The CMS Final Rule is set to change the way provider agencies structure and provide services for people with intellectual and developmental disabilities. This report covers what changes to expect and how to prepare

2. A PUBLICATION OF MEDISKED, LLC
A Note Regarding
the Importance
of this eReport
Big changes are coming – and they’re coming fast.
In order to reinforce a life of independence and choice for
every individual, the CMS Final Rule is altering many of the
regulations that direct how supports are delivered.
In order to remain in compliance, many provider agencies
will have to make significant updates to the way that they
manage their programs, their documentation, and more.
Agencies that currently rely on paper-based systems are the
most vulnerable, as the Final Rule updates are set to make
technology more necessary than ever before.
The good news is a little planning goes a long way! This
eReport is designed to educate you on the upcoming
changes, help you assess your current operations, and
ensure that you’re prepared for the future.
Copyright ©2015 MediSked, LLC.

3. TABLE OF CONTENTS
4
Section 1
The New Definition of
Home and Community-Based Settings
7
Section 2
Person-Centered Planning
(And Person-Centered Supports)
10
Section 3
Residential Changes:
A Whole New Set of House Rules
(Or Lack Thereof)
13
Section 4
Compliance is King
(A King that Can Terminate Your Waiver)
3

4. The New Definition of
Home & Community Based Settings
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SECTION 1
CMS is intently focusing on the nature and quality of
participants’ experiences, establishing a far more outcome-
oriented definition of home and community-based settings.
Moving forward with the Final Rule’s clarification,
settings will need to be able to prove that they:
•Provide a true alternative to the services provided in
institutions
•Maximize the opportunities for waiver participants to have
access to the benefits of community living, including receiving
services in the most integrated setting
Currently, settings for services qualify based only on:

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SECTION 1
These changes mean :
•Less centralized services
•More locations – with most being smaller than today’s
typical settings and more integrated within the community
•More required documentation to ensure that every
experience is aligned with the individual’s goals, needs, and
preferences
•A need to track goals and outcomes (by service) for every
individual

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SECTION 1
All of these changes would be virtually impossible to manage
without the help of technology.
In order to maintain and coordinate supports and multiple
settings that meet Final Rule standards, agencies need a
solution that can:
• Keep geographically distant settings connected – in a
way that allows them to share information easily and
instantly
• Make absolutely certain that DSPs dedicate the full
amount of allotted time per service and log all required
notes and information
• Securely store all of that information for easy access at
any time

7. Person-Centered Planning
(And Person-Centered Supports)
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SECTION 2
The Final Rule specifies that
service planning for
participants must be developed
through a “person-centered
planning process that addresses
health and long-term services
and support needs in a manner
that reflects that particular
individual’s preferences and
goals.”
The person-centered planning
process must be directed by the
individual and may include a
representative (or
representatives) that the
individual has freely chosen to
contribute to the process.

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SECTION 2
This plan must include individually identified goals & preferences,
including those related to:
• Community participation
• Employment
• Income and savings
• Health care and wellness
• Education
• Others
This planning process, and the resulting person-centered
service plan, will:
•Assist the individual in achieving personally defined
outcomes
•Ensure delivery of services in a manner that reflects
personal preferences and choices
•Contribute to the assurance of their health and welfare

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SECTION 2
CMS will provide guidance
regarding the process for
operationalizing person-
centered planning, and it’s
believed that their guidance
will include technology
driven updates, including:
•Electronic record keeping
•The ability to track and store preferences
•Client and family satisfaction surveys
•Cross-program communication regarding health, safety,
and each person’s general well being
•The ability to share information between service
providers, healthcare providers, and possibly even the
individuals themselves
•Client portals

10. A Whole New Set of House Rules
(Or Lack Thereof)
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SECTION 3
•Are selected by the individual from setting
options, including non-disability specific settings
and an option for a private unit in a residential
setting
•Ensure an individual’s rights of privacy, dignity,
respect, and freedom from coercion and restraint
•Optimize individual initiative, autonomy, and
independence in making life choices
•Facilitate individual choices regarding services,
supports, and who delivers them
•Are owned, rented, or occupied under a legally
enforceable agreement (lease)
‘
(Continued on the next page)
When it comes to residential settings, the Final Rule is
really shaking things up. Some of the most notable changes
include mandates that residential settings:

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SECTION 3
• Offer each individual privacy in their sleeping unit
• Have lockable entrance doors
• Give individuals sharing units a choice of roommates
• Include the freedom for individuals to furnish and
decorate units within the lease agreements
• Offer individuals the freedom and support to control
their schedules and activities
• Allow individuals access to food at any time
• Allow individuals to have visitors at any time
A Whole New Set of House Rules
(Or Lack Thereof)
- Continued -

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SECTION 3
These are big changes – and they’re really going to reform
the way that residential services are managed.
To comply with the new rules, agencies will need:
•Significantly more residential options with
plenty of private units
•More integrated buildings and communities
•A system to allow individuals to select their
own units and roommates
•A way to keep track of all individuals’ lease
agreements and their expiration dates
•Client portals to allow individuals access to
their schedules

13. Compliance is King
(A King That Can Terminate Your Waiver)
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SECTION 4
Section 1915(f) of the Act requires the Secretary to monitor
implementation of waivers to assure compliance with all
requirements and also provides for termination of waivers
where the Secretary has found noncompliance.
This new level of authority and the process for termination
of waivers are both addressed in the Final Rule.
A primary concern in the oversight
of 1915(c) HCBS waivers is the
health and welfare of the
individuals supported within the
programs.

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SECTION 4
CMS has included provisions that describe additional
strategies they may employ to ensure state compliance with
the requirements for a waiver, making it more important than
ever to take every precautionary measure to ensure total
compliance before there is an issue.
Technology helps you track and monitor:
• Employees’ qualifications & HR data
• Client information and eligibility expiration dates
• Approved notes and service documentation
• Utilization
• Submitted claims and billing details
The good news is, once you have the right software system
implemented your audit results will be something you brag
about – rather than worry about.

15. The I/DD industry has evolved tremendously over the
past few years – and it’s great to look back and see how
far we’ve come.
At the same time, we still have a long way to go – and it’s
inevitable that technology is a big part of what will get us
there.
For more information on how your agency can prepare,
get in touch!
CONCLUSION
www.medisked.com
866-633-4753
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