Since the Centers for Medicare and Medicaid Services (CMS) final rule on Home and Community-Based Services (HCBS) took effect in the beginning of 2014, each state has had to produce a transition plan outlining a schedule and strategy for bringing all services into compliance with the HCBS final rule within five years. All healthcare, residential, day and employment services receiving HCBS waiver funding must be brought into compliance during the transition period. Following statewide public comment processes for each state’s draft transition plan, the final transition plans have been submitted to CMS for approval over the last several months.
As of August 26th, CMS has posted official responses to 12 state submissions, for which CMS requested clarifications and modifications that will be required before giving initial approval. CMS has published letters responding to submissions from Alaska, Colorado, Georgia, Hawaii, Illinois, Kentucky, Nevada, North Dakota, Ohio, Tennessee, West Virginia, and Wyoming. The letters largely outline concerns around inadequate planning for statewide assessment processes of current compliance, relocation of beneficiaries in settings that may be deemed noncompliant, ongoing monitoring processes to ensure compliance, setting remediation for settings that can be brought into compliance with modification, and settings identified by the state for heightened scrutiny due to presumptively institutional characteristics. In addition, CMS requested that Alaska submit assessments of their current regulations of non-residential services, such as supported employment, in addition to residential settings.