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DRW Shares Information to Clarify Misunderstandings about Impact of new HCBS Rule

Disability Rights Wisconsin will be sharing regular updates to help people with disabilities better understand what is happening related to the state’s five year plan to help home and community based settings comply with a federal new rule. The announcement below is significant as it clarifies what happens if people are receiving services in a setting that does not comply with the rule.

From the Bazelon Center: January 12, 2015 – Today the Bazelon Center and other disability and aging advocacy groups, state officials, and providers issued a joint statement regarding guidance recently released by the Centers for Medicare & Medicaid Services (CMS) concerning its Home and Community Based Services (HCBS) rule: http://www.bazelon.org/LinkClick.aspx?fileticket=em42S5P9d7I%3d&tabid=58. This guidance — Questions and Answers Regarding Home and Community-Based Settings — directly addresses the misunderstanding that people are at immediate risk of losing services as a result of the rule: http://www.medicaid.gov/medicaid-chip-program-information/by-topics/long-term-services-and-supports/home-and-community-based-services/downloads/q-and-a-hcb-settings.pdf.

In January 2014, the CMS released a final rule establishing requirements for settings funded under Medicaid Home and Community-Based Services (HCBS) programs. The rule requires HCBS settings to, among other things, provide opportunities for participants to engage in community life, have access to the community, control their personal resources, and seek employment and work in competitive settings. The rule, which became effective in March 2014, allows states time to transition their HCBS programs into compliance with the new settings requirements. States are required to submit “transition plans” by March 17, 2015. Plans may be up to five years in length. Some mistakenly thought people could lose services by March 17, 2015 if they were receiving them in settings that did not meet the new rule’s requirements. In answer to the question, “If a state determines that a current HCB setting is not compliant with a new regulation, does it have to stop providing services in that setting immediately?” CMS unequivocally states, “No.”

The guidance also makes clear that states can continue receiving Medicaid funding for such settings during the transition period. “We are pleased that CMS has provided clarification to address this confusion, which was causing unnecessary fear for people with disabilities, seniors and their families,” says the joint statement. “Our organizations look forward to working together with CMS, state officials, providers and HCBS program participants and their families as states begin implementing the new HCBS rules.” The Bazelon Center is joined in this statement by the National Association of State Directors of Developmental Disabilities, the provider association of the American Network of Community Options and Resources, and a coalition of other disability and aging advocates working together with Bazelon around implementation of the rule – the Association of University Centers on Disabilities, Autistic Self Advocacy Network, Coalition to Promote Self-Determination, National Association of Councils on Developmental Disabilities, National Disability Rights Network, National Health Law Program, National Senior Citizens Law Center, and TASH.

Recently released guidance from CMS explains the rule’s timelines and makes clear that funding for settings that do not currently meet the rule’s requirements can continue during states’ transition period of up to five years.

The facts:

• CMS finalized the rule in January 2014, and it came into effect in March 2014.

• The rule gives states time to “transition” to meet the rule’s settings requirements.

• Each state is writing a plan for “transitioning” into compliance with the settings requirements, called a “transition plan.” The public must have a chance to comment on the plan. Plans must be submitted to CMS by March 2015.

• Each plan can be up to 5 years in length from the time the rule took effect in March of 2014. Most states that have written draft plans so far expect to reach full compliance by March 2019.

• During the period covered by the transition plan, states can continue to use Medicaid to fund all settings, including those that do not yet meet the rule’s requirements.

• States had to comply with the other parts of the rule, including person-centered planning and conflict-free case management, by its effective date of March 2014. To learn more about the HCBS rules, see www.HCBSadvocacy.org, a website maintained by several member organizations in the coalition.