According to a recent update released by the Ohio Department of Developmental Disabilities (DODD), the Department now finds it “unlikely” that the Centers for Medicare and Medicaid Services (CMS) will grant Ohio ten years to transition to delivering all of their home-and-community-based waiver services (HCBS) in integrated settings. Read the full statement here. This announcement comes as a result of new waiver regulations released by CMS in 2014, intended to guarantee that individuals served through Medicaid Waiver programs have access to integrated, community services to the same degree as individuals not receiving waiver services, and is a part of a broader shift away from segregated services for individuals with disabilities. The new rules emphasize that HCBS must “…ensure that individuals receiving services and supports through Medicaid’s HCBS programs have full access to the benefits of community living, and are able to receive services in the most integrated setting.” (What is an HCBS Waiver? Watch our animated video to find out.)
This will have a considerable impact on sheltered work and adult day services, as they have traditionally been delivered in Ohio, because these services will likely no longer meet the revised waiver requirements. Residential services funded through waivers will also be effected, as the new rules clearly state that HCBS cannot be reimbursed for institutional settings (like hospitals or nursing homes) or settings that are determined to be “institution-like,” by sharing qualities of institutional settings, such as segregation and regimentation.
States were required to submit transition plans (Ohio’s plan was submitted last March) outlining how they would come into compliance with the new rules. CMS established a five-year period for states to the make this transition; however, Ohio requested an additional five-year extension (to conclude in 2024). As it now appears that CMS has denied this extension, DODD, County Boards of Developmental Disabilities, and other providers will have to work quickly to come into compliance.
According to a survey of waiver providers conducted prior to the transition plan being submitted, many HCBS settings already meet the requirements, while others could with modifications. However, 76 residential settings, and 32 adult day settings would either face “heightened scrutiny” under the new rules due to their institution-like environments, or would be unable to come into compliance.
The new rules were not without controversy, as some individuals with developmental disabilities, county boards, and family members have expressed concern about the shift away from sheltered work and the sole emphasis on integration. Some fear that certain individuals with developmental disabilities will struggle in community employment settings, and will be left with nowhere to go. However, others remain critical of sheltered work settings, which not only segregate workers from those without disabilities, but also often pay at rates far below the minimum wage. According to the recently released DODD Scorecard, combined sheltered work and adult day enrollment in Ohio is currently at over 23,000 while just 8,487 participate in integrated employment. However, the data also indicate that some counties have integrated employment rates of over 50 percent, while others have fewer than 5 percent participating. It is clear that some counties will have further to go to comply with the new rules than others.
The statement from DODD suggests that should CMS deny Ohio’s request for an extension, and the state cannot meet the 2019 deadline, “CMS will work with Ohio to develop an alternative compliance plan and related timeline.” It is unclear what an alternative compliance plan may look like at this time. This setback for the Department does not impact the extension Ohio has been granted by CMS to come into compliance with the “conflict free case management” requirement, which will impact the role County Boards play in delivering direct services.
To learn more about CMS rule change, sheltered work, and the developmental disabilities system in Ohio, visit Ohio at the Crossroads: Developmental Disabilities in Ohio.