On Monday, June 6th, the Ohio Office of Health Transformation released a statement announcing the recent initial approval of the state’s Home and Community-Based Services (HCBS) Transition Plan, by the Centers for Medicare and Medicaid Services (CMS). The plan, submitted originally in March, 2015, was developed in response to new CMS rules for states operating 1915(c) HCBS Medicaid waivers. The new rules are intended to increase the quality of HCBS settings, enhance person-centered planning, and maximize opportunities for waiver participants to interact with the community and live and work in the most integrated settings possible (see text box for details). In short, states may not use federal Medicaid funds to support HCBS settings that do not comply with the new rules and that have institution-like qualities. These regulations have garnered significant attention from providers, consumers, and family members as they will have a substantial impact on adult day programs, sheltered workshops, and HCBS residential settings.
CMS required states to submit plans for transition. After Ohio submitted its original draft plan, CMS provided a response in July 2015 based on the initial review, and additional changes were made based on that feedback. The draft was revised multiple times and was last submitted on June 1st. Opportunities for public comment were available throughout the process. Despite efforts to extend the timeline for transition for certain HCBS settings, like sheltered workshops, all transition activities must be completed by March, 2019. Read more about this here.
According to the CMS website, “initial approval” indicates to the state that “public comment, input and summary requirements are met, the STP (Statewide Transition Plan) is sufficient, but systemic and/or site-specific assessments are not yet completed. The response to the state will vary dependent on whether the state has or has not identified settings that are presumed to have institutional characteristics and any information the state may wish CMS to consider under the heightened scrutiny process.” According to data submitted with Ohio’s plan, 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. Site-specific assessments will provide more in-depth opportunities to evaluate these “heightened scrutiny” settings and determine the steps necessary to bring them into full compliance; these assessments are a requirement to receiving final approval for the plan. According to the statement, “Ohio’s final approval will follow the completion of several activities required in the plan, including an assessment of all HCBS settings, a remediation strategy to resolve any site-specific issues identified in the assessment, and ongoing monitoring and quality assurance.”
A press release circulated earlier this week states that Ohio is one of only three states that has received approval of their plan to date, and points to overall efforts to expand options for community-based services, and decrease reliance on institutional settings. According to the statement, “’the goal of Ohio’s plan is to maximize opportunities for individuals receiving HCBS services to have access to the benefits of community living,’ said Department of Developmental Disabilities Director John Martin. ‘It builds on Governor Kasich’s transformational budget that created 3,000 new waivers for persons to experience community living.’”
As no state was fully in compliance with the new regulations, presumably, other states should be receiving approval in the weeks and months to come. Proposed state plans from across the country are available here and additional information on Ohio’s plan, including draft versions and CMS’ response, can be found here.