OLTL Transition Plan CMS HCBS Regulations. Introduction

Transcription

1 OLTL Transitin Plan CMS HCBS Regulatins Intrductin New Centers fr Medicare and Medicaid Services (CMS) rules utlined at 42 CFR (c)(4) require public cmment n any new 1915(c) waivers, waiver renewals r substantive waiver amendments. Public cmment is als required n a state s transitin plan that utlines hw the state will bring the subject waivers int cmpliance with the new federal prvisins. Infrmatin n these federal prvisins can be fund at Tpics/Lng-Term-Services-and-Supprts/Hme-and-Cmmunity-Based-Services/Hme-and- Cmmunity-Based-Services.html. The Department f Public Welfare s (DPW) Office f Lng-Term Living (OLTL) is submitting amendments t the Aging, Attendant Care and Independence waivers t increase the allwable number f unduplicated participants in each f these waivers fr the fiscal year. Click here t access a public ntice detailing the amendments. As a result, OLTL must seek public cmment n the prpsed amendments and n a transitin plan t bring these three waivers int cmpliance with the new federal rule. The Aging, Attendant Care and Independence waivers ffer a brad cntinuum f services. These services, depending n the specific waiver, may include, Persnal Assistance Services, Respite, Persnal Emergency Respnse System, Accessibility Adaptatins, Specialized Medical Equipment and Supplies, TeleCare, Nn-Medical Transprtatin, Hme Health, Adult Day Services and Cmmunity Transitin Services amng ther services all designed t supprt individuals t live mre independently in their hmes and cmmunities. These three waivers d nt include Residential Habilitatin Services, but rather Persnal Assistance Services which are traditinally prvided t participants wh reside in their wn hmes. OLTL has determined that all services ffered in these three waivers cmply with the new federal rule. What fllws is an assessment f persn-centered planning, Adult Daily Living Services and Persnal Assistance Services. It is in these three areas that OLTL has determined a need fr further evaluatin and ptential strengthening. Each area f assessment is fllwed by a transitin plan that OLTL will put in place t attain r maintain cmpliance with the rule. At the end f the dcument is a timeline fr cmpletin f transitin plan steps. Fr sme f these areas, Pennsylvania is waiting fr CMS guidance t determine the next steps in the transitin prcess. 1. ASSESSMENT A. Persn-Centered Planning Thrughut the last several years, OLTL has develped and implemented plicies, prcedures and trainings t establish a cmprehensive Individual Service Planning prcess that is persn-centered. Overall, all f the OLTL waivers are in cmpliance with Persn-Centered Planning regulatins published n March 17, 2014, hwever there are a few areas that will be strengthened. June 27, 2014 Page 1

2 OLTL Transitin Plan CMS HCBS Regulatins Areas in which OLTL is cmpliant: 42 CFR (b) (1) (i) Services are furnished under a written persn-centered service plan that is based n a persn-centered apprach and is subject t apprval by the Medicaid agency. 42 CFR (b) (6) (c) (1) The individual will lead the persn-centered planning prcess where pssible, the individual's representative shuld have a participatry rle, as needed and as defined by the individual, unless State law cnfers decisin-making authrity t the legal representative, all references t individuals include the rle f the individual's representative. Includes peple chsen by the individual, prvides necessary infrmatin and supprt t ensure that the individual directs the prcess t the maximum extent pssible, and is enabled t make infrmed chices and decisins, is timely and ccurs at times and lcatins f cnvenience t the individual. Prviders f HCBS fr the individual, r thse wh have an interest in r are emplyed by a prvider f HCBS fr the individual must nt prvide case management r develp the persn-centered service plan, except when the State demnstrates that the nly willing and qualified entity t prvide case management and/r develp persn-centered service plans in a gegraphic area als prvides HCBS. Offers infrmed chices t the individual regarding the services and supprts they receive and frm whm. Includes a methd fr the individual t request updates t the plan as needed. Recrds the alternative hme and cmmunity-based settings that were cnsidered by the individual. 42 CFR (b) (6) (c) (2) The persn-centered service plan must reflect the services and supprts that are imprtant fr the individual t meet the needs identified thrugh an assessment f functinal need, as well as what is imprtant t the individual with regard t preferences fr the delivery f such services and supprts. Reflect that the setting in which the individual resides is chsen by the individual. Reflect the individual's strengths and preferences. Reflect clinical and supprt needs as identified thrugh an assessment f functinal need. Include individually identified gals and desired utcmes. Reflect the services and supprts (paid and unpaid) that will assist the individual t achieve identified gals, and the prviders f thse services and supprts, including natural supprts. Reflect risk factrs and measures in place t minimize them, including individualized back-up plans and strategies when needed. Be understandable t the individual receiving services and supprts, and the individuals imprtant in supprting him r her. 42 CFR (b) (6) (c) (3) The persn-centered service plan must be reviewed, and revised upn reassessment f functinal need as required, at least every 12 mnths, when the individual's circumstances r needs change significantly, r at the request f the individual. June 27, 2014 Page 2

3 OLTL Transitin Plan CMS HCBS Regulatins Areas that will be strengthened: 42 CFR (b) (6) (c) (1) Reflects cultural cnsideratins f the individual and is cnducted by prviding infrmatin in plain language and in a manner that is accessible t individuals with disabilities and persns wh are limited English prficient. Includes strategies fr slving cnflict r disagreement within the prcess, including clear cnflict-f-interest guidelines fr all planning participants. 42 CFR (b) (6) (c) (2) The State must ensure that the setting chsen by the individual is integrated in, and supprts full access f individuals receiving Medicaid HCBS t the greater cmmunity, including pprtunities t seek emplyment and wrk in cmpetitive integrated settings, engage in cmmunity life, cntrl persnal resurces, and receive services in the cmmunity t the same degree f access as individuals nt receiving Medicaid HCBS. At a minimum, fr the written plan t be understandable, it must be written in plain language and in a manner that is accessible t individuals with disabilities and persns wh are limited English prficient. Dcument the psitive interventins and supprts used prir t any mdificatins t the persn-centered service plan. Dcument less intrusive methds f meeting the need that have been tried but did nt wrk. Include a regular cllectin and review f data t measure the nging effectiveness f the mdificatin. Include established time limits fr peridic reviews t determine if the mdificatin is still necessary r can be terminated. Include an assurance that interventins and supprts will cause n harm t the individual. Transitin Plan: In areas that will be strengthened, a wrk plan will be develped t include amendment f current plicy dcuments, develpment and delivery f service crdinatr training and/r develpment and delivery f a service crdinatr mnitring tl. B. Hme and Cmmunity-Based Settings - Adult Daily Living Centers: Adult Daily Living Services are prvided in the Aging and Independence waivers but nt in the Attendant Care Waiver. The centers in which Adult Daily Living Services are prvided fall under the regulatry jurisdictin f bth the Pennsylvania Department f Aging thrugh 6 Pa. Cde, Chapter 11 and DPW June 27, 2014 Page 3

4 OLTL Transitin Plan CMS HCBS Regulatins thrugh 55 Pa. Cde, Chapter Mst f these centers are wned by individuals, partnerships r small Limited Liability Crpratins. Pennsylvania is waiting fr CMS guidance t determine the next steps in the transitin prcess fr this setting. In the meantime, OLTL s transitin plan includes initial steps necessary t ptentially assess cmpliance. There are apprximately 2,580 Aging Waiver participants receive Adult Daily Living Services in 121 settings. There are apprximately 60 Independence Waiver participants receive Adult Daily Living Services in 15 settings. Areas in which OLTL is cmpliant: (c) (4) Is selected by the individual frm amng setting ptins including nndisability specific settings and an ptin fr a private unit in a residential setting. The setting ptins are identified and dcumented in the persn-centered service plan and are based n the individual's needs, preferences, and, fr residential settings, resurces available fr rm and bard (c) (4) Ensures individual rights f privacy, dignity and respect, and freedm frm cercin and restraint (c) (4) Facilitates chice regarding services and wh prvides them. Areas that will be strengthened and/r will receive additinal evaluatin: (c) (5) (CMS Prhibited Settings) Hme and Cmmunity-Based Settings d nt include a nursing facility, institutin fr mental diseases, ICF/ID and hspitals. OLTL has identified ne prvider that may nt be in cmpliance with this prvisin. Twenty-nine Aging Waiver participants receive services at: (c) (5) (v) (CMS Presumed Institutinal) Settings in a publicly r privately wnedfacility that prvides inpatient treatment. Only seven Adult Daily Living prviders have been identified that may nt cmply with this prvisin. Fifty-five Aging Waiver participants receive services at these centers (c)(5)(v) (CMS Presumed Institutinal) Settings n the grunds f, r immediately adjacent t, a public institutin. All Adult Daily Living Centers are assumed t be in cmpliance with this regulatin with the pssible exceptin f thse nted abve (c) (5) (v) (CMS Presumed Institutinal) Settings that have the effect f islating individuals receiving HCBS frm the brader cmmunity f individuals nt receiving HCBS. All Adult Daily Living Centers are assumed t be in cmpliance with this regulatin with the pssible exceptin f thse nted abve. June 27, 2014 Page 4

5 OLTL Transitin Plan CMS HCBS Regulatins (c)(4) The setting is integrated in and supprts full access t the greater cmmunity, including pprtunities t seek emplyment and wrk in cmpetitive integrated settings, engage in cmmunity life, cntrl persnal resurces, and receive services in the cmmunity, t the same degree f access as individuals nt receiving Medicaid HCBS. All Adult Daily Living Centers with the pssible exceptin f thse nted abve are assumed t be in cmpliance. Adult Daily Living Centers d nt prvide emplyment and wrk. Transitin Plan: OLTL is currently develping a Service Crdinatr mnitring tl which will be utilized by Service Crdinatin Entities (SCE) t ensure cnsistent mnitring f the health and welfare f waiver participants, and t ensure that services are being prvided in accrdance with the individual service plan. OLTL plans t incrprate questins relating t hme and cmmunity-based settings as part f this mnitring tl. OLTL als intends t require prviders t cnduct a self-assessment f cmpliance with these prvisins f the regulatin. In additin, OLTL will be utilizing the Quality Management and Efficiency (QMET) mnitring teams t cnduct n-site assessments t identify settings that d nt cmply with the regulatin. A survey will be cnducted f all Adult Daily Living participants t seek their feedback n the hme and cmmunity-based envirnment f the center they attend. OLTL intends t wrk with the SCE, prvider and QMET t identify where the setting is nt in cmpliance with the regulatin, and steps fr meeting cmpliance. Where nn-cmpliance exists r is fund and cnfirmed, OLTL will develp a wrk plan that includes, but is nt limited t, wrking with any nn-cmpliant prviders as they secure ther settings in which t prvide their services; develping plicies that if fllwed wuld ensure that the setting meets the qualities fr being hme and cmmunity-based and des nt have the qualities f an institutin even if physically lcated in a setting presumed institutinal, wrking with departmental, ther state agencies and licensing entities t ptentially make plicy and regulatry changes t clearly articulate where waiver Adult Daily Living Services can be prvided; r transitining participants t ther prviders f this service. T ensure OLTL has rbust stakehlder input, OLTL s established stakehlder review prcess will be used t infrm the develpment f any new plicies. June 27, 2014 Page 5

6 OLTL Transitin Plan CMS HCBS Regulatins OLTL is waiting fr CMS guidance t determine the next steps in the transitin prcess. C. Hme and Cmmunity-Based Settings Residential Settings As stated abve, the Aging, Attendant Care and Independence waivers d nt ffer traditinal residential services; the majrity f participants receive Persnal Assistance Services, which are traditinally prvided t participants wh reside in their wn hmes. Persnal Assistance Services prvide hands-n assistance t participants and are aimed at assisting the participant t cmplete tasks f daily living that wuld be perfrmed independently if the individual had n disability. Persnal Assistance Services enable the participant t integrate mre fully int the cmmunity and ensure the health, welfare and safety f the participant. Areas in which OLTL is cmpliant: 42 CFR (c) (5) (CMS Prhibited Settings) Hme and cmmunity-based settings d nt include a nursing facility, institutin fr mental diseases, ICF/ID and hspitals. 42 CFR (c) (5) (v) In summary, settings that are presumed t have the qualities f an institutin include: settings in a publicly r privately wned facility that prvides inpatient treatment; settings n the grunds f, r immediately adjacent t, a public institutin; and settings that have the effect f islating individuals receiving HCBS frm the brader cmmunity f individuals nt receiving HCBS. 42 CFR (c) (4) (i) The setting is integrated in and supprts full access t the greater cmmunity, including pprtunities t seek emplyment and wrk in cmpetitive integrated settings, engage in cmmunity life, cntrl persnal resurces, and receive services in the cmmunity, t the same degree f access as individuals nt receiving Medicaid HCBS. 42 CFR (c) (4) (ii) Is selected by the individual frm amng setting ptins including nn-disability specific settings and an ptin fr a private unit in a residential setting. The setting ptins are identified and dcumented in the persn-centered service plan and are based n the individual's needs, preferences, and, fr residential settings, resurces available fr rm and bard. 42 CFR (c) (4) (iii) Ensures individual rights f privacy, dignity and respect, and freedm frm cercin and restraint. 42 CFR (c) (4) (iv) Optimizes, but des nt regiment, individual initiative, autnmy, and independence in making life chices, including but nt limited t, daily activities, physical envirnment, and with whm t interact. 42 CFR (c) (4) (v) Facilitates chice regarding services and wh prvides them. 42 CFR (c) (4) (vi) The unit r dwelling is a specific physical place that can be wned, rented, r ccupied under a legally enfrceable agreement by the individual receiving services, and the individual has, at a minimum, the same respnsibilities and prtectins frm June 27, 2014 Page 6

7 OLTL Transitin Plan CMS HCBS Regulatins evictin that tenants have under the landlrd/tenant law f the State, cunty, city, r ther designated entity. Fr settings in which landlrd tenant laws d nt apply, the State must ensure that a lease, residency agreement r ther frm f written agreement will be in place fr each HCBS participant, and that the dcument prvides prtectins that address evictin prcesses and appeals cmparable t thse prvided under the jurisdictin's landlrd tenant law. 42 CFR (c) (4) (vi) (B) (1) thrugh (3) The individual has privacy in their unit, which includes: Units have entrance drs lckable by the individual, with nly apprpriate staff having keys t drs; individuals sharing units have a chice f rmmates in that setting; and individuals have the freedm t furnish and decrate their sleeping r living units within the lease r ther agreement. 42 CFR (c) (4) (vi) (C) Individuals have the freedm and supprt t cntrl their wn schedules and activities, and have access t fd at any time. 42 CFR (c) (4) (vi) (D) Individuals are able t have visitrs f their chsing at any time. 42 CFR (c) (4) (vi) (E) The setting is physically accessible t the individual. Areas that will be strengthened and/r will receive additinal evaluatin: 42 CFR (c) (4) (i) The setting is integrated in and supprts full access t the greater cmmunity, including pprtunities t seek emplyment and wrk in cmpetitive integrated settings, engage in cmmunity life, cntrl persnal resurces, and receive services in the cmmunity, t the same degree f access as individuals nt receiving Medicaid HCBS. Six Aging waiver participants reside in Dmiciliary (Dm) Care hmes. These individual prvider hmes are private husehld r family dwellings and serve n mre than three Dm Care residents. These settings are under the regulatry jurisdictin f the PA Department f Aging, and are inspected annually by the lcal Area Agency n Aging (AAA) t ensure they meet health and safety standards. If the hme and prvider passes this inspectin, they are certified by the AAA. A requirement t live in a Dm Care hme is that the participant has n relative, r ther persn whse relatinship with the participant is imprtant t the participant s cntinued well-being, that is willing r able t prvide the participant with the necessary supprts fr independent living. The participant must be incapable f living alne regardless f available services, r require services t live alne and the services are nt available. Eight Independence waiver participants with acquired brain injuries reside in prvider leased apartments. These waiver participants were transitined frm Persnal Care June 27, 2014 Page 7

8 OLTL Transitin Plan CMS HCBS Regulatins Hmes, an unallwable service setting in the Independence waiver, tw years ag as part f OLTL s Glbal Crrective Actin Plan with CMS. 2. TRANSITION PLAN: OLTL is waiting fr CMS guidance t determine the next steps in the transitin prcess. In the meantime, the fllwing actins are being planned: OLTL is currently develping a Service Crdinatr mnitring tl which will be utilized by SCEs t ensure cnsistent mnitring f the health and welfare f waiver participants, and t ensure that services are being prvided in accrdance with the individual service plan. OLTL plans t incrprate questins relating t hme and cmmunity-based settings as part f this mnitring tl. OLTL intends t require prviders t cnduct a self-assessment f cmpliance with these prvisins f the regulatin. In additin, OLTL will be utilizing the QMET mnitring teams t cnduct n-site assessments t identify settings that d nt cmply with the regulatin. OLTL intends t cnduct face-t-face mnitring visits with a sampling f participants in each waiver t assess cmpliance frm the participants perspective and t ensure participant participatin in the prcess. OLTL intends t wrk with the SCE, prvider and QMET t identify where the setting is nt in cmpliance with the regulatin, and steps fr meeting cmpliance. T ensure OLTL has rbust stakehlder input, we will fllw ur established stakehlder review prcess t infrm the develpment f any new plicies. 3. TIMELINE: A wrkplan will be develped t address all transitin plan items after CMS guidance is issued and within 120 days after submissin f OLTL s amendments t CMS. At least tw drafts f the wrkplan will be shared with stakehlders prir t submissin. T summarize these items: Develpment f plicy dcuments, training and/r a service crdinatin mnitring tl t address persn-centered planning weaknesses. Develpment f a Service Crdinatr mnitring tl incrpratin f questins relating t hme and cmmunity-based settings as part f the tl. June 27, 2014 Page 8

9 OLTL Transitin Plan CMS HCBS Regulatins Institutin f a brad department-wide assessment f all hme and cmmunity-based settings t identify any nn-cmpliant utliers. Implementatin f a prvider self-assessment tl, which will bth educate them abut the new rule and ensure their cmpliance. Utilizatin f OLTL s QMET mnitring teams t cnduct n-site assessments t identify utlier settings that d nt cmply with the regulatin. Survey f all Adult Daily Living participants t seek their feedback n the hme and cmmunitybased envirnment f the centers they attend. When prvider nn-cmpliance exists r is fund and cnfirmed: Develp plicies that if fllwed wuld ensure that the setting meets the qualities fr being hme and cmmunity-based and des nt have the qualities f an institutin even if physically lcated in a setting presumed institutinal; Wrk with nn-cmpliant prviders as they secure ther settings in which t prvide their services; Wrk with departmental, ther state agencies and licensing entities t ptentially make plicy and regulatry changes t clearly articulate where waiver Adult Daily Living services can be prvided; r Transitin participants t ther prviders f this service. Utilize, OLTL s established stakehlder review prcess t seek input n cmpliance activities and infrm the develpment f any new plicies t ensure OLTL has rbust stakehlder input. June 27, 2014 Page 9