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How the Rules are Made
Presented by Aquila “Q” Jordan, JD/MPA
Director of Policy and Regulations
Background
• Previous Director for HCBS Programs
• Director for Policy and Regulation
– Responsible for developing revising and
maintaining the agencies policies and
regulations
– Coordinates with the assistance Secretary on
statutes, reviews, and summarizes federal
statues and regulations for the agency
January 11, 2016
Overview
• Rules & Regulations
• Federal Regulations
– Recent Federal Final Rules
– Federal Rulemaking Process
– Proposed Rules
• State Regulations
– State Rulemaking Process
– Impact of Change on State Regulations
January 11, 2016
Rules & Regulations
Rules are government (federal or state)
statements that either:
– Carry out or explain new or existing law or policy
– Describe the agency’s organization or procedures
Regulations are a set of rules that have legal
connotations (official)
– Promulgated through a specific state or federal
process
– Do not change easily, create the framework for
policies
January 11, 2016
Order of Authority
• Federal Statute – HCBS waiver authority
• Federal Regulation – HCBS Final Rule
• State Statute – Authorizes HCBS in KS
• State Regulation – Application of HCBS
• Agency Policy & Procedures – Program
specific policies connecting all authority
January 11, 2016
Recent Federal Final Rules
Over the last three year there have been a number of crucial statutes and
regulations impact Medicaid and HCBS Programs
• Affordable Care Act
– Increased access to health insurance and Medicaid through state/federal exchanges
– Parents of adult children with disabilities do not pay FUTA, SUTA and FICA
• ABLE Act
– Allows special 529 accounts for individuals with disabilities
– Specifically helps individuals with IDD save up to $14,000 without impacting benefits
• HCBS Final Rule
– Settings = statewide transition plan
– Conflict-free system
– Person centered planning
– www.medicaid.gov
• DOL Final Rule
– Homecare rule
– Fair Labor Standards Act
– www.dol.gov/whd/homcare
January 11, 2016
Federal Regulations
• Online: www.regulations.gov
• Publication method: Federal Register
• Found: Code of Federal Regulations (CFR)
• Statutes: United States Code (U.S.C.)
Example: For Medicaid programs authorized
under the Social Security Administration
HCBS Final Rule is found at 42 CFR § 441.301
(regulation), which is under the Social Security
Act at 42 U.S.C. 1396n (statute).
January 11, 2016
January 11, 2016
Federal Regulation Process
January 11, 2016
October 14, 2015 – Interhab Conference
January 11, 2016
Federal Proposed Rules
• Long Term Care facilities - HHS
– Increased quality assurance requirements/reporting
– Adding comprehensive person centered planning
– Adding requirements for transfers to hospitals
– Comments closed October 14, 2015
• SNAP Benefits - USDA
– Added food delivery for individuals 60 and older
– Pay for food with SNAP, pay for delivery separately
– Comments closed September 14, 2015
January 11, 2016
Federal Proposed Rule (cont’d)
• Managed Care Proposal
– Complete rewrite of the managed care regulation
– Added provisions for managed long term care and
managed long-term services and supports
– Added consumer rights and protections
– Added quality assurance and accountability
– Almost 200 pages of new or revised regulations
– Nearly 400 pages of comments and explanations
– Comments closed July 27, 2015
January 11, 2016
Kansas Regulations
• Online:
http://www.kssos.org/pubs/pubs_kar.aspx
• Publication: Kansas Register
• Found: Kansas Administrative Regulation
(K.A.R.)
• Statutes: Kansas Statutes Annotated
(KSA)
January 11, 2016
Kansas Regulations (cont’d)
Kansas Statutes
• KSA 39-1901 to 1914 - Reorganization
– Statute creating KDADS
– Separates duties and authority from DCF &
KDHE
• KSA 75-59 for KDADS statutes
– NOTE: Some statutes have not had their number
changed and are still found in other sections of
KSA
• KSA 39-6501 et seq = Adult care homes in the KDHE
section of the statutes
January 11, 2016
Kansas Regulations (cont’d)
Kansas Regulations
• Two Books
– 2009 K.A.R. Vol. 1 & 2 = everything up to 12/31/08
– 2015 K.A.R. Supplement = Changes from 1/1/09 t0
12/31/14
• KDADS regulations are found in 3 places:
– K.A.R. ch. 26 = KDADS
– K.A.R. ch. 28 = KDHE
– K.A.R. ch. 30 = DCF
NOTE: eventually all KDADS regulations will be moved to
K.A.R. ch. 26 under KDADS
January 11, 2016
Regulations Pre-rule
• Review of statutory authority
• Review of regulations
– Ex: Update language (i.e. MR to IDD)
– Ex: Comply with federal statutes, regulation
• Draft language for internal review
– Reviewed by KDADS Legal
– Approved by Commissioner & Secretary
– May include stakeholder input
January 11, 2016
Proposed Rule
State Required Concurrence
– Sent to Dept of Administration for approval of content,
structure, and compliance with regulation
– Sent to Attorney General’s office for review of legality
and statutory authority
State Required Documents
– Economic/Environmental Impact Statement
– Copy of proposed regulations
– Notice of Public Hearing
Posted in Kansas Register (60 days before hearing)
January 11, 2016
Public Hearing and Comment
• Public Comment Period from posting through
Hearing
• Joint Committee reviews regulation
– May propose changes to regulations
• Joint Committee Hearing
– Open to public to provide comment on regulations
for committee to hear
– Notes or minutes are taken of the hearing
January 11, 2016
Final Rule
• Revisions recommended by Joint
Committee are made and sent back
through concurrence process (Dept of
Administration and Attorney General)
• Posted in Kansas Register
– At least 10 days before effective
• Added to the K.A.R. Supplemental
January 11, 2016
New or Revised Regulations
• Statewide Transition Plan
– CMS requested states review all statutes and regulations
and list possible changes and dates for updating these as
part of the Statewide Transition Plan
• Compliance with 42 CFR 441.301
– Conflict Free System – conflict free case management
– Person-Centered Planning process (all waivers)
• Moving KDADS regulations from K.A.R. ch. 28
(KDHE) and ch. 30 (DCF)
• Ex: IDD licensing and CDDO authority K.A.R. 30-63 and 30-64
• Waiver Integration
– WISE Workgroup policy and regulation focus group
– Possible changes needed if changes to services,
definitions, or provider qualifications
January 11, 2016
Questions?
January 11, 2016

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How the Rules Are Made - KDADS

  • 1. How the Rules are Made Presented by Aquila “Q” Jordan, JD/MPA Director of Policy and Regulations
  • 2. Background • Previous Director for HCBS Programs • Director for Policy and Regulation – Responsible for developing revising and maintaining the agencies policies and regulations – Coordinates with the assistance Secretary on statutes, reviews, and summarizes federal statues and regulations for the agency January 11, 2016
  • 3. Overview • Rules & Regulations • Federal Regulations – Recent Federal Final Rules – Federal Rulemaking Process – Proposed Rules • State Regulations – State Rulemaking Process – Impact of Change on State Regulations January 11, 2016
  • 4. Rules & Regulations Rules are government (federal or state) statements that either: – Carry out or explain new or existing law or policy – Describe the agency’s organization or procedures Regulations are a set of rules that have legal connotations (official) – Promulgated through a specific state or federal process – Do not change easily, create the framework for policies January 11, 2016
  • 5. Order of Authority • Federal Statute – HCBS waiver authority • Federal Regulation – HCBS Final Rule • State Statute – Authorizes HCBS in KS • State Regulation – Application of HCBS • Agency Policy & Procedures – Program specific policies connecting all authority January 11, 2016
  • 6. Recent Federal Final Rules Over the last three year there have been a number of crucial statutes and regulations impact Medicaid and HCBS Programs • Affordable Care Act – Increased access to health insurance and Medicaid through state/federal exchanges – Parents of adult children with disabilities do not pay FUTA, SUTA and FICA • ABLE Act – Allows special 529 accounts for individuals with disabilities – Specifically helps individuals with IDD save up to $14,000 without impacting benefits • HCBS Final Rule – Settings = statewide transition plan – Conflict-free system – Person centered planning – www.medicaid.gov • DOL Final Rule – Homecare rule – Fair Labor Standards Act – www.dol.gov/whd/homcare January 11, 2016
  • 7. Federal Regulations • Online: www.regulations.gov • Publication method: Federal Register • Found: Code of Federal Regulations (CFR) • Statutes: United States Code (U.S.C.) Example: For Medicaid programs authorized under the Social Security Administration HCBS Final Rule is found at 42 CFR § 441.301 (regulation), which is under the Social Security Act at 42 U.S.C. 1396n (statute). January 11, 2016
  • 8. January 11, 2016 Federal Regulation Process
  • 10. October 14, 2015 – Interhab Conference
  • 12. Federal Proposed Rules • Long Term Care facilities - HHS – Increased quality assurance requirements/reporting – Adding comprehensive person centered planning – Adding requirements for transfers to hospitals – Comments closed October 14, 2015 • SNAP Benefits - USDA – Added food delivery for individuals 60 and older – Pay for food with SNAP, pay for delivery separately – Comments closed September 14, 2015 January 11, 2016
  • 13. Federal Proposed Rule (cont’d) • Managed Care Proposal – Complete rewrite of the managed care regulation – Added provisions for managed long term care and managed long-term services and supports – Added consumer rights and protections – Added quality assurance and accountability – Almost 200 pages of new or revised regulations – Nearly 400 pages of comments and explanations – Comments closed July 27, 2015 January 11, 2016
  • 14. Kansas Regulations • Online: http://www.kssos.org/pubs/pubs_kar.aspx • Publication: Kansas Register • Found: Kansas Administrative Regulation (K.A.R.) • Statutes: Kansas Statutes Annotated (KSA) January 11, 2016
  • 15. Kansas Regulations (cont’d) Kansas Statutes • KSA 39-1901 to 1914 - Reorganization – Statute creating KDADS – Separates duties and authority from DCF & KDHE • KSA 75-59 for KDADS statutes – NOTE: Some statutes have not had their number changed and are still found in other sections of KSA • KSA 39-6501 et seq = Adult care homes in the KDHE section of the statutes January 11, 2016
  • 16. Kansas Regulations (cont’d) Kansas Regulations • Two Books – 2009 K.A.R. Vol. 1 & 2 = everything up to 12/31/08 – 2015 K.A.R. Supplement = Changes from 1/1/09 t0 12/31/14 • KDADS regulations are found in 3 places: – K.A.R. ch. 26 = KDADS – K.A.R. ch. 28 = KDHE – K.A.R. ch. 30 = DCF NOTE: eventually all KDADS regulations will be moved to K.A.R. ch. 26 under KDADS January 11, 2016
  • 17. Regulations Pre-rule • Review of statutory authority • Review of regulations – Ex: Update language (i.e. MR to IDD) – Ex: Comply with federal statutes, regulation • Draft language for internal review – Reviewed by KDADS Legal – Approved by Commissioner & Secretary – May include stakeholder input January 11, 2016
  • 18. Proposed Rule State Required Concurrence – Sent to Dept of Administration for approval of content, structure, and compliance with regulation – Sent to Attorney General’s office for review of legality and statutory authority State Required Documents – Economic/Environmental Impact Statement – Copy of proposed regulations – Notice of Public Hearing Posted in Kansas Register (60 days before hearing) January 11, 2016
  • 19. Public Hearing and Comment • Public Comment Period from posting through Hearing • Joint Committee reviews regulation – May propose changes to regulations • Joint Committee Hearing – Open to public to provide comment on regulations for committee to hear – Notes or minutes are taken of the hearing January 11, 2016
  • 20. Final Rule • Revisions recommended by Joint Committee are made and sent back through concurrence process (Dept of Administration and Attorney General) • Posted in Kansas Register – At least 10 days before effective • Added to the K.A.R. Supplemental January 11, 2016
  • 21. New or Revised Regulations • Statewide Transition Plan – CMS requested states review all statutes and regulations and list possible changes and dates for updating these as part of the Statewide Transition Plan • Compliance with 42 CFR 441.301 – Conflict Free System – conflict free case management – Person-Centered Planning process (all waivers) • Moving KDADS regulations from K.A.R. ch. 28 (KDHE) and ch. 30 (DCF) • Ex: IDD licensing and CDDO authority K.A.R. 30-63 and 30-64 • Waiver Integration – WISE Workgroup policy and regulation focus group – Possible changes needed if changes to services, definitions, or provider qualifications January 11, 2016