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HCBS Transition Plans Update

November 29, 2016

Arkansas

On November 7, 2016, the Centers for Medicare and Medicaid Services (CMS) granted initial approval for the Arkansas HCBS Transition Plan. CMS stated that they granted initial approval because the state completed its systemic assessment and clearly outlined remediation strategies that rectified compliance issues uncovered by the systemic assessment.

Several issues of compliance that Arkansas rectified in its latest revisions to the Plan relate to employment. The state now says that it will modify the definition of Supported Employment services in its regulations to fully address the Final Rule and reflect the state’s participation in the Department of Labor Office of Disability Employment Policy (ODEP)’s Employment First State Leadership Mentoring Program.

Arkansas still needs to take some steps in order to receive final approval from CMS, including: (a) assessing all settings that cluster participants, including prevocational settings, sheltered workshops and settings that provide day habilitation, for compliance with the Rule; (b) explaining the action steps they will take  to improve outreach to beneficiaries of Medicaid-funded HCBS; and (c) ensuring that providers are aware that reverse integration alone does not meet the requirements of the Final Rule.

For more information, read the CMS letter granting Arkansas initial approval.

South Carolina

On November 3, 2016, CMS granted initial approval to South Carolina for its HCBS Transition Plan. Several issues of compliance that South Carolina rectified in its latest revisions to the Plan relate to employment. For instance, CMS was particularly concerned that beneficiaries in adult day care settings might not have opportunities to pursue Competitive Integrated Employment (CIE). South Carolina originally included language showing that, when the state determines an individual would benefit from employment, the state will regulate the terms and conditions of employment and “supervise” the beneficiary. CMS asked for further clarification that this new provision does not make the state/provider the employer of record. South Carolina stated it will include language by January 31, 2017 affirming the following: (a) individualized employment services in the community are the first and preferred service option; (b) individuals are not mandated to have the provider as their employer of record, and (c) language defining  the meaning of “supervision.”

South Carolina still needs to take some steps in order to receive final approval from CMS: including clarifying whether all HCBS beneficiaries were given an opportunity to complete the state’s survey of beneficiaries and family members, and whether the state ensured beneficiary and family members’ surveys were independent of one another.

For more information, read the CMS letter granting South Carolina initial approval.

Indiana

On November 8, 2016, the Centers for Medicare and Medicaid Services (CMS) granted initial approval to the Indiana HCBS Transition Plan.

Several issues of compliance that Indiana rectified in its latest revisions to the Plan relate to employment, but do not fully address CMS’ concerns. CMS asked Indiana to verify that all Supported Employment services that cluster participants were reviewed for compliance with the Final Rule. CMS also asked Indiana to clarify the service ratio in the Transition Plan to reflect that all Supported Employment services require a 1:1 service ratio or, if that is not the case, “to include group Supported Employment settings among the settings that will be assessed and validated for compliance with the home and community-based settings requirements.” 

In Indiana’s Division of Disability and Rehabilitative Services (DDRS) systemic assessment, CMS said that Indiana needed to include language showing that individuals would be able to control their resources and pursue Competitive Integrated Employment in the community. Indiana created language that would put protections in place to address control of personal resources, but not what it would do with regards to employment.

For more information, read the CMS letter granting Indiana initial approval.