Florida Statewide Transition Plan Home and Community Based Settings Rule CMS 2249-F and CMS 2296-F February 12, 2015
Table of Contents I. Purpose... 3 II. Overview... 3 III. HCBS Compliance Assessment... 4 A. Overall Programmatic Assessment... 4 B. Service Assessment... 4 C. Regulatory Assessment... 5 D. Residential Setting Assessment... 5 E. Non-Residential Setting Assessment... 6 IV. Remediation... 6 A. Transition of HCBS Waiver Recipients... 7 V. Continued Compliance... 8 VI. Communication and Education... 8 A. Recipient Outreach... 9 B. Provider Outreach... 9 C. Stakeholder Outreach... 9 D. Education and Training... 9 VII. Public Notice Process... 10 A. Statements of Public Notice...10 Attachment I... 11 Attachment II... 15 Attachment III... 17 Attachment IV... 25 2
I. Purpose The Centers for Medicare and Medicaid Services (CMS) published rule (CMS-2249-F) in January 2014 requiring all home and community-based services (HCBS) waivers authorized under Section 1915(c) and programs authorized under 1915(i) of the Social Security Act to comply with home and community based (HCB) settings requirements specified in the 42 CFR 441.301(c)4. The rule directed all states to evaluate their current HCB settings and develop a transition plan to demonstrate how the State plans to come into compliance with the requirements outlined in the rule. CMS also included in the rule a requirement for a public notice process for states in order to ensure transparency. The purpose of this statewide transition plan is to ensure individuals receiving home and community based services in all of Florida s HCBS programs are integrated in, and have access to, supports in the community including opportunities to seek employment, work in competitive integrated settings, engage in community life, and control personal resources. The transition plan describes how the state will assess, determine compliance, remediate and monitor the operations of its HCBS waivers and state plan programs to ensure continued compliance with the HCB settings requirements. II. Overview The Florida Agency for Health Care Administration (Agency) is responsible for administering Florida s HCBS programs. The Department of Elder Affairs (DOEA), the Agency for Persons with Disabilities (APD), the Department of Juvenile Justice (DJJ) and the Department of Health (DOH) are responsible for certain HCBS program operational and monitoring requirements dependent on the program. Florida s HCBS programs are being assessed to ensure individuals receiving Medicaid funded HCBS have full access to a home-like environment and community inclusion to the same degree as individuals not receiving Medicaid funded HCBS. Florida will continually assess its programs to ensure that all HCB settings are in compliance with the HCB Setting Rule requirements specified in 42 CFR 441.301(c)4. Table 1 provides a list of Florida s HCBS programs, the authority under which they are authorized and the respective administering, operating and monitoring agencies. Table 1 Florida s Home and Community-Based Programs Control Administering Operating Monitoring Program Name Authority Number Agency Agency Agency FL.0962 Long-term Care (LTC) Managed Care Waiver 1915(c) AHCA AHCA DOEA FL.40205 Familial Dysautonomia (FD) Waiver 1915(c) AHCA AHCA AHCA FL.0867 Developmental Disabilities Individual Budgeting (ibudget) Waiver 1915(c) AHCA APD APD FL.0194 Project AIDS Care (PAC) Waiver 1915(c) AHCA AHCA AHCA FL.0342 Traumatic Brain and Spinal Cord Injury (TBI/SCI) Waiver 1915(c) AHCA DOH DOH FL.40166 Model Waiver 1915(c) AHCA AHCA AHCA FL.0392 Adults with Cystic Fibrosis (ACF) Waiver 1915(c) AHCA DOH DOH SPA13-013 State Plan Redirections 1915(i) AHCA DJJ DJJ 3
III. Compliance Assessment A. Overall Programmatic Assessment To assess the level of compliance with the HCB setting requirements, Florida assessed the State s statutory and administrative regulatory requirements, managed care contract requirements, waiver and state plan program monitoring processes and remediation activities. The assessment was conducted to determine whether HCB settings: fully align with the federal requirements, do not comply with the federal requirements and will require modifications, cannot meet the federal requirements and require removal from the program and/or the relocation of individuals, or are presumed to be institutional. Based upon the analysis, the Agency has determined the State does not have any significant impediments impending Florida s HCBS program s compliance with the HCB setting requirements. The State has initiated the development of a thorough review and monitoring process to ensure it optimizes compliance with the federal requirements including a process for the assessment and monitoring of impacted residential and non-residential provider sites. B. Service Assessment Additionally, the State assessed the services offered under the HCBS programs. This assessment was completed by reviewing waiver and state plan requirements and enrolled recipient case files. Many of Florida s HCBS programs administer services in the recipient s home or in the community at large. Upon completion of the assessment, the Agency has determined the FD, ACF, Model and Redirections programs provide services in the recipient s own home and community-based service locations that are accessible to individuals receiving HCBS waiver services to the same degree as individuals not receiving HCBS waiver services and are therefore compliant with the HCB setting rule requirements. The Agency will continue to monitor these waiver operations to ensure individuals continue tot receive services in compliant settings. Table 2 provides the enrollment capacity, number of services and the settings under which the waiver or state plan services are provided. Table 2 Services and Settings Crosswalk Program Name Enrollment Number of Capacity Services Settings FD Waiver 20 7 Recipient Home/Community Model Waiver 12 4 Recipient Home/Community ACF Waiver 150 19 Recipient Home/Community Redirections N/A 4 Recipient Home/Community The Agency has determined services provided under the LTC, ibudget, PAC, and TBI programs are delivered in settings that will require assessment by the State to determine compliance. The Agency is developing a comprehensive assessment, remediation and monitoring process to ensure impacted provider sites are in compliance with the HCB settings rule. 4
Table 3 provides the enrollment capacity, number of services and the settings under which the waiver or state plan services are provided. Program Name LTC Managed Care Waiver ibudget Waiver 32,400 24 PAC Waiver 7,400 13 TBI/SCI Waiver 410 18 Table 3 Services and Settings Crosswalk Enrollment Number of Settings Capacity Services - Assisted Living Facilities - Adult Family Care Homes 36,795 24 - Adult Day Care Centers - Recipient Home/Community - Group Homes - Assisted Living Facilities - Residential Habilitation Centers - Comprehensive Transitional Education Program - Adult Day Training Centers - Foster Care Homes - Recipient Home/Community - Adult Day Care Centers - Foster Homes - Shelter Care Homes - Recipient Home/Community - Assisted Living Facilities - Group Homes - Recipient Home/Community C. Regulatory Assessment The Agency conducted a preliminary assessment of current Florida laws, rules, regulations, standards and policy that determined that state facility settings requirements are consistent with HCB settings requirements. To assess regulatory requirements, the Agency reviewed all applicable state laws and rules and determined their compliance with federal regulation. Please see Attachment II, State Laws, Rules and Regulations Crosswalk, which outlines the states assessment process and its results. To ensure continued compliance, the Agency will monitor on an on-going basis all changes to future state statutes, regulations, standards, and policy each year. D. Residential Setting Assessment The Agency has conducted a preliminary review of residential facilities providing HCBS including assisted living facilities, adult family care homes and group homes. Residential providers in the LTC waiver are currently monitored by the managed care plans for compliance with the elements of the rule. DOEA monitors a representative sample of providers annually and the State used this data in its assessment. For residential providers that are not in LTC, the State analyzed provider self-assessments using the HCB Characteristics Review Tool. Please see Attachment III to view the Tool. The assessment tool was designed by the State to determine whether residential providers are compliant with the HCB settings requirements of a home-like environment and community 5
inclusion. Reviewers were instructed to employ multiple assessment tactics when analyzing each standard including independent observation, record and file review, provider interviews, and resident/recipient questions as appropriate. To make determinations for future monitoring improvements, the State analyzed the on-site monitoring and self-assessment results. The results of the analysis showed that the majority of residential providers are either already meeting the new federal standards or should 1 be able to achieve full compliance with the implementation of programmatic changes.. The State will conduct a complete assessment of all residential settings in which HCBS are being rendered in order to determine full compliance. The Agency will continue assessing the residential monitoring tool and provider training in accordance with its findings. For a timeline of all steps required in the assessment of residential facilities, please see Attachment I, Implementation Action Plan. E. Non-Residential Setting Assessment The State has developed an assessment tool to evaluate non-residential settings to ensure compliance with the federal requirements. Please see Attachment IV to view the Tool. The Agency will send non-residential providers the tool for the purposes of self-assessment. Based on the results and provider feedback, the Agency will determine initial compliance and modify the tool as necessary. The State will also incorporate the finalized assessment tool into the monitoring process for each HCBS waiver and state plan program. This will ensure the validity of all provider assessments and allow the Agency to determine future actions necessary to ensure continued compliance with the federal requirements. For a timeline of steps required in the assessment of non-residential facilities, please see Attachment I, Implementation Action Plan. IV. Remediation The State will develop a comprehensive remediation strategy that optimizes cooperation and consultation between the State and providers while minimizing any potential negative impact on individuals who receive services in these settings. The strategy will allow for ample time for providers to rectify deficiencies in order to comply with the rule. Remediation plans will be highly individualized and provider-driven based on the individual provider assessments. The State will determine compliance and necessary remediation actions through its assessment process. Based on its assessment results, the State will determine which CMS-provided compliance category a setting falls into by determining whether it: Fully aligns with the federal requirements, Does not comply with the federal requirements and will require modifications, Cannot meet the federal requirements and require removal from the program and/or the relocation of individuals, or Is presumed to be institutional. 1 Remediation actions for facilities that are found to be non-compliant are outlined in Section IV of this document. 6
For sites that are determined to be fully aligned with federal requirements, the State will ensure continued compliance through routine monitoring and evaluation of the site. For sites that do not comply with the federal requirements and will require modifications, the State will initiate the following remediation steps: The Agency, or its delegate will send written findings and a determination of compliance to the provider based on the site survey or monitoring. The provider will have a given timeframe in which to respond to the Agency, or its delegate, with a remediation action plan and engage in further discussion. The Agency, or its delegate will approve the provider remediation plan and monitor its implementation progress. The plan may be modified with approval, throughout the implementation process. The Agency, or its delegate will reassess the provider site at the end of the implementation period to ensure compliance. The suitable course of action for provider sites that remain non-compliant will be determined on a case-by-case basis. Options will include: o o o Continuing to collaborate with the provider to remediate outstanding issues. The Agency, or its delegate, sending a final compliance order detailing how, and when, it expects the provider to come into compliance. Terminating the provider from the program and transitioning recipients to compliant settings. For sites that are presumed to be institutional, the State will implement a case-by-case heightened scrutiny process. This process will include convening with stakeholder and advocacy groups in order to determine if the site in question has qualities of an institution. If the site is determined to be of institutional quality, the Agency will provide written notice that the site will be terminated from the program and recipients will be transitioned into a compliant setting. If the site is determined to be compliant with the HCB Settings Rule and not of institutional quality, the State will submit evidence and a recommendation to CMS. A. Transitioning of HCBS Recipients In the event remediation attempts have proved unsuccessful, it will be necessary to transition impacted individuals to a setting that meets the requirements of the rule. The State will develop a comprehensive transition protocol to operationalize how it will transition individuals into compliant settings as necessary in a manner that minimizes the impact on the individual while optimizing their personal choice and care coordination. The protocol will include the following steps: The Agency, or its delegate will send impacted HCBS recipients a written notice explaining the need for transition, including alternate provider options and outlining options to helpful resources. Waiver support coordinators/case managers will work with impacted individuals, providers and the individuals support group to develop an individualized transition plan that is approved by the individual or their representative. 7
Individuals will be monitored during transition and after completing transition to ensure their new service provider maintains compliance with the HCBS Settings Rule and that their services continue to meet waiver standards and requirements. Individuals who do not want to change providers and receive services in a compliant setting will be counselled as to the consequences and will be disenrolled from the applicable waiver. V. Continued Compliance The State will develop an annual monitoring program that focuses on individual recipient feedback, provider monitoring and overall program and regulatory monitoring. The State is developing monitoring tools by program that address each aspect to ensure ongoing compliance. The State will implement a process to evaluate the individual s person-centered plan and seek feedback from the recipient and the recipient s family or representative. The focus of this annual review will be to guarantee the recipient has the opportunity to be active in the community, reside in a home-like living environment and make personal choices. The HCB Characteristics Tool will be used to determine compliance for the provider sites. A representative sample of residential and non-residential settings will be reviewed by the state agency responsible for the waiver s monitoring process. The residential and non-residential review tools will be updated based on provider and reviewer feedback. Updating the tools will ensure accurate results and better determine the remediation actions necessary to ensure continued compliance. The Agency will also monitor all changes to state laws, rules, regulations, standards, and policy each year. To ensure on-going compliance of the HCBS programs with the provisions of the HCB Settings Rule, the Agency has established following monitoring principles that will guide the development of its monitoring plan: The Agency will assure continued compliance with the HCB settings rule prior to the submission of any waiver or state plan amendments and renewals. Waiver case managers and support coordinators will ensure recipients do not receive services in a setting that does not comply with the HCB settings rule. The Agency will ensure on-going monitoring of residential and non-residential provider sites. The Agency will continue to modify its monitoring activities based on its continuing assessment and public input to ensure full compliance with the rule. VI. Communication and Education The Agency has implemented an outreach strategy for sharing information about the HCB Settings Rule with recipients, providers, interested parties and stakeholders. It is the Agency s goal to promote transparency regarding implementation actions and procedures by disseminating direct, clear and timely communication of information relating to applicable programs, waiver services and the State s HCB settings rule implementation activities. 8
All updates relating to the rule can be found on the Agency website at http://ahca.myflorida.com/medicaid/hcbs_waivers/index.shtml. The website is a resource open to recipients, providers and other stakeholders and includes general information about the rule, the State s HCBS programs and any updates to the waivers. This website will be updated when new information becomes available. The Agency has also established an email inbox and encourages all interested parties to submit their comments regarding its HCB settings transition and waiver or state plan amendment and waiver renewal activities (FLMedicaidWaivers@ahca.myflorida.com). are logged and taken into consideration when finalizing the implementation processes and prior to submission to CMS. Additionally, DJJ and DOEA each have methods of communicating with the individuals, providers and stakeholders they serve and will utilize those processes in conjunction with the Agency. A. Recipient Outreach The Agency will employ a direct approach to communicating information with recipients through their support coordinator or case manager accordingly. The Agency believes this personal approach will help to engage recipients in the implementation process and facilitate a greater understanding of its actions. B. Provider Outreach The primary method of communication to providers is through provider alerts. These alerts are distributed to all waiver and state plan providers and contain relevant information regarding updates to the HCBS programs. A phone number and email address are provided in the alerts so that providers may contact the Agency if they have any questions or concerns. In addition to receiving provider alerts, managed care plans that are part of the LTC program receive direct provider communications from their Agency contract manager. C. Stakeholder Outreach The Agency prioritizes effective communication to its many stakeholder groups. The primary method of communication is the Agency s provider alert system in which many stakeholder participate. Additionally, the Agency publically notices its public comment periods and public meetings in the Florida Administrative Register (FAR). In order to ensure proper and collaborative implementation of the rule, the Agency has established an interagency workgroup that consists of staff members from each of its impacted sister agencies. These meetings occur once weekly and have attendants from the Agency, DOEA, DOH, APD and DJJ. The workgroup includes subject matter experts and other stakeholders. D. Education and Training The Agency strives to ensure all of its stakeholders are well informed about the HCB settings rule and its implementation activities. The Agency developed an introductory training plan to introduce the rule and its requirements. These trainings were held during the summer of 2014 and consisted of a webinar presentation and a Q&A session. A copy of the HCBS Rule Overview and Transition Planning 2014 presentation can be located on the Agency s HCBS website. 9
The Agency is developing a comprehensive, progressive, training and education program designed to reach all stakeholders that address its implementation activities. VII. Public Notice Process The Agency is required to have a 30-day public comment period to allow for meaningful public comment prior to submission of this transition plan. The Agency will provide two statements of public notice on the transition plan. The Agency will summarize all comments received during that public comment period and describe how the issues raised were addressed in the transition plan prior to submission to CMS. A. Statements of Public Notice The Agency will publish a notice of the comment period and a link to the transition plan on Florida s Administrative Register and the Agency website. The statements of public notices will provide information on the upcoming public comment period for the statewide transition plan, a link to the plan, and the locations and addresses where public comments may be submitted. In addition, the Agency will send notice to the LTC Plans, waiver support coordinators and case managers who will distribute the public notice to share the information with their members. Written comments and suggestions may be mailed to: Agency for Health Care Administration Attention: HCBS Waivers 2727 Mahan Drive, MS #20 Tallahassee, Florida 32308 Electronic comments may be emailed to: FLMedicaidWaivers@ahca.myflorida.com. 10
Attachment I Implementation Action Plan Subject Description/Action Start End Resource(s) Status Operational Assessments, Development and Implementation HCB Settings Rule Assessment Preliminary Operational Assessment Stakeholder Training HCB Settings Rule Programmatic Preliminary Assessment Stakeholder Training New HCB Settings Rule Statewide Transition Plan Stakeholder Training HCB Settings Rule Implementation Regulatory and Policy Assessment Systems Assessment Determine elements of rule and categorize. Determine affected waivers, review impacted service descriptions, applicable settings and regulations. Develop initial stakeholder training re. new HCB settings rule requirements Overall preliminary assessment from operating/programmatic agencies Conduct webinar series for interested stakeholders re. HCB settings rule requirements and initial State transition plans Develop statewide transition plan, hold public comment and submit to CMS Develop ongoing, progressive, training re. State implementation activities Assess impacted state rules (Florida Administrative Code) and policy documents. Recommend amendments as necessary Determine and develop any required changes to State IT system requirements 3/5/14 3/5/14 AHCA Policy Completed 3/5/14 5/30/14 5/15/14 6/30/14 6/18/14 8/25/14 APD,DOH,DJJ DJJ, DOEA, Stakeholders DJJ, DOEA Completed Completed Completed 7/1/14 9/30/14 AHCA Policy Completed 8/25/14 3/17/15 2/1/15 4/30/15 4/1/15 6/30/15 5/1/16 7/31/16 DJJ, DOEA, Stakeholders DJJ, DOEA, Stakeholders DJJ, DOEA DJJ, DOEA, In process In process Not started Not Started 11
Attachment I Implementation Action Plan Subject Description/Action Start End Resource(s) Status Operational Assessments, Development and Implementation Regulation and Policy Updates Systems Changes Site Assessment and Determination Promulgate recommended changes affected FAC s, amend policy documents Implement recommended State IT systems changes 12 7/1/15 8/30/16 8/1/16 5/31/17 Residential Assessment Tool Develop residential setting tool 5/1/14 6/16/14 Residential Assessment Tool Residential Provider Self-Assessment Period Implement residential tool for LTC monitoring activity Disseminate and collect data from residential providers not in LTC (ibudget) Non-Residential Assessment Tool Develop non-residential tool 1/15/15 2/19/15 Non-Residential Provider Self-Assessment Period Residential and Non-Residential Assessment Tools Disseminate assessment and collect data from non-residential provider sites Update tools based on selfassessment experiences and stakeholder feedback DJJ, DOEA, Stakeholders DJJ, DOEA APD, DOEA Not started Not started Completed 6/17/14 Ongoing DOEA Completed 6/20/14 7/25/14 APD Completed 2/23/15 4/30/15 3/1/15 5/30/15 Assessment Data Analyze self-assessment data 5/1/15 5/15/15 Residential and Non-Residential Site Assessment Process Develop assessment process and plan 5/1/15 7/31/15 DJJ, DOEA, Stakeholders AHCA Plan Management, APD, Providers DJJ, DOEA DJJ, DOEA DJJ, DOEA In process Not started Not started Not started Not started
Attachment I Implementation Action Plan Subject Description/Action Start End Resource(s) Status Operational Assessments, Development and Implementation Onsite Residential and Non- Residential Provider Assessment Remediation, Enhanced Scrutiny and Transition Provider Remediation and Termination Protocol Recipient Transition Process Provider Site Remediation Period Provider Continuation/Termination Determination Recipient Transition Period Monitoring Program Monitoring Provider Monitoring State validates provider self-assessment responses and determines individual site compliance Develop provider remediation and termination process Develop transition process and plan for recipients in non-compliant facilities Work with providers to remediate site deficiencies Determine provider sites that can/will not meet setting standards and terminate from program Transition recipients receiving services from non-compliant providers Develop process to monitor waiver operations, policies and MCP activities for continued compliance with the HCBS Settings Rule Develop provider monitoring process to ensure continued compliance 7/1/15 6/30/16 1/1/16 4/30/16 5/1/16 8/30/16 7/1/16 6/30/17 7/1/17 12/31/17 10/1/17 3/1/18 5/1/15 6/30/15 7/1/15 12/31/15 DOEA, Providers DJJ, DOEA, Stakeholders DJJ, DOEA DJJ, DOEA, Stakeholders DJJ, DOEA, Stakeholders DJJ, DOEA, Stakeholders DJJ, DOEA DJJ, DOEA Not started Not started Not started Not started Not started Not started Not started Not started 13
Attachment I Implementation Action Plan Subject Description/Action Start End Resource(s) Status Program Monitoring Site Monitoring Monitor waiver operations, policies and LTC plan activities to ensure compliance with the HCBS Settings rule. Monitor provider sites for compliance with HCBS settings rule 1/1/16 Ongoing 7/1/16 Ongoing DJJ, DOEA, DJJ, DOEA, Stakeholders In progress Not started 14
Florida Statutes State Regulatory Requirement 393.062 F.S. 393.067 F.S. 393.13 F.S. Description Legislative Findings and Declaration of Intent Developmental Disabilities, Facility license Treatment of Persons with Developmental Disabilities 419.001 F.S. Community Residential Homes Attachment II State Laws, Rules and Regulations Crosswalk Settings Impacted Compliance with Federal Rule Action Steps All Licensed Facilities No conflict Ongoing monitoring Licensed residential Facilities No conflict Ongoing monitoring Residential and non-residential settings Assisted Living Facilities Adult Family Care Homes No conflict No conflict Ongoing monitoring Ongoing monitoring Chapter 408, Part II, F.S. Health Care Licensing: General Provisions All Licensed Facilities No conflict Ongoing monitoring 409.175 F.S. Licensure of Family Foster Homes, Residential Child-Caring Agencies, and Child Placing Family Foster Homes No conflict Ongoing monitoring Agencies Chapter 429, Part I F.S. Assisted Living Facilities Assisted Living Facilities No conflict Ongoing monitoring Chapter 429, Part II F.S. Adult Family Care Homes Adult Family Care Homes No conflict Ongoing monitoring Chapter 429, Part III F.S. Adult Day Care Centers Adult Day Care Centers No conflict Ongoing monitoring Private/Semi Private Room Choice, Choice of Roommate, Locking Door to Living Unit, 429.24(2) F.S. Eating and Snack Preparation Schedule, Participation in Facility and Community Activities, Maintaining a Personal Sleeping Schedule All Licensed Residential Facilities No conflict Ongoing monitoring 429.28 F.S. Access to Telephone and Usage Length, Unlimited Visitation, Snacks as Desired All Licensed Residential Facilities No conflict Ongoing monitoring 15
Florida Rules and Handbooks State Regulatory Requirement Attachment II State Laws, Rules and Regulations Crosswalk Description Programs Impacted Action Steps Chapter 58A-14 F.A.C. Adult Family Care Homes LTC No conflict Ongoing monitoring Chapter 58A-5, F.A.C. Assisted Living Facilities LTC, ibudget, TBI/SCI No conflict Ongoing monitoring Chapter 58A-6 F.A.C. Adult Day Care Centers LTC, PAC No conflict Ongoing monitoring Chapter 58T-1 F.A.C. Chapter 59A-35 F.A.C. Chapter 59G Training Requiring Provider and Curriculum Approvals Health Care Licensing Procedures Florida Medicaid Handbooks: Coverage and Limitation Policy LTC, ibudget, TBI/SCI No conflict Ongoing monitoring LTC, ibudget, TBI/SCI, PAC No conflict Ongoing monitoring All HCBS programs 1) Review further to determine necessary changes to ensure rule compliance 2) Develop internal agency group to develop revisions 3) Make and implement revisions 4) Monitor continued compliance Chapter 65C-13 F.A.C. Foster Care Licensing ibudget, PAC No conflict Ongoing monitoring 1) Add definition of lease Chapter 65G-2 F.A.C. Licensure of Residential Facilities ibudget 2) Reference the lease or legally enforceable agreement in sections related to client choice issues Chapter 65G-3 F.A.C. Chapter 65G-4 F.A.C. Termination, Suspension, or Reduction of Client Services by Service Providers Service Delivery Practice and Procedure ibudget ibudget 1) Replace minimum time frame for termination notices to 30 days 1) Preliminarily determined to be compliant 2) To be further reviewed pending outcome of ibudget Handbook promulgation Chapter 65G-5 F.A.C. Supported Living Services ibudget No conflict Ongoing monitoring Chapter 65G-8 F.A.C. Reactive Strategies ibudget No conflict Ongoing monitoring 16
Date Facility Reviewer Name Enrollee ID (if interview conducted) Facility Name Address 1. Setting 1.1 Does the facility s setting intentionally, or effectively, isolate individuals from the surrounding community and persons who are not receiving Medicaid HCBS services? Individuals do not live in isolated compounds, or settings which limit their potential integration with the community at large. 1.2 Do the facility s common areas have a homelike feel? The communal areas do not resemble an institution and are conducive to comfortable and social interactions free from undue restrictions. 1.3 Is the facility traversable by the individuals it serves; does it meet the needs of individuals who require supports? Individuals are able to maneuver through the hallways, doorways, and common areas with or without assistive devices. Supports are available to individuals who require them. Attachment III HCB Characteristics Review Tool Residential Settings Facility Type - Is the facility surrounded by high walls/fences and/or have closed/locked gates? - Is the facility setting among private residences/businesses and community resources? - Does the facility purposefully separate individuals receiving Medicaid HCBS services from those who do not, or groups of individuals from others? - Is the facility on the grounds of, or adjacent to, a public institution? - Is the setting on a gross lot area exceeding 8 acres? - Is the setting located on a parcel of land that contains more than one State licensed facility? - Is there an ADT program, or a licensed residential facility on the same or adjacent parcels of land? - Does the licensed capacity of the facility exceed 15 residents? - Are the common areas decorated in a homely fashion (paint, artwork, home furnishings etc.)? - Is there a common living room/social area with homely furnishings? - Are individuals free to move around common areas? - Are supports provided for individuals who need them to move around the setting independently/at will (grab bars, ramps, viable emergency exits etc.)? - Are appliances/amenities accessible to individuals with varying access needs? - Can individuals make use of furniture and spaces conveniently and comfortably? - Are hallways/common areas accessible to individuals of varying needs? - Are individuals, or groups of individuals, restricted from areas of the facility because it is inaccessible to individuals with specific ambulatory needs? 17
1. Setting 1.4 Are visitors restricted from entering the facility? Do individuals have a private meeting room to receive visitors? Individuals are able to receive visitors. Visitation is not restricted or hampered by facility policies or practices. visiting hours are posted and individuals are made aware of afterhours visiting policy. Visitors must be allowed outside of standard visiting hours, but restrictions to accommodate other residents, such as limiting visitors to certain areas of the facility and observing quiet hours, may be imposed. There is a comfortable private place for individuals to have visitors. 1.5 Are there areas within the facility that an individual cannot enter without permission or an escort? If so, list in. Individuals are able to access all areas of the facility unless their safety would be jeopardized, e.g., individuals do not have access to maintenance rooms, janitor s closets, etc. 1.6 Do individuals have access to standard household amenities/appliances? Individuals have independent access to appliances and household amenities in order to complete standard household chores and activities of daily living as appropriate. 2.1 Do individuals have a choice of private/semiprivate room and choice of roommate if applicable? Individuals have the ability to choose whether to upgrade to a private room (room and board rates may be differ based on the individual s election of a private or semi-private room.) If the individual is housed in a semi-private room, they are not auto-assigned a roommate. Attachment III HCB Characteristics Review Tool Residential Settings - Are visiting hours restricted; if so, are visiting hours posted? - Are individuals or visitors required to give advance notice or visitation? - Are there provisions for private visitation in home-like settings? - Are there restricted visitor meeting areas? - Which areas are individuals restricted from entering? - How are individuals prevented from entering restricted areas (industrial gates, locked door, barriers etc.)? - Do individuals have access to laundry facilities? - Do individuals have access to cooking/food preparation facilities? - Are individuals able to do personal chores/housekeeping if necessary? - Do individuals have the option to elect a private room? - Can individuals chose their roommate if applicable? - How can an individual select their roommate (identify character requirements, nominate a specific person, personality/needs matching etc.)? - Does the individual talk positively about their roommate? - Do individuals know how to request a roommate change? - Can married couples elect to share, or not to share, a room? 18
2. Room/Privacy 2.2 Are the facility s rooms home-like? Individuals living quarters do not resemble institutional settings or wards. Individuals have the ability to maintain their personal space according to their preferences, and living quarters are the appropriate size for the number of residents. 2.3 Do individuals have privacy in their living quarters? Individuals have the right to privacy including lockable doors to their living quarters unless the individual s physical or cognitive condition means their safety could be compromised if afforded privacy. Reasons to impede a person s right to privacy are fully and accurately documented. 2.4 Does the facility have a policy and procedure that addresses staff access to individuals rooms? Facility staff respects the individual s privacy in their room, and is familiar with and properly implement s the policy and procedure to enter an individual s room (e.g., knock twice and wait for a response, etc.). 2.5 If the desired living arrangement is not available when the individual moves in, are they given the opportunity to change when their first choice becomes available? Individuals are given the option to move room and/or change roommate if their preference becomes available. 2.6 Are individuals able to make/send private telephone calls/text/emails at their preference and convenience? Individuals are able to communicate at will with persons of their choosing and in privacy. Attachment III HCB Characteristics Review Tool Residential Settings - How many beds are in the bedroom? - Can the individual decorate their personal space? - Can the individual personalize their furnishing? - Can the individual have home furnishings in their personal space? - Can the individual personalize their furniture arrangement? - Does the individual have the ability to keep and/or prepare food/snacks in their personal space? - Is the individual allowed visitors in their personal space? - Does the individual s room and bathroom have a locking door? - Who has keys to access individual s rooms? - Do furniture arrangements ensure privacy? - Do staff, other residents and visitors always knock, and receive permission prior to entering an individual s room or bathroom? - Are cameras present in the facility? - Under what circumstances would an individual s room be accessed without their permission, or without prior notification; were these provisions discussed with, and agreed to by the individual? - Provide/describe the facility s privacy and access policy? - Under what circumstances can an individual change room and/or roommate? - How do individuals request a change of room/roommate? - Does the facility alert individuals to the fact their room/roommate preference is available? - Are individuals able to contact persons of their choosing at will? - Do individuals have private cell phones, computers, telephones or other communication devices for personal communications? - Do individuals rooms have telephones/telephone jack/internet access or internet capabilities? - Are individuals able to contact persons of their choosing in privacy? 19
2. Room/Privacy 2.7 Is the individual s right to dignity and privacy respected? The individual s right to dignity and privacy is protected and respected? 3. Meals 3.1 Are individuals required to follow a set schedule for meals? Individuals have the choice of when to eat? 3.2 Do individuals have a choice of meals that are consistent with their preferences? Individuals have a choice of what to eat and are offered a substitute meal if they prefer. Posted menus state that alternate meals are available or list the alternate menu selections. 3.3 Do individuals have a choice of where, and with whom to eat their meals in the facility? Individuals are given the option to eat in areas other than the dining room, including their private living quarters, and may choose to eat with persons of their choosing, or alone. 3.4 Are individuals afforded dignity and respect during meal times? Individuals are free from unnecessary interventions and rules during meal times which may impinge on their ability to eat and drink with dignity and respect. Attachment III HCB Characteristics Review Tool Residential Settings - Is PHI and personal information kept private? - Are individuals service schedules posted in common areas? - Are individuals who need assistance with grooming groomed in accordance with their schedule and style preferences? - Are individuals well kempt and clean? - Are individual who need assistance with dressing clothes appropriately for the time of day/weather etc. and/or in accordance with their preferences? - Can individuals eat at times of their choosing? - Do individuals have access to food/snacks outside of prescribed meal times? - If an individual misses a meal, can they eat it, or a replacement at another time? - How are individual s preferences incorporated into the facility s menus? - Can individuals choose from a variety of menu options? - Can individuals make special menu/meal requests? - Can individuals request an alternate meal? - What restrictions are there on individuals requesting alternate meals? - Are individuals required to sit in an assigned seat for meals? - May individuals eat alone, or with people of their choosing? - May individuals eat in their private living quarters or in areas of the facility other than a designated dining room? - Do individuals converse during meal times? - Are individuals required to wear bibs or other protection equipment? - Does the facility use home-like dishes and cutlery or disposable table wear? - Are individuals required to stay in the dining room/at the table during meal times? 20
3. Meals 3.5 Do individuals have access to snacks? Are they allowed to make their own snacks? Is there an area individuals can use to keep their own food and prepare snacks (e.g., kitchen or snack preparation area with refrigerator, sink, and microwave)? Individuals have access to a kitchenette (microwave, refrigerator and sink), a food preparation area (a place to prepare and reheat foods), or a food pantry where they can store snacks that are accessible at any time. 4. Activities/Community Integration 4.1 Are individuals able to move freely outside of the facility? Individuals have full access to the community and are allowed to come and go from the facility, as they desire, unless the individual s safety would be jeopardized. Reasons to restrict movement are documented in the facility s individual record. Attempts to mitigate safety issues prior to revoking an individual s right to freedom of movement are documented. 4.2 Are individuals made aware of community activities via a community board, flyers, etc.? Individuals have the opportunity, but are not required, to participate in scheduled and unscheduled community and social activities. An activities calendar is posted in a common area of the facility. Individuals are consulted in selecting, planning and scheduling organized activities. Attachment III HCB Characteristics Review Tool Residential Settings 21 - Do individuals have to ask staff for a snack? - Can individuals prepare their own snack at will? - What facilities are available for individuals to prepare their own snack? - Does the facility provide snacks; if so, how can individuals access them? - How/where can individuals store snacks/personal food items? - Are individuals able to come and go from the facility and its grounds at will? - Can individuals engage in community and social activities of their preference outside of the facility at will? - Are individuals moving around inside and outside of the facility? - Does the facility impose a curfew, or otherwise restrict individuals ability to enter of leave the facility at will? - Do individuals have access to public transportation; are transport options accessible to the individual? - Are public transport schedules and contact information readily accessible to individuals? - Does the facility provide accessible transportation so individuals may access the community? - Does the facility offer training to individuals on how to use public transportation? - Are individuals able to participate in community activities? - How does the facility facilitate individual access to community activities? - Where is the activity calendar posted; how often is it updated? - Does the facility organize activities, or facilitate access to activities of individuals choosing? - Do individuals shop, attend religious services, schedule appointments, meet family and friends etc. in the community and at their will and convenience? - Do individuals in the facility talk about social/community activities? - Are individuals required to participate in any activities?
4. Activities/Community Integration 4.3 Do individuals have access to newspapers, radio, computers, television, and/or the Internet? Individuals have access to outside communications. 4.4 Are individuals allowed to create their personal daily schedules (e.g., decide when to wake up or go to bed; go to the movies, the mall, religious events, etc.)? Individuals are allowed to choose how to spend their day including sleeping schedule (i.e., wake up and bedtimes, scheduled or unscheduled naps). Individuals are allowed to vary their schedule at will in accordance with their personcentered plan. 4.5 Is transportation provided or arranged by the facility to community activities? Attachment III HCB Characteristics Review Tool Residential Settings - What publications are available to individuals? - Where are publications kept? - Can individuals choose which publications are available? - Do individuals have access to radios and televisions? - Does the facility afford individuals access to the internet for personal use and/or computers with internet access for communal use? - How does the facility ensure an individual knows they do not have to conform to prescribed schedule for activities of daily living and social activities? - Do individual schedules vary from others? - Do any facility policies or practices inhibit individuals choice? Transportation is provided or arranged to community activities such as shopping, restaurants, religious institutions and senior centers, etc. The facility should have a policy for requesting transportation and individuals should be made aware of the policy. Observe sign-up sheets, instructions on how to request transportation, etc. 4.6 Are individuals employed outside of the facility? Individuals have the ability to seek and gain competitive employment in the community - How does the facility organize appropriate transportation to community activities? - Provide/describe the facility s policies and procedures regarding transportation to community activities? - Does the facility have a sign-up sheet and information about provided transportation accessible to individuals? - How does the facility aid individuals who wish to pursue competitive employment in the community? 22
5. Respect/Rights/Choice 5.1 Can individuals keep/control their own resources? Individuals have the option to keep their own money and to control their own finances/resources. 5.2 Do individuals know how to file an anonymous complaint? Information is available to individuals on how to file an anonymous complaint. Telephone numbers for the Agency Consumer Complaint Hotline, Long-Term Care Ombudsman, and the Abuse and Exploitation Hotline are posted in a common area of the facility. 5.3 Are individuals free from coercion? Individuals have the right to live in an environment and exercise their right to choice and self-determination free from coercion. 5.4 How does staff treat individuals? Staff treats individuals in a dignified manner. 5.5 Are individual choices accommodated? Individual choice are accounted for an honored unless the individual s safety would be jeopardized and in accordance with the personcentered plan. Attachment III HCB Characteristics Review Tool Residential Settings - Do individuals have the option of having personal bank accounts? - How can individuals access their personal funds? - How does the facility ensure individuals understand they are not required to sign over their personal resources to the provider? - How does the facility make information about how to register an anonymous complaint available to individuals? - Is information about filing complaints posted in obvious and accessible areas? - Are individuals comfortable with discussing concerns? - Do individuals in the setting display different personal styles/haircuts etc. - Do individuals greet and chat with staff? - Does staff converse with individuals while providing assistance/services and during the course of the day? - Does staff talk to other staff in front of individuals as if they are not there? - Does staff address individuals in the manner they like to be addressed? - Does staff ask the individual about their needs/preferences? - Are individuals aware of how to make service requests? - Are individuals satisfied with the services/supports received and those who deliver them? - Are individual requests accommodated? - Is individual choice facilitated such that the individual feels empowered to make decisions? - Can the individual choose from whom they receive services and supports? - Do individuals know how to request a change of service provider or support staff? 23
5. Respect/Rights/Choice 5.6 Are individuals, or their delegate, an active participant in the development of, and updates to, the person-centered plan? Individuals and/or their representatives are active participants in the person-centered planning process. Their ability to participate is not impinged upon by the facility, and their contributions/opinions are not viewed as instrumental to the facilities care planning process. 6. Other 6.1 Is there a legally enforceable agreement for the unit or dwelling where the individual resides? The individual has the same landlord/tenant protections, are protected from eviction and afforded appeal rights as persons not receiving Medicaid HCBS services. 6.2. How are modifications to the HCB Characteristics addressed and documented? Modifications to the HCB Characteristics requirements are supported by an assessed need and justified in the individual s personcentered plan. Attachment III HCB Characteristics Review Tool Residential Settings - Is/are the individual/chosen representative(s) aware of how to schedule a person-centered planning meeting? - Can individuals explain how they would initiate a person-centered plan meeting/update? - Was the individual/representative(s) present during the last person-centered plan meeting? - Do planning meeting occur at times convenient to the individual/representative(s) Does the individual have a lease, or for setting in which landlord/tenant laws do not apply a residency agreement? - Are individuals aware of their housing rights? - Do individuals know how to relocate and request new housing? - Does the lease/agreement include protections to address eviction processes and appeals comparable to Florida s landlord tenant laws? Probing Questions - Does documentation note if positive interventions and supports were used prior to any plan modifications and/or the restriction of an HCB Characteristic requirement? - Were less intrusive methods of meeting the need tried and documented first? - Does the plan include a description of condition that is directly proportional to the assessed need, data to support the ongoing need for modification, informed consent and an assurance the intervention will not cause harm to the individual? Additional Notes: Facility reviewer s signature and credentials Date 24