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CMS Responds to Statewide HCBS Transition Plans

October 29, 2015

As of October 2015, the Center for Medicare and Medicaid Services has sent 42 states Clarifications and/or Modifications Required for Initial Approval (CMIA) letters in response to each state’s published Statewide Transition Plan. These plans describe a timeline and steps that a state will take in order to bring existing and future settings into compliance with CMS’ Final Rules on Medicaid-funded Home and Community Based Services (HCBS), which promote services in inclusive community settings.

CMS’ CMIA letters highlight the concerns that CMS has with the reporting requirements of many of the plans and whether the state has clearly defined how it assesses the settings that must undergo heightened scrutiny review. These are settings and services that isolate people with disabilities from the broader community, including services and settings that may limit integrated employment opportunities.

For example, CMS notes, in the CMIA letter sent to New York, that the state said it completed the required systemic review designed to identify barriers to the HCBS rule’s implementation, but New York did not identify the standards that were assessed or provide evidence that the review was completed. Several of the letters note that the Public Notice and Comment Period for the state’s transition plans are either inefficient or inaccessible to the public. CMS has noted that, in many states, information on how the state identifies which settings are presumed to be institutional is lacking or absent.

Many transition plans discuss strategies that show that the state is working toward ensuring that people with disabilities have access to services that support them in integrated employment and other nonresidential services that enable them to live and work in the community. For instance, Delaware’s DDDS waiver states that it may fund “Prevocational Services,” which are designed to help people develop generalized work skills. This type of service can include unpaid or sub-minimum wage work in either “fixed site” or community-based locations, which may be interpreted to include sheltered workshops. The Delaware waiver, however, notes that pre-vocational services also includes “volunteer work and internships” and that services must be geared toward attaining competitive, integrated employment . The District of Columbia has created and funded a waiver service under its Developmental Disabilities waiver, known as Individualized Day Supports, that provides individualized services within community settings and provide opportunities for life skill development and vocational exploration. It has also created an Employment Learning Community, which brings providers together to focus on customized, integrated employment in the District of Columbia, with support from the U.S. Administration on Intellectual and Developmental Disabilities.

For further information on each of the transition plans and CMS’ CMIA responses, visit the Medicaid.gov website.