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Date ArticleType
10/3/2016 INCAL
Update on HCBS Waiver Transition Plan and Provider Enrollment

On Friday, September 16, 2016, IHCA/INCAL attended a site visit with the Indiana Division of Aging to a Supportive Living Facility (SLF) in the State of Illinois. SLFs provide a great deal of Medicaid waiver Assisted Living service and our DA wanted to get a picture of what one looked and felt like. Our counterparts from LeadingAge Indiana, HOPE, and INALA were also in attendance.

A great deal of dialogue occurred in the post-tour meeting at which time the DA discussed some of its upcoming plans related to the HCBS transition plan and provider enrollment into the current program.

The DA has announced that they want to continue to “hit pause” for another 6 months on certifying any new Medicaid waiver providers. This “pause” applies to any existing RCF provider that wants to become a waiver provider, any new construction, and/or any change of ownership. At one point they suggested 4-6 months but then reverted to talking about 6 months. The DA believes this pause is needed because:

  • Staffing shortages at Division of Aging
  • Want further discussions with ISDH about the ISDH residential care facility licensure rules. At a recent meeting with ISDH, the Division of Aging proposed an MOU between the two agencies. The MOU would call for ISDH to waive certain licensure rules that the DA believes are not in compliance with federal HCBS rules. The Division of Aging has given us a cross walk between the federal rules and the ISDH rules showing needed changes but told us today that the cross walk is being updated.

The DA is still strongly considering its own certification program that would not reply on RCF licensure for participation in the waiver program. This determination depends on how the RCF rules can change to become compliant with HCBS rules, amongst other factors such as how the new certification program would be administered.

DA is trying to decide what type of Medicaid waiver best suits Indiana. Our current 1915(c) waiver or a 1915(i) or (k) waiver or some combination of waivers. Once that decision is reached, transition planning would have to occur.

DA still doesn’t believe they have clarity from the feds about what is required under the federal HCBS rules, and Indiana does not yet have a statewide transition plan. Indiana plans to submit the next version of the transition plan next week. They also plan to have a provider meeting on December 13th to talk about what providers need to do to remediate deficiencies identified through the PCG surveys over the summer and to roll out the Division of Aging rule for all Medicaid waiver providers.

DA indicated that the heightened scrutiny process was not yet determined and should be within the 6-month pause period. They indicated that RCFs that are under the licensure of a Comp Care facility would need to separate licensure in order to comply, assuming and MOU with ISDH to waive institutional components of the RCF rule can be completed.

DA indicated that RCFs that are only on the same campus of or are adjacent to a Comp Care facility without being under the same roof or physically connected would not be deemed institutional for only that physical location. There may be other issues the RCF must remediate to comply. They need further provider and consumer input.

Immediate next steps include:

  • DA to submit the next version of the statewide transition plan next week (at least one additional revision will be required to conform to some technical requirements from CMS). When the statewide transition plan is submitted, it will contain an overview of the on-site surveys done over the summer. DA is also going to respond to the comments submitted by the trade associations.
  • DA is trying to create a statewide advisory committee.
  • DA says it can release a bulleted list of provider requirements based on the survey instrument and physical plant requirements.
  • Continue conversations with ISDH although it is unclear what the ISDH position is on the idea of an MOU. The ISDH representatives at the meeting were unaware of the MOU idea.
  • Letters to existing AL waiver providers will be sent at the beginning of 2017 with specific findings from the provider's site visit and include steps for remediation the provider must complete in order to comply with the new HCBS rules.

For more information, please contact Zach Cattell zcattell@ihca.org.