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CMS Grants Initial Approval to HCBS Transition Plans for Kentucky and Ohio

June 29, 2016

On June 2, 2016, the Centers for Medicare and Medicaid Services (CMS) granted initial approval to the Home and Community-Based Services (HCBS) Transition Plans of Kentucky and Ohio. Kentucky and Ohio are now the second and third states to receive initial approval from CMS. 

In its approval letter for the Kentucky Transition Plan, CMS noted that the state had completed its systemic assessment of all settings (including settings providing employment services) and taken material steps to bring all settings into compliance with CMS’ regulations requiring that services be provided in integrated settings that maximize autonomy, provide support for people to achieve competitive integrated employment, and more. The state revised several of its regulations to comply with the requirements of HCBS settings rule. Kentucky’s Transition Plan specifically emphasizes that, in order for providers to comply with its Transition Plan, they must provide opportunities for individuals with disabilities to seek and maintain employment. CMS also requested that Kentucky take steps to ensure that all of its personnel and existing infrastructure for investigating compliance are trained in all aspects of CMS’ final rule, so that they can effectively evaluate the compliance of settings in their state.  

In its approval of Ohio’s Transition Plan, CMS also noted that the state had made an extensive effort to ensure that all state stakeholders, including those with and without disabilities, were involved in the development of its Transition Plan. Ohio’s plan affirms the state’s commitment to provide employment services in the most integrated environment possible. That is, the Transition Plan responded to concerns of some constituents regarding Ohio’s move away from facility-based services by stating that community-integrated supported employment options would provide the same or a greater level of support services, and would also provide the benefits that individuals with disabilities can only gain by working independently and being integrated with people without disabilities. 

In its letters, CMS reiterated the need for both states to address three concerns it had with both state Transition Plans in order to receive final approval. First, CMS stated that reverse integration, a practice by which individuals not receiving HCBS are brought over to participate in activities with HCBS beneficiaries, is not by itself enough to comply with CMS’ community integration requirements in the final rule. Second, CMS noted that both states must show that they are building up the state’s capacity for offering non-disability-specific residential and non-residential settings. An example of a non-residential, non-disability-specific setting would be Medicaid-funded supported employment services provided in a competitive, integrated employment setting. Finally, CMS reaffirmed the need for both states to reassess compliance of all group non-residential settings, including group supported employment and group community-based day services. 

For more information on Kentucky, read the Kentucky Transition Plan or view the CMS letter announcing initial approval of the Kentucky plan.  For more information on Ohio, read the Ohio Transition Plan or view the CMS letter announcing initial approval of the Ohio plan.