On September 5, Centers for Medicare and Medicaid Services (CMS) issued the Statewide Transition Plan Toolkit containing guidance for states on how to create transition plans for compliance with new regulations governing the settings in which Medicaid-funded home and community-based services (HCBS) may be provided. The new rule requires that HCBS, including residential supports, employment supports and pre-employment services, be provided in settings that promote full access to the community, including access to competitive integrated employment and opportunity to control personal resources.
Under the new rule, states must submit written transition plans to CMS detailing a five-year process for coming into compliance with the new regulations. Transition plans must be submitted by March 2015 or sooner if they are seeking an amendment to or reauthorization of an HCBS program. The new CMS guidance explains that states should develop transition plans in two stages. First, states should conduct an assessment of the extent to which their existing rules, standards, or other policies and practices are already in compliance with the new rule. Next, in the event that the state is not already in compliance with the new regulations, it should develop an action plan for bringing its programs into compliance.
Although CMS has announced that it will issue further detailed guidance on how the new regulations apply to non-residential services such as employment services, states are still awaiting this guidance. In the meantime, however, states must evaluate their HCBS-funded employment services as part of the process of developing a transition plan. States must carefully evaluate HCBS-funded employment services, with a particular focus on the settings in which individuals receive those services and the degree to which those settings facilitate integration into the community, competitive integrated employment, and the ability to control personal resources. As the guidance notes, states are encouraged to conduct site visits and surveys of service recipients during the course of this process. Once this evaluation is complete, states may review the status of their employment services programs in light of the new regulations and any further guidance from CMS.