Update on the Home and Community- Based Services Rule. Presentation Outline. Home and Community Based Services

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1 Michigan Department of Health & Human Services Update on the Home and Community- Based Services Rule Heather Hill and Phil Kurdunowicz LeadingAge Training Day October 22 nd, 2015 Putting people first, with the goal of helping all Michiganders lead healthier and more productive lives, no matter their stage in life. 1 Presentation Outline Overview of the Home and Community Based Services Rule Home and Community Based Services Rule Michigan s Statewide Transition Plan Key Information on the Assessment Process Key Information on the Remediation Process MI Health Link HCBS Waiver Questions about State Licensing and the Federal Rule Additional Resources Questions 2 Home and Community Based Services Rule Issued by the Centers for Medicare and Medicaid Services Affects Medicaid waiver programs We are focusing on this part of the rule today. Has three major components: Characteristics for Home and Community Based Settings Conflict Free Level of Care Determination Person Centered Planning 3 1

2 Home and Community Based Services Rule To ensure that individuals receiving long term services and supports through home and community based service (HCBS) programs under the 1915(c), 1915(i) and 1915(k) Medicaid authorities have full access to benefits of community living and the opportunity to receive services in the most integrated setting appropriate To enhance the quality of HCBS and provide protections to participants 4 Home and Community Based Services Rule The Home and Community Based setting: Ensures an individual s rights of privacy, dignity, respect, and freedom from coercion and restraint Optimizes individual initiative, autonomy, and independence in making life choices Facilitates individual choice regarding services and supports, and who provides them 5 Home and Community Based Services Rule Additional requirements: Specific unit/dwelling is owned, rented, or occupied under legally enforceable agreement Same responsibilities/protections from eviction as all tenants under landlord tenant law of state, county, city or other designated entity If tenant laws do not apply, state ensures lease, residency agreement or other written agreement is in place providing protections to address eviction processes and appeals comparable to those provided under the jurisdiction s landlord tenant law 6 2

3 Home and Community Based Services Rule Additional requirements: Each individual has privacy in their sleeping or living unit Units have lockable entrance doors, with the individual and appropriate staff having keys to doors as needed Individuals sharing units have a choice of roommates Individuals have the freedom to furnish and decorate their sleeping or living units within the lease or other agreement Individuals have freedom and support to control their schedules and activities and have access to food any time Individuals may have visitors at any time Setting is physically accessible to the individual 7 Home and Community Based Services Rule Specific Needs and Modifications Modifications can be made to the service plan to address the specific needs of individuals. Modifications must meet the following requirements: Should be based on the assessed need of the individual Should be documented in the service plan Cannot be based on the requirements of the setting Must meet all other requirements under the rule Providers will have an opportunity to explain these modifications through the survey tool. 8 Michigan s Statewide Transition Plan Timeline for Developing the Statewide Plan MDHHS developed the plan during the fall of MDHHS submitted the plan to the Centers for Medicare and Medicaid Services on January 16, Current Status of the Statewide Plan MDHHS received feedback on the plan from the Centers of Medicare and Medicaid Services in August. MDHHS will be working on revising and updating the Statewide Transition Plan based on that feedback. This process will include a formal public comment period. MDHHS will continue implementation by using the current statewide transition plan in the short term. 9 3

4 Michigan s Statewide Transition Plan CMS Response to the Statewide Transition Plan Greater clarification on the relationship between the Statewide Transition Plan and Individual Waiver Transition Plans Overview of settings to be assessed under the rule More details about the assessment, remediation, and relocation process for the affected waivers Questions about the public comment process 10 Michigan s Statewide Transition Plan The final rule affects Medicaid 1915 (c), (i), and (k) waiver programs. Michigan has five 1915 (c) waiver programs: MI Choice Waiver Habilitation Supports Waiver MI Health Link HCBS Waiver Children s Waiver Program Settings must be assessed for compliance Settings are presumed to be compliant Waiver for Children with Serious Emotional Disturbances 11 Key Information about the Assessment Process MDHHS must assess all settings under 1915 (c), (i), and (k) authorities for compliance with the rule. If the individual (1) lives in their own home or apartment or (2) lives in the home of a family member, the setting is presumed compliant. Settings that are provider owned and/or controlled must be assessed. This assessment process will include licensed and unlicensed settings. 12 4

5 Waiver Program Survey Tool(s) Waiver Entity Assessment Process Community All settings under this waiver are Children s Waiver Program N/A Mental Health presumed compliant with the rule. Service Provider Children with Serious Community All settings under this waiver are Emotional Disturbances N/A Mental Health presumed compliant with the rule. Waiver Service Provider Provider Tools, Initial Sample: Conducted by the Participant Tool, Prepaid Developmental Disabilities Institute Habilitation Supports and Prepaid Inpatient Health starting on April 13, 2015 Waiver Inpatient Health Plan Plan Tool Ongoing Assessments: To Be Determined Assessments: Conducted by Integrated MI Health Link HCBS Integrated Care Care Organizations Provider Tools Waiver Organization Start Date: March 1, 2015 Assessments: Conducted by MI Choice MI Choice Waiver Agents MI Choice Waiver Provider Tools Waiver Agency Start Date: April 1, 2015 Final Date for Compliance Presumed Compliant Presumed Compliant September 30, 2018 Immediate Compliance September 30, Key Information about the Assessment Process The MI Choice Waiver and MI Health Link HCBS Waiver are working together to ensure that settings are only assessed once and that results can be shared across programs. Your local waiver entity (MI Choice Waiver Agency or Integrated Care Organization) is your point of contact for learning about the timeline and requirements for the assessment process. MDHHS will make the final decision in terms of the compliance of specific settings. 14 Key Information about the Assessment Process Providers can make modifications to the setting to address the specific needs of individuals. Modifications must meet the following requirements: Should be based on the assessed need of the individual Should be documented in the service plan Cannot be based on the requirements of the facility Must meet all other requirements under the rule Providers will have an opportunity to explain these modifications through the survey tool. 15 5

6 Key Information on the Remediation Process Presumed compliance with the rule Next Step: Ongoing review Full compliance on the survey Next Step: Ongoing monitoring May need remediation but could come into compliance Next Step: Development of a corrective action plan Presumed not to be home and community based Next Steps: Development of a correction action plan and potential heightened scrutiny review Cannot come into compliance (Institutional) Next Step: Transition of individuals from the setting 16 MI Health Link HCBS Waiver 17 MI Health Link program People may be eligible for MI Health Link if they: Live in one of the four regions; Are age 21 or over ; Are eligible for full benefits under both Medicare and Medicaid; and Are not enrolled in hospice. Adults who are age 21 or over who are enrolled in the Children s Special Health Care Services program are not eligible for MI Health Link. 18 6

7 Region Counties in the Region Integrated Care Organizations (ICOs) Alger, Baraga, Chippewa, Delta, Dickinson, Gogebic, 1) Upper Peninsula Health Plan Houghton, Iron, Keweenaw, Luce, Mackinac, Marquette, Menominee, Ontonagon, and Schoolcraft Barry, Berrien, Branch, Calhoun, Cass, Kalamazoo, St. 1) Aetna Better Health Joseph, and Van Buren 2) Meridian Health Plan Wayne 1) AmeriHealth Michigan 2) Aetna Better Health 3) Fidelis SecureCare of Michigan 4) HAP Midwest Health Plan 5) Molina Healthcare of Michigan 9 Macomb 1) AmeriHealth Michigan 2) Aetna Better Health 3) Fidelis SecureCare of Michigan 4) HAP Midwest Health Plan 5) Molina Healthcare of Michigan 19 MI Health Link People enrolled in Program of All Inclusive Care for the Elderly (PACE) and MI Choice are eligible, but must leave their programs before joining MI Health Link. People with a Medicaid deductible are not eligible for MI Health Link. 20 Part of the new MI Health Link program Joins Medicare and Medicaid benefits, rules, and payments into one coordinated delivery system 21 7

8 The MI Health Link program has an HCBS waiver component for some MI Health Link enrollees who meet the following criteria:» Meet Medicaid Nursing Facility Level of Care» Aged and/or physically disabled» Live in the community» Have a need for at least one of the 14 waiver services 22 Services and Supports under the MI Health Link HCBS Waiver Adaptive Medical Equipment and Supplies Adult Day Program Assistive Technology (Van lifts and other assistive technology items ) Chore Services Community Transition Services Environmental Modifications Fiscal Intermediary Home Delivered Meals Non Medical Transportation Personal Emergency Response System Preventive Nursing Services Private Duty Nursing Expanded Community Living Supports Respite 23 All residential (place where the person lives) and nonresidential (Adult Day Program) settings must be in compliance with the Rule at the time of the individual s enrollment in the HCBS waiver for the individual to live and/or receive services in these settings. The setting s compliance with the Rule will be verified via survey of the provider prior to MDHHS approving the individual for participation with the waiver. ICOs are responsible for conducting the provider surveys with the provider, and sending them to MDHHS for review. 24 8

9 If an individual who applies for the HCBS waiver lives in a setting that is not compliant with the rule, he or she must move to a compliant setting before being enrolled in the HCBS waiver, or the setting will need to come into compliance with the rule before the individual can enroll in the HCBS waiver. There will be ongoing monitoring of these settings by MDHHS and the Integrated Care Organizations. Each residential and non residential setting will receive a letter from MDHHS indicating whether or not the setting is compliant with the rule. The setting will also receive some suggestions or comments about what needs to be done to fix issues identified in the survey process. 25 Questions about State Licensing and the Federal Rule Partnership with the Department of Licensing and Regulatory Affairs Lockable Doors Visiting Hours Residency Agreements/Leases 26 Additional Resources Home and Community Based Services Transition Project >> Health Care Coverage >> Home and Community Based Services Program Transition MI Health Link Demonstration Home and Community Based Services Rule >> Medicaid >> By Topic >> Long Term Services and Supports >> Home & Community Based Services 27 9

10 Questions Phil Kurdunowicz Office of Health Policy and Innovation Heather Hill Integrated Care Division 28 10