HCBS Settings Rule and Minnesota s Transition Plan Aimee Rumpza, Program Administrator, Aging and Adult Services Division, DHS 5/1/2017 2017 Assisted Living and Home Care Conference August 2 nd, 2017 10:45-11:45 a.m. 1 Learning Objectives Participants will: Understand how the HCBS settings rule affects: people served, providers, lead agencies and Department of Human Services (DHS) Understand the online attestation process Understand the site assessment process for customized living services Answer frequently asked questions and concerns specific to customized living 7/25/2017 Minnesota Department of Hum Health and Human Services mn.gov/dhs 2 1
Who is affected by the HCBS settings rule? Provider settings/sites that provide the following waiver paid services: Customized Living Foster Care Supported living services provided in a licensed facility Adult Day Day Training and Habilitation Prevocational and Structured Day 7/25/2017 Minnesota Department of Human Services mn.gov/dhs 3 HCBS Settings Transition Plan What is a statewide transition plan? What is the status of Minnesota s statewide transition plan? 7/25/2017 Minnesota Department of Human Services mn.gov/dhs 4 2
HCBS Standards 7/25/2017 Minnesota Department of Human Services mn.gov/dhs 5 Systemic Assessment and Remediation MINNESOTA S SYSTEMIC ASSESSMENT Compares the standards set forth in Center for Medicare and Medicaid Services (CMS) rule to Minnesota s current regulatory system, including Minnesota Department of Health (MDH) and DHS licensing and federally approved waiver plans. DHS reviewed all relevant regulations and proposed legislative changes to meet compliance with the rule. Proposed Regulatory changes related to Customized Living : CHAPTER 144D HOUSING WITH SERVICES ESTABLISHMENT 7/25/2017 Minnesota Department of Human Services mn.gov/dhs 6 3
What changes were made to the statutes for Chapter 144D this session? Who will these changes apply to? See language below: Subd. 2a. Additional contract requirements. (a) For a resident receiving one or more health-related services from the establishment's arranged home care provider, as defined in section 144D.01, subdivision 6, the contract must include the requirements in paragraph(b) 7/25/2017 Minnesota Department of Human Services mn.gov/dhs 7 Changes to 144D continued. (b) The contract must include a statement: (1) regarding the ability of a resident to furnish and decorate the resident's unit within the terms of the lease; (2) regarding the resident's right to access food at any time; (3) regarding a resident's right to choose the resident's visitors and times of visits; (4) regarding the resident's right to choose a roommate if sharing a unit; and (5) notifying the resident of the resident's right to have and use a lockable door to the resident's unit. The landlord shall provide the locks on the unit. Only a staff member with a specific need to enter the unit shall have keys, and advance notice must be given to the resident before entrance, when possible. 7/25/2017 Minnesota Department of Human Services mn.gov/dhs 8 4
Systemic Assessment and Remediation We also reviewed and revised as needed: Policies assessment tools support plan documents guidance documents program templates 7/25/2017 Minnesota Department of Human Services mn.gov/dhs 9 Site Specific Assessment and Remediation 7/25/2017 Minnesota Department of Human Services mn.gov/dhs 10 5
Initial assessment and site specific validation We must have a validation approach for assessment of provider settings to ensure compliance with HCBS qualities and characteristics. Minnesota s strategy for validation: Provider attestation process Person s experience assessment On site assessment 7/25/2017 Minnesota Department of Human Services mn.gov/dhs 11 Provider attestation: Overview What is the HCBS provider attestation? Why do providers need to complete it? Who needs to complete an attestation? When does it have to be completed? What is the deadline for all areas to be compliant? Where can I find information? www.mn.gov/dhs/hcbs 7/25/2017 Minnesota Department of Human Services mn.gov/dhs 12 6
Provider attestation: Process Providers will indicate compliance for each standard separately. Comply with this requirement (with supporting documentation) Do not yet comply, but has a plan to become compliant by September 1, 2017 If a provider needs additional time to make changes to meet the requirements, they must sign back in and update the attestation form indicating compliance by September 1, 2017 Initial responses will help DHS focus assistance and information specific on the areas needed. 7/25/2017 Minnesota Department of Human Services mn.gov/dhs 13 Provider attestation: Outreach to providers Direct mailings to settings Email MNITs mailbox Provider news Associations 7/25/2017 Minnesota Department of Human Services mn.gov/dhs 14 7
Provider attestation: Resources Examples of documents that may require revision: Lease agreements, adding addendum Handbooks Recipient Rights documents Flexible scheduling of programming and staff Food storage practices 7/25/2017 Minnesota Department of Human Services mn.gov/dhs 15 Provider attestation: Resources Guidebooks specific to service type Frequently asked questions Fact sheets Where to find additional information HCBS settings email box- direct technical assistance 7/25/2017 Minnesota Department of Human Services mn.gov/dhs 16 8
Presumed not to be HCBS PRONG 1 Services provided in a facility that also provides inpatient institutional treatment. PRONG 2 Settings on the grounds of, or immediately next to, a public institution. PRONG 3 Settings with the effect of isolating individuals from the broader community of individuals, not receiving Medicaid HCBS. 7/25/2017 Minnesota Department of Human Services mn.gov/dhs 17 What does effect of isolating mean for customized living providers who serve the aging population? Settings that are: Designed to provide people with disabilities or older adults multiple types of services and activities onsite, including any two of the following: 1) residential, 2) day services and 3) medical without the option to receive these services offsite. A residential setting that the provider also owns/ operates multiple homes located on the same street or adjacent property (does not include duplex or multiplex houses, unless there is more than one on the same street). As a provider this does NOT mean you are not compliant, only that DHS may need additional information to determine compliance. 7/25/2017 Minnesota Department of Human Services mn.gov/dhs 18 9
What happens if you fall into the presumed not to be HCBS? Those settings will trigger the heightened scrutiny process A state may overcome the presumption that a setting has institutional qualities by submitting evidence to CMS demonstrating the setting does not have the qualities of an institution AND that it does have the qualities of a home and community-based setting When the state submits this evidence to CMS, the state triggers a process known as heightened scrutiny Under the heightened scrutiny process, CMS reviews the evidence submitted by the state. 7/25/2017 Minnesota Department of Human Services mn.gov/dhs 19 Person s experience How does a person s experience fit into the HCBS settings rule? Ensure person s experience matches the rule requirements Validate provider attestation Federal reporting 7/25/2017 Minnesota Department of Human Services mn.gov/dhs 20 10
Commonly asked questions by customized living providers, con t Standard: Privacy in their bedroom or living unit including lockable doors. What if the person doesn t want a lock or can t use it? What if it is a memory care unit? 7/25/2017 Minnesota Department of Human Services mn.gov/dhs 21 Commonly asked questions by customized living providers, con t Standard: Freedom and support to control schedule and activities including access to food at any time What does access to food at any time mean? What if I have congregate dining? How do I comply with no specific meal times? 7/25/2017 Minnesota Department of Human Services mn.gov/dhs 22 11
Commonly asked questions by customized living providers, con t Standard: Able to have visitors at any time What about the rights/needs of rest of other residents? What if it s not safe for the person to have any visitors they want? Does this mean overnight guests as well? 7/25/2017 Minnesota Department of Human Services mn.gov/dhs 23 Commonly asked questions by customized living providers, con t What if it isn t safe for a person who lives in my setting to have these rights as described? Certain standards can be modified, as long as there is an assessed and documented need for a modification and all documentation standards have been met. 7/25/2017 Minnesota Department of Human Services mn.gov/dhs 24 12
Standards that may be modified when an assessed need is identified, and all documentation is completed 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 7/25/2017 Minnesota Department of Human Services mn.gov/dhs 25 MN HCBS webpage mn.gov/dhs/hcbs 7/25/2017 Minnesota Department of Human Services mn.gov/dhs 26 13
Thank you! Questions? Email: HCBS.settings@state.mn.us www.mn.gov/dhs/hcbs 7/25/2017 Minnesota Department of Human Services mn.gov/dhs 27 14