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Date ArticleType
9/5/2018 INCAL
HCBS Update

On 8/27/18, Lilly Hummel from NCAL attended the annual HCBS conference and reported that CMS officials acknowledged that heightened scrutiny guidance is forthcoming, hopefully within weeks.  As it relates to the HCBS Settings Rule, Seema Verma’s stated goals were (1) to lengthen the transition period (done to 2022) and (2) to engage with states to develop process efficiencies for settings presumed to be institutional. CMS has worked with states and stakeholders to develop this guidance to achieve the second objective. Lilly further reported that CMS was vague and would not give any further specifics, including whether CMS’ heightened scrutiny reviews will begin once the guidance is released.

On 8/24/18, Indiana’s Division of Aging Chief Medical Officer, Dr. Counsell, sent out this draft rule concerning requirement for secured memory units within Assisted Living for purposes of HCBS Medicaid waiver participation. This effort is a result of Senate Enrolled Act 421 that INCAL pushed through last legislative session.  Comments on this draft are due by September 14th.  You can send comments directly to the DA via email DAComments@fssa.IN.gov or to kniehoff@ihca.org.

On 8/22/18, FSSA released the 8th version of the Statewide Transition Plan (STP) required of each state by the federal Settings Rule (click here for the STP draft). This version included several updates in the Division of Aging (DA) section regarding the Aged & Disabled waiver.  Those changes include: 

  • DA rules regarding HCBS services scheduled to be released in early 2019 for implementation in late 2019 (pages 8-43)
  • Updates full compliance deadline with federal Setting Rule to March of 2021, instead of December 2018 (pages 45; 64)
  • Removes presence of secure memory unit from required heightened scrutiny (pages 53; 62)
  • Provides new detail on heightened scrutiny (HS) process (pages 62-63)
    • Heighted Scrutiny Evidence Packet (HSEP) reviewed by a new Provider Relations team at the DA, which includes the Provider Relations Director and Deputy Director. This team makes decision on status of HS packet.
    • Clearly states the three prongs that trigger HS (this is based in the federal Settings Rule)
    • Remediation Plan developed for HS process, which will be validated by DA
    • Details components of the HSEP and limits length to 10 pages
    • Requires for Prong 2 HS, co-located AL (same building as NF):
      • Information supporting a meaningful distinction between HCBS setting and institution – that the HCBS setting supports full community integration
    • Requires for Prong 3 HS, settings that isolate:
      • Information to support community integration to the extent the persons without disabilities in the same community would considerate part of their community and not a setting of only persons with disabilities
  • Other language updated to reflect passage of time and actions that have already occurred, or have not occurred though were proposed in the past

 The comment period runs from August 22 to September 21, and comments can be submitted directly via email to HCBSrulecomments@fssa.in.gov or submit comments to kniehoff@ihca.org by September 19th.