for the purpose ofdeveloping the planVisited facilities that were identified as“presumed institutional”Determined needed actions in order to comply7

What Does the Transition Plan Cover?Overview of HCBS Systems in WashingtonDescription of Public Input ProcessResults of Statewide Assessment of HCBS SettingsAnalysis by SettingState Assessment of Presumptively Non-HCBS SettingsState’s Remedial Strategies and Timelines8

How can I get a copy of the Transition Plan?Draft is posted s/For a copy:You may also request a copy by calling: 360-7252528 (provide your name, phone number, ande-mail address)Comment Period:Now through January 20, 2015 at 5pm9

2014 Transition Plan Key DatesMay 30-conducted statewide webinar on new rulesMay through end of October- gathered stakeholder andTribal input for draft transition planSeptember 3, September 30 and October 15-publishednotices on the State RegisterOctober 23 -Tribal ConsultationDecember 3 - completed draft transition planDecember 12- posted plan for 30 day public comment10

Analysis by SettingAppendix AThe Plan lists the following elements for eachsetting: Each of the federal requirements, How our state’s laws, rules and policies meeteach requirement, A description of the oversight process forensuring compliance, and Any changes needed to comply with therequirements11

(Appendix A)Results of Statewide Assessment:Settings that Fully Comply with HCBSCharacteristicsIn HomeSupported LivingAdult Day ServicesGroup HomesStaffed ResidentialAssisted Living FacilitiesDDA Individual EmploymentDDA Group Supported Employment12

Assisted Living Contract (AL)Characteristics/Requirements MetCharacteristics/RequirementsThe setting is integrated inandsupports full access ofindividualsreceiving Medicaid HCBS tothe greatercommunity Assisted LivingState AssessmentOversight ProcessRCW 70.129.140 (b) interactwith members of thecommunity both inside andoutside the facility.70.129.040 (1) personalresources70.129.020 Exercise of rights.As part of the facilityinspection processdescribed in theoverview, RCS conductscomprehensive residentinterviews, reviewsresident records,interviewsproviders/residentmanagers, and interviewsstaff regarding thisrequirement.13

Characteristics/RequirementsAssisted LivingState AssessmentThe setting is selected by the During the assessmentindividual from amongprocess, it is a CMsetting options responsibility to informindividuals of their optionsregarding settings andproviders. This isdocumented in the ServiceEpisode Record of the CAREassessment tool.Oversight ProcessCMs offer the individualchoices of long-termcare settings andprovider types.RCS conductsobservations, client andcollateral interviews,provider and staffinterviews. RCSconducts client recordreviews.14

Characteristics/RequirementsAn individual’s essentialpersonal rights of privacy,dignity and respect, andfreedom from coercion andrestraint are protected.Assisted LivingState AssessmentOversight ProcessRights are protected in RCW70.129.005 and WAC,including not usingrestraints on any resident.(RCW 70.129.120)As part of the facilityinspection processdescribed in theoverview, RCS conductscomprehensive residentinterviews, reviewsresident records,interviewsproviders/residentmanagers, andinterviews staffregarding this15requirement.

Characteristics/RequirementsIndividual initiative,autonomy, andindependence in making lifechoices, including but notlimited to, daily activities,physical environment, andwith whom to interact areoptimized and notregimented.Assisted LivingState AssessmentRights are protected in RCW70.129.140 and RCW70.129.005.Oversight ProcessAs part of the facilityinspection processdescribed in theoverview, RCS conductscomprehensive residentinterviews regarding thisrequirement.16

Results of Statewide Assessment:Settings that Will Comply, with ChangesAdult Family HomesAdult Residential/Enhanced Adult ResidentialDDA Group Training HomesDDA Companion HomesChanges to be discussed as part of Appendix C17

Results of Statewide Assessment:Settings that Will Comply, with ChangesAdult Family HomesAdult Residential/Enhanced Adult ResidentialChanges (re: units have lockable entrance doors)to be discussed as part of Appendix C18

Results of Statewide Assessment:Settings that Will Comply, with ChangesDDA Group Training HomesDDA Companion HomesChanges (re: units have lockable entrance doorsand eviction rights) to be discussed as part ofAppendix C19

Results of Statewide Assessment:Settings that Do Not or Cannot Meet HCBSCharacteristicsDDA Pre-Vocational Services are currentlyoffered in settings that are not integrated.Appendix C outlines Washington’s RemedialStrategies and Timelines20

(Appendix C)State’s Remedial Strategies and TimelinesTo ensure Washington complies with and maintainscompliance with the HCBS rulesHere’s a sample of what Appendix C looks like:ActivityDescriptionMilestonesStart DateEnd DateWAC ChangesRevise Adult FamilyHome Chapter 38876 WAC andARC/EARC Chapter388-110 and 78AWACChange WAC tomandate residentchoice regardinglocking bedroomdoor.RCS will followrulemakingtimeframeestablished in WAC11/1/1411/30/1721

(Appendix C)State’s Remedial Strategies and TimelinesRCS Activities: Revise WACs to mandate resident choice re: lockingbedroom door Revise survey tools for AFHs, ALFs, and SupportedLiving—add questions for surveyors to assess whetherresidents rights are protected Provide training to providers and staff on the newexpectations22

(Appendix C)State’s Remedial Strategies and TimelinesDDA Activities: Revise DDA Group Training Homes and CompanionHomes contract to require lockable doors Revise DDA Group Training Homes and CompanionHomes contract regarding protections from eviction Provide training to providers and staff on the newexpectations23

(Appendix C)State’s Remedial Strategies and TimelinesDDA Activities: Eliminate new admissions to Pre-Vocational Services Transition PVS clients into integrated service optionswithin 4 years24

Settings Presumed to be InstitutionalCMS presumes certain settings to have institutionalqualities; these include settings located in a buildingprovides inpatient institutional treatment.The state must provide information to CMS aboutwhether each setting has the qualities of HCBS settingsand does not have the qualities of an institutionHCS staff conducted site visits and interviews withidentified residential and adult day service settings togather information about choice, communityinvolvement and freedom25

(Appendix B)State Assessment of Presumptively Non-HCBS SettingsThere were 17 ALFs attached to institutionsState Determination: 15 fully meet HCBS characteristics 1 does not fully meet and must strengthenopportunities for residents to be more fully integrated Action plan in Appendix B 1 did not meet HCBS characteristics and contract wasterminated. This facility had no residents at the timethe contract was terminated26

(Appendix B)Other Settings Evaluated1 ALF identified by stakeholders as potentially not havingHCBS characteristics. The state determined the facilityfully complied with the new requirements.All 29 Adult Day Services 28 fully complied 1 did not comply Provider terminated contract Provider was not currently serving Medicaidclients27

Transition Plan Next StepsDecember 17 – January 20, 2015- gather public feedbackand make any revisions to transition planJanuary 30, 2015- Submit draft transition plan to CMSand repost for public viewCMS may request changesState implements plan28

Questions29

Send commentsby January 20, 2015 (5pm) to:By E-mail:Bob Beckman, DDAbob.beckman@dshs.wa.govBarb Hanneman, HCShannebj@dshs.wa.govPatty Craig, RCScraigpl@dshs.wa.govOr by Mail:Barb HannemanMedicaid Unit ManagerALTSAPO Box 45600Olympia, WA 9850430

AdjournThank you for participating!31

2014 Transition Plan Key Dates May 30-conducted statewide webinar on new rules May through end of October- gathered stakeholder and Tribal input for draft transition plan September 3, September 30 and October 15-published notices on the State Register October 23 -Tribal Consultation December 3 - completed draft transition plan