The document summarizes new rules from the Centers for Medicare and Medicaid Services (CMS) regarding home and community-based services (HCBS) settings. The rules define HCBS settings and person-centered planning requirements. Settings must be integrated in the community and not isolate individuals. Transition plans are required to bring existing programs into compliance. Public input on assessments and plans is encouraged. The rules aim to enhance HCBS quality and protections while maximizing community inclusion.
The document outlines guidelines for a grassroots participatory budgeting process in the Philippines. It aims to make the national budget more responsive to local needs, strengthen local governance, and encourage civic participation. Key steps include civil society assemblies to elect budget representatives, identifying poverty reduction projects through local planning committees, validating projects, and implementing projects while requiring local government counterpart funds. The process is enhanced for municipalities that have participated in a community-driven development program.
The document outlines Bottom-Up Budgeting (BUB), a budgeting approach used in the Philippines that emphasizes participation of local communities and civil society organizations. The goals of BUB include making the national government more responsive to local needs, strengthening devolution of services, incentivizing local governance reforms, and empowering citizens. BUB requires local poverty reduction action plans be developed with input from local governments and CSOs. The plans inform the budgets of participating national government agencies.
This document summarizes several key provisions of the 2010 health reform law and how they may impact employees. It outlines new restrictions on lifetime and annual dollar limits on coverage, requirements for preventive services coverage without cost sharing, an extension of dependent coverage until age 26, and standards for uniform coverage documents and reporting of medical loss ratios.
This document provides indicators that will be used to assess local governments for the 2022 Seal of Good Local Governance (SGLG) award. It lists the data sources and indicators for the assessment criteria in various areas such as financial administration, disaster preparedness, social protection, health, education, business environment, safety, and environmental management. Requirements are provided for provinces, highly urbanized/independent component cities, and component cities to qualify for the SGLG award.
The document summarizes key points from a civil rights workshop for transit agencies. It discusses increased emphasis by FTA on ensuring compliance with civil rights regulations like Title VI, EEO, and DBE. Programs must be submitted and approved, and reviews will be more in-depth. It provides guidance on updating contact information, requirements for different civil rights programs, changes to DBE goals and public participation requirements to promote inclusiveness.
The Broadband Technology Opportunities Program (BTOP) was established through the American Recovery and Reinvestment Act of 2009 to expand broadband access across the United States. It provides $4.7 billion in competitive grants for broadband infrastructure projects, sustainable broadband adoption programs, and improvements to public computer centers. The National Telecommunications and Information Administration administers BTOP grants and oversees compliance with federal regulations regarding financial management, procurement, record keeping, and environmental reviews.
The document outlines guidelines for locally-identified priority poverty reduction projects to be funded by national government agencies in the Philippines. It describes the process for municipalities to conduct workshops to identify priority projects, have them approved by local government councils, and submit the lists of projects to oversight agencies by certain deadlines. National agencies will accommodate projects within their budgets and include excess projects in special above-ceiling budgets. The document provides details on participating local and national stakeholders and their respective roles in the process.
Wisconsin implemented Medicaid rate reform in two versions to achieve required budget savings while maintaining coverage. Version 1 involved over 200 stakeholders and identified 56 ideas, saving $277 million. Version 2 proposed 36 smaller ideas, like recouping duplicate payments and care coordination, estimated to save $39.7 million through program improvements without major eligibility cuts or benefit reductions. Lessons included engaging stakeholders, considering legislative and staff limitations, and embracing continuous quality improvement.
The document outlines guidelines for a grassroots participatory budgeting process in the Philippines. It aims to make the national budget more responsive to local needs, strengthen local governance, and encourage civic participation. Key steps include civil society assemblies to elect budget representatives, identifying poverty reduction projects through local planning committees, validating projects, and implementing projects while requiring local government counterpart funds. The process is enhanced for municipalities that have participated in a community-driven development program.
The document outlines Bottom-Up Budgeting (BUB), a budgeting approach used in the Philippines that emphasizes participation of local communities and civil society organizations. The goals of BUB include making the national government more responsive to local needs, strengthening devolution of services, incentivizing local governance reforms, and empowering citizens. BUB requires local poverty reduction action plans be developed with input from local governments and CSOs. The plans inform the budgets of participating national government agencies.
This document summarizes several key provisions of the 2010 health reform law and how they may impact employees. It outlines new restrictions on lifetime and annual dollar limits on coverage, requirements for preventive services coverage without cost sharing, an extension of dependent coverage until age 26, and standards for uniform coverage documents and reporting of medical loss ratios.
This document provides indicators that will be used to assess local governments for the 2022 Seal of Good Local Governance (SGLG) award. It lists the data sources and indicators for the assessment criteria in various areas such as financial administration, disaster preparedness, social protection, health, education, business environment, safety, and environmental management. Requirements are provided for provinces, highly urbanized/independent component cities, and component cities to qualify for the SGLG award.
The document summarizes key points from a civil rights workshop for transit agencies. It discusses increased emphasis by FTA on ensuring compliance with civil rights regulations like Title VI, EEO, and DBE. Programs must be submitted and approved, and reviews will be more in-depth. It provides guidance on updating contact information, requirements for different civil rights programs, changes to DBE goals and public participation requirements to promote inclusiveness.
The Broadband Technology Opportunities Program (BTOP) was established through the American Recovery and Reinvestment Act of 2009 to expand broadband access across the United States. It provides $4.7 billion in competitive grants for broadband infrastructure projects, sustainable broadband adoption programs, and improvements to public computer centers. The National Telecommunications and Information Administration administers BTOP grants and oversees compliance with federal regulations regarding financial management, procurement, record keeping, and environmental reviews.
The document outlines guidelines for locally-identified priority poverty reduction projects to be funded by national government agencies in the Philippines. It describes the process for municipalities to conduct workshops to identify priority projects, have them approved by local government councils, and submit the lists of projects to oversight agencies by certain deadlines. National agencies will accommodate projects within their budgets and include excess projects in special above-ceiling budgets. The document provides details on participating local and national stakeholders and their respective roles in the process.
Wisconsin implemented Medicaid rate reform in two versions to achieve required budget savings while maintaining coverage. Version 1 involved over 200 stakeholders and identified 56 ideas, saving $277 million. Version 2 proposed 36 smaller ideas, like recouping duplicate payments and care coordination, estimated to save $39.7 million through program improvements without major eligibility cuts or benefit reductions. Lessons included engaging stakeholders, considering legislative and staff limitations, and embracing continuous quality improvement.
This document discusses eligibility requirements for HUD's multifamily housing programs. It covers determining if families are eligible to receive housing assistance and live in specific subsidized properties. Key factors in determining eligibility include whether a family's income is below program income limits, disclosure of social security numbers, signed consent forms, citizenship status, and other occupancy restrictions depending on the subsidy program. The document provides guidance on using income limits, verifying eligibility, and the variations in eligibility criteria based on the type of housing program.
Equalization fund in kenya power pointFelix Muyove
One of the progressive elements of the Constitution of Kenya,2010 was the recognition of marginalized and minority groups and the specific provision of an Equalization Fund to help in bridging the inequities and inequalities that characterised their marginalization. This Fund was therefore intended to remedy all the shortcomings that arose from marginalization caused by colonial and successive administrations, during and after independence by ensuring that access to basic services including water,roads,health facilities and electricity were brought to the same level as those generally enjoyed by the rest of the nation.
- West Virginia has four Continuums of Care (CoCs) that access HUD homeless funding through an annual competition. Only the Huntington/Cabell and Wayne Counties CoC received adequate funding in 2008.
- The Balance of State (BoS) CoC, which covers all non-urban counties, scored poorly (-33 points out of 100) in areas like strategic planning, data collection, and performance outcomes. As a result, it failed to obtain $1.76 million in funding available.
- To improve scores and funding, the document recommends providing training, technical assistance, and staff support to CoCs, and designating the Governor's Office of Economic Opportunity as the lead agency for the BoS
Georgia broadband deployment initiative overviewState of Georgia
The Georgia Broadband Deployment Initiative aims to expand broadband access in unserved rural areas of the state through mapping, planning, and grant programs as outlined in SB402, the ACE Act. Key activities include developing a statewide broadband map to identify unserved locations, establishing rules for a broadband grant program to fund last mile infrastructure, and coordinating with state agencies and industry stakeholders to achieve connectivity goals. The initiative is led by the Department of Community Affairs and Georgia Technology Authority with input from an advisory committee.
Our autumn planning club of 2016 covered the following topics:
- starter homes and devolution
- environmental impact assessments
- and sustainable urban drainage systems.
https://www.brownejacobson.com/sectors-and-services/sectors/public-sector
Discussion Regarding Land Development Code Amendments for Group Residential UsesCityOfPrescott
The City of Prescott is proposing amendments to its Land Development Code to better regulate group residential uses in single-family neighborhoods. The proposed amendments are intended to define single-family uses and provide criteria to determine whether group residential uses are compatible with single-family neighborhoods or require alternative zoning. If approved, the amendments would classify group homes based on size and relationships between residents, establish permitting processes, and provide operational standards to ensure compatibility with surrounding neighborhoods.
The document summarizes key changes and updates related to employee benefit plans from recent legislation and IRS guidance. It discusses revisions to the Employee Plans Compliance Resolution System (EPCRS) in Revenue Procedure 2019-19, including expanded self-correction options. New hardship distribution rules from the Bipartisan Budget Act of 2018 are explained, such as eliminating the loan requirement. Upcoming deadlines for defined benefit and contribution plan amendments are noted. Provisions of the proposed SECURE Act addressing retirement plans are highlighted.
BabyNet is South Carolina's early intervention program for infants and toddlers under age 3 who have developmental delays or disabilities. It is a statewide system that provides family-centered services through interagency teams. Anyone can refer a child to BabyNet if developmental delays are suspected. Children receive services outlined in their Individualized Family Service Plans to help them meet developmental goals. Before transitioning out of BabyNet, plans are made to help children and families transition smoothly.
Deep Dive: FHA's Small Building Risk Sharing Initiativecdbanks
The document provides an overview of the Small Buildings Risk Sharing Initiative (SBRS) program details from the U.S. Department of Housing and Urban Development. The SBRS program allows qualified lenders called Qualified Participating Entities to share mortgage default risk with HUD on loans for small multifamily affordable housing properties (5 units or more). The overview describes the application and approval process for lenders, eligible project types, underwriting standards, closing process, servicing responsibilities, and plans to utilize the Federal Financing Bank for favorable fixed rate financing under the program.
HUD has issued guidance to encourage more affordable and integrated housing options for people with disabilities following the Olmstead decision. The guidance allows preferences for non-elderly disabled individuals transitioning from institutions into HUD programs like Housing Choice Vouchers and Project-Based Rental Assistance. Section 811 Project Rental Assistance creates new supportive housing by providing rental subsidies to projects financed through Low Income Housing Tax Credits and HOME funds.
Richard Quodomine
Systems Specialist
NYS Department of Transportation
Many communities have completed the first round of Coordinated Transportation Plans. The plans are required to be in place for funding relating to JARC, New Freedom and 5310 projects. The presentation will provide an overview of what the State expects in the second generation of coordinated transportation plans. A major theme of the presentation is: adapt rather than adopt. Best practices will be discussed in detail including:
-Focus on origins, destinations and paths of travel.
-Focus on quality and objectively rating the projects.
-Including stakeholders and keeping them involved.
-Sharing knowledge and encouraging new ideas.
This executive summary provides an overview of the City of Palm Bay's 2011-2016 5 Year Strategic Plan. The plan identifies priority community development needs based on census data, a community survey, and public input. The top priorities are improving public facilities, infrastructure like drainage and roads, and providing assistance to low-income homeowners and renters. The plan will address these needs through activities that provide decent housing, a suitable living environment, and expand economic opportunities for low-income residents, with an emphasis on job creation, training, and access to services. The objectives and outcomes will focus on these national goals over the next five years. The plan evaluates the city's past performance in meeting community needs as it develops this new strategic roadmap
This document provides an overview of Section 1115 Medicaid waivers. It explains that Section 1115 waivers allow the Secretary of HHS to approve experimental projects in state Medicaid programs and waive certain federal requirements. Recently, many states have used waivers to shape their Medicaid programs in new ways. The document outlines the legal standards and process for obtaining waivers, including the requirement that projects be likely to promote Medicaid's objectives. It also discusses how different administrations have interpreted this standard and recent key waiver guidance and court decisions related to Section 1115 waivers.
9/8 THUR 16:00 | DCA Discussion on New Growth Mgt LawAPA Florida
Secretary Billy Buzzett
Mike McDaniel
DCA staff will provide an update on DCA activities, including the role of the Department in rulemaking, implementing new legislation, and providing State oversight in Florida’s growth management system.
This document provides resources for advocates regarding implementation of the Home and Community Based Settings (HCBS) Rule. It outlines the key points of the rule, including that settings must be integrated in the community and ensure participant self-determination. It discusses state transition plan requirements, opportunities for stakeholder engagement, and tips advocates can use to get involved in the process and help ensure full compliance with the rule. Key dates outlined include the rule's effective date of March 2014 and the March 2015 deadline for states to submit transition plans.
The document outlines Florida's plans to ensure Medicaid waiver programs providing services in assisted living facilities and adult family care homes maintain a home-like environment and support full community integration. Key aspects include:
- Requiring facilities to meet characteristics of a home-like setting and allow community participation
- Developing person-centered care plans addressing resident preferences and goals
- Having state agencies and managed care organizations conduct reviews and ensure compliance
New Elder Law Rules for 2017: How legislative, regulatory, and policy updates in 2016 will affect seniors in 2017
Please visit us at https://www.hazenlawgroup.com/ for more information on estate planning, elder law, special needs planning and medicaid.
This document discusses leveraging managed long-term services and supports (MLTSS) to accomplish system objectives. It provides examples from Kansas, Tennessee, and Texas of how MLTSS programs in these states aim to increase access to home and community-based services (HCBS), improve care coordination and quality, and balance long-term care spending between institutional and HCBS. Key levers discussed include capitated rate-setting, performance measures, quality incentives, and flexibility for managed care organizations. Challenges and opportunities for further strengthening MLTSS are also presented.
Practical lessons to develop an STP and ACS - Peter Ware, Browne JacobsonBrowne Jacobson LLP
This document discusses practical considerations for public authorities, such as local authorities and NHS bodies, working together. It outlines the current local government context of reduced funding and increased focus on social care. It then discusses methods that public authorities can use to partner, such as Section 75 agreements, virtual partnerships, and corporate joint ventures. Key considerations for these partnerships include issues around sovereignty of services, staffing, governance, risk sharing, and procurement regulations. Section 75 agreements and powers to cooperate without such agreements are described in detail.
Citizen charters aim to improve governance and public services by establishing commitments between government agencies and citizens. They empower citizens to demand standards of service and help eliminate gaps between citizens and administration. However, citizen charters in India often face problems with vague promises and lack of accountability. Recommendations include clearly outlining remedies for missed standards, consulting stakeholders, and periodically evaluating charters. Overall, properly designed and implemented citizen charters can enhance transparency, accountability and quality of public services.
Entering the Final Stretch - Preparing for New Affordable Care Act ObligationsPSOW
This document summarizes a presentation on how the Affordable Care Act will affect emergency medical organizations as employers and providers. Key points include:
- As employers, emergency organizations with 50 or more full-time employees must comply with "pay or play" rules starting in 2015, which require offering affordable health insurance or paying penalties.
- As providers, emergency organizations will face increased fraud enforcement from expanded oversight and penalties under the ACA. The Office of Inspector General will examine Medicare claims data and review transports for medical necessity.
- All non-grandfathered health plans must cover essential health benefits, including emergency transport services. Presenters advise emergency organizations to understand and prepare for new ACA obligations and opportunities.
The Next Generation ACO Model team hosted an open door forum on Tuesday, March 28, 2017. The Next Generation Model features three payment rule waivers, referred to as benefit enhancements. This open door forum provided an overview of the Model’s three benefit enhancements.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
This document discusses eligibility requirements for HUD's multifamily housing programs. It covers determining if families are eligible to receive housing assistance and live in specific subsidized properties. Key factors in determining eligibility include whether a family's income is below program income limits, disclosure of social security numbers, signed consent forms, citizenship status, and other occupancy restrictions depending on the subsidy program. The document provides guidance on using income limits, verifying eligibility, and the variations in eligibility criteria based on the type of housing program.
Equalization fund in kenya power pointFelix Muyove
One of the progressive elements of the Constitution of Kenya,2010 was the recognition of marginalized and minority groups and the specific provision of an Equalization Fund to help in bridging the inequities and inequalities that characterised their marginalization. This Fund was therefore intended to remedy all the shortcomings that arose from marginalization caused by colonial and successive administrations, during and after independence by ensuring that access to basic services including water,roads,health facilities and electricity were brought to the same level as those generally enjoyed by the rest of the nation.
- West Virginia has four Continuums of Care (CoCs) that access HUD homeless funding through an annual competition. Only the Huntington/Cabell and Wayne Counties CoC received adequate funding in 2008.
- The Balance of State (BoS) CoC, which covers all non-urban counties, scored poorly (-33 points out of 100) in areas like strategic planning, data collection, and performance outcomes. As a result, it failed to obtain $1.76 million in funding available.
- To improve scores and funding, the document recommends providing training, technical assistance, and staff support to CoCs, and designating the Governor's Office of Economic Opportunity as the lead agency for the BoS
Georgia broadband deployment initiative overviewState of Georgia
The Georgia Broadband Deployment Initiative aims to expand broadband access in unserved rural areas of the state through mapping, planning, and grant programs as outlined in SB402, the ACE Act. Key activities include developing a statewide broadband map to identify unserved locations, establishing rules for a broadband grant program to fund last mile infrastructure, and coordinating with state agencies and industry stakeholders to achieve connectivity goals. The initiative is led by the Department of Community Affairs and Georgia Technology Authority with input from an advisory committee.
Our autumn planning club of 2016 covered the following topics:
- starter homes and devolution
- environmental impact assessments
- and sustainable urban drainage systems.
https://www.brownejacobson.com/sectors-and-services/sectors/public-sector
Discussion Regarding Land Development Code Amendments for Group Residential UsesCityOfPrescott
The City of Prescott is proposing amendments to its Land Development Code to better regulate group residential uses in single-family neighborhoods. The proposed amendments are intended to define single-family uses and provide criteria to determine whether group residential uses are compatible with single-family neighborhoods or require alternative zoning. If approved, the amendments would classify group homes based on size and relationships between residents, establish permitting processes, and provide operational standards to ensure compatibility with surrounding neighborhoods.
The document summarizes key changes and updates related to employee benefit plans from recent legislation and IRS guidance. It discusses revisions to the Employee Plans Compliance Resolution System (EPCRS) in Revenue Procedure 2019-19, including expanded self-correction options. New hardship distribution rules from the Bipartisan Budget Act of 2018 are explained, such as eliminating the loan requirement. Upcoming deadlines for defined benefit and contribution plan amendments are noted. Provisions of the proposed SECURE Act addressing retirement plans are highlighted.
BabyNet is South Carolina's early intervention program for infants and toddlers under age 3 who have developmental delays or disabilities. It is a statewide system that provides family-centered services through interagency teams. Anyone can refer a child to BabyNet if developmental delays are suspected. Children receive services outlined in their Individualized Family Service Plans to help them meet developmental goals. Before transitioning out of BabyNet, plans are made to help children and families transition smoothly.
Deep Dive: FHA's Small Building Risk Sharing Initiativecdbanks
The document provides an overview of the Small Buildings Risk Sharing Initiative (SBRS) program details from the U.S. Department of Housing and Urban Development. The SBRS program allows qualified lenders called Qualified Participating Entities to share mortgage default risk with HUD on loans for small multifamily affordable housing properties (5 units or more). The overview describes the application and approval process for lenders, eligible project types, underwriting standards, closing process, servicing responsibilities, and plans to utilize the Federal Financing Bank for favorable fixed rate financing under the program.
HUD has issued guidance to encourage more affordable and integrated housing options for people with disabilities following the Olmstead decision. The guidance allows preferences for non-elderly disabled individuals transitioning from institutions into HUD programs like Housing Choice Vouchers and Project-Based Rental Assistance. Section 811 Project Rental Assistance creates new supportive housing by providing rental subsidies to projects financed through Low Income Housing Tax Credits and HOME funds.
Richard Quodomine
Systems Specialist
NYS Department of Transportation
Many communities have completed the first round of Coordinated Transportation Plans. The plans are required to be in place for funding relating to JARC, New Freedom and 5310 projects. The presentation will provide an overview of what the State expects in the second generation of coordinated transportation plans. A major theme of the presentation is: adapt rather than adopt. Best practices will be discussed in detail including:
-Focus on origins, destinations and paths of travel.
-Focus on quality and objectively rating the projects.
-Including stakeholders and keeping them involved.
-Sharing knowledge and encouraging new ideas.
This executive summary provides an overview of the City of Palm Bay's 2011-2016 5 Year Strategic Plan. The plan identifies priority community development needs based on census data, a community survey, and public input. The top priorities are improving public facilities, infrastructure like drainage and roads, and providing assistance to low-income homeowners and renters. The plan will address these needs through activities that provide decent housing, a suitable living environment, and expand economic opportunities for low-income residents, with an emphasis on job creation, training, and access to services. The objectives and outcomes will focus on these national goals over the next five years. The plan evaluates the city's past performance in meeting community needs as it develops this new strategic roadmap
This document provides an overview of Section 1115 Medicaid waivers. It explains that Section 1115 waivers allow the Secretary of HHS to approve experimental projects in state Medicaid programs and waive certain federal requirements. Recently, many states have used waivers to shape their Medicaid programs in new ways. The document outlines the legal standards and process for obtaining waivers, including the requirement that projects be likely to promote Medicaid's objectives. It also discusses how different administrations have interpreted this standard and recent key waiver guidance and court decisions related to Section 1115 waivers.
9/8 THUR 16:00 | DCA Discussion on New Growth Mgt LawAPA Florida
Secretary Billy Buzzett
Mike McDaniel
DCA staff will provide an update on DCA activities, including the role of the Department in rulemaking, implementing new legislation, and providing State oversight in Florida’s growth management system.
This document provides resources for advocates regarding implementation of the Home and Community Based Settings (HCBS) Rule. It outlines the key points of the rule, including that settings must be integrated in the community and ensure participant self-determination. It discusses state transition plan requirements, opportunities for stakeholder engagement, and tips advocates can use to get involved in the process and help ensure full compliance with the rule. Key dates outlined include the rule's effective date of March 2014 and the March 2015 deadline for states to submit transition plans.
The document outlines Florida's plans to ensure Medicaid waiver programs providing services in assisted living facilities and adult family care homes maintain a home-like environment and support full community integration. Key aspects include:
- Requiring facilities to meet characteristics of a home-like setting and allow community participation
- Developing person-centered care plans addressing resident preferences and goals
- Having state agencies and managed care organizations conduct reviews and ensure compliance
New Elder Law Rules for 2017: How legislative, regulatory, and policy updates in 2016 will affect seniors in 2017
Please visit us at https://www.hazenlawgroup.com/ for more information on estate planning, elder law, special needs planning and medicaid.
This document discusses leveraging managed long-term services and supports (MLTSS) to accomplish system objectives. It provides examples from Kansas, Tennessee, and Texas of how MLTSS programs in these states aim to increase access to home and community-based services (HCBS), improve care coordination and quality, and balance long-term care spending between institutional and HCBS. Key levers discussed include capitated rate-setting, performance measures, quality incentives, and flexibility for managed care organizations. Challenges and opportunities for further strengthening MLTSS are also presented.
Practical lessons to develop an STP and ACS - Peter Ware, Browne JacobsonBrowne Jacobson LLP
This document discusses practical considerations for public authorities, such as local authorities and NHS bodies, working together. It outlines the current local government context of reduced funding and increased focus on social care. It then discusses methods that public authorities can use to partner, such as Section 75 agreements, virtual partnerships, and corporate joint ventures. Key considerations for these partnerships include issues around sovereignty of services, staffing, governance, risk sharing, and procurement regulations. Section 75 agreements and powers to cooperate without such agreements are described in detail.
Citizen charters aim to improve governance and public services by establishing commitments between government agencies and citizens. They empower citizens to demand standards of service and help eliminate gaps between citizens and administration. However, citizen charters in India often face problems with vague promises and lack of accountability. Recommendations include clearly outlining remedies for missed standards, consulting stakeholders, and periodically evaluating charters. Overall, properly designed and implemented citizen charters can enhance transparency, accountability and quality of public services.
Entering the Final Stretch - Preparing for New Affordable Care Act ObligationsPSOW
This document summarizes a presentation on how the Affordable Care Act will affect emergency medical organizations as employers and providers. Key points include:
- As employers, emergency organizations with 50 or more full-time employees must comply with "pay or play" rules starting in 2015, which require offering affordable health insurance or paying penalties.
- As providers, emergency organizations will face increased fraud enforcement from expanded oversight and penalties under the ACA. The Office of Inspector General will examine Medicare claims data and review transports for medical necessity.
- All non-grandfathered health plans must cover essential health benefits, including emergency transport services. Presenters advise emergency organizations to understand and prepare for new ACA obligations and opportunities.
The Next Generation ACO Model team hosted an open door forum on Tuesday, March 28, 2017. The Next Generation Model features three payment rule waivers, referred to as benefit enhancements. This open door forum provided an overview of the Model’s three benefit enhancements.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
This document discusses the CMS Final Rule on home and community-based services (HCBS). It covers three main areas: person-centered planning, developing a conflict-free HCBS system, and transitioning HCBS settings to be fully compliant with the rule. It provides an overview of the rule's requirements and best practices for states to establish a conflict-free system, including separating eligibility and assessment functions from direct service provision and establishing safeguards for any exceptions. The document also discusses mitigating conflicts of interest in areas like guardianship and targeted case management.
This document provides an overview of the latter stages of the neighbourhood planning process, including submission of the plan, examination, and referendum. It discusses the basic conditions that plans must meet, the examination process conducted by an independent examiner, and timelines which typically include around 20-25 weeks from submission to adoption. Resources and support available to communities developing plans are also outlined.
The document provides a service specification for residential respite services for adults with learning disabilities. It outlines the need for the service, principles and standards, service users, access, activities, and outcomes. The service aims to provide short stay residential care on an overnight basis to support positive outcomes for adults with learning disabilities in all aspects of life. It will be person-centered and promote rights, autonomy, independence and choice. Performance will be monitored based on outcomes in areas like exercising choice and control, health and wellbeing, and personal dignity and respect.
The document provides a service specification for residential respite services for adults with learning disabilities. It outlines the need for the service, principles and standards, service users, access, activities, and outcomes. The service aims to provide short stay residential care on an overnight basis to support positive outcomes for adults with learning disabilities in all aspects of life. It will be person-centered and promote rights, autonomy, independence and choice. Performance will be monitored based on outcomes in areas like exercising choice and control, health and wellbeing, and personal dignity and respect.
This document discusses trends in Medicaid Section 1115 waivers. It provides an overview of the National Association of Medicaid Directors (NAMD), which supports state Medicaid directors. The rest of the document summarizes key topics discussed in a NAMD presentation on Section 1115 waivers, including why states use them, operational aspects like stakeholder engagement and budget neutrality, and trends in waiver policies around community engagement, pharmacy benefits, delivery system reform, and behavioral health integration. The document concludes by providing additional NAMD resources on these topics.
Integration and the Better Care Fund - DFG Champions Roadshows 2017Foundations HIA
The document provides an overview of the Better Care Fund (BCF) program in the UK, which brings together health and social care funding. It discusses how the Disabled Facilities Grant (DFG) is an integral part of delivering BCF plans by funding home adaptations. The main changes for 2017-2019 include a two-year planning cycle, reduced national conditions, and increased funding contributions. Examples are given of how the DFG has been used through the BCF to fund home adaptations that support independent living and reduce hospital admissions.
This webinar presentation summarized key aspects of Ontario's Housing Services Act, 2011 and related regulations. It discussed changes to rent-geared-to-income assistance rules, special priority housing eligibility, and opportunities for advocacy around local housing and homelessness plans, social housing appeals processes, and the setting of local rules by service managers. The webinar concluded by emphasizing the importance of ongoing monitoring and participation in developing local rules and plans to advocate for the needs of tenants and those in need of affordable housing.
This presentation covers protections afforded to enrollees and providers participating in the Long-term Care aspect of Florida's Statewide Medicaid Managed Care program.
In this webinar, Roberta Newton, manager of the Los Angeles Office of the State Council on Developmental Disabilities speaks about:
> The importance of the Centers for Medicare and Medicaid Services (CMS) and Home & Community Based Services (HCBS) for people with developmental disabilities and their families.
> What changes are coming to HCBS and and how people with developmental disabilities will be affected.
> How to prepare for and participate in the development of new HCBS regulations.
The Care Act - Consultation on guidance and regulations: Personalisation and ...Think Local Act Personal
The document discusses regulations and guidance related to personalization and care planning under the Care Act. It provides an overview of key aspects of the Care Act related to personalization, including placing personal budgets into law and clarifying rights to direct payments. It then outlines guidance on personalization and regulations regarding exclusions from personal budgets and direct payments. Finally, it poses consultation questions on these topics.
This document discusses different structures that developmental disability councils use to conduct business, such as committee structures and the use of workgroups. It provides an overview of the types of committees most councils currently use, which are mostly operational rather than focused on policy issues. The document poses questions for councils to consider about how they structure committees and workgroups, including their purpose, how staff support is provided, and how to maximize member effectiveness and involvement. It recommends councils take an intentional look at their structures and roles to ensure they are appropriately aligned with the council's mission and goals.
This document outlines a diversity strategy for the Administration for Community Living (ACL). It aims to maximize participation for all people with disabilities, older adults, their families and caregivers. The strategy has four main outcomes: 1) Build ACL's cultural competence capacity; 2) Increase diversity of leadership, staff and governing bodies across the disability network; 3) Build cultural competence capacity within leadership, staff and governing bodies; 4) Implement culturally competent practices across the disability network. It lists specific tasks and timelines to achieve these outcomes, such as developing cultural competence training, assessing current practices, and increasing outreach. The strategy is a collaborative effort between ACL, its programs, and partners like universities and advocacy organizations.
The document discusses obesity rates among people with and without disabilities. It finds that in all states, obesity rates are higher for those with disabilities, indicating inequities in health promotion. Public health professionals are encouraged to include disability data in surveillance efforts and ensure people with disabilities are included in health programs. Tables of data from all US states and territories show the prevalence of obesity is an average of 13.8 percentage points higher among those with disabilities.
The Maternal and Child Health Bureau (MCHB) is responsible for promoting and improving the health of mothers and children in the United States. MCHB administers the Title V Maternal and Child Health Services Block Grant program and other key programs. Through Title V, MCHB partners with states and communities to strengthen infrastructure for maternal and child health and build knowledge and resources. MCHB aims to address health disparities and social determinants of health to promote optimal health across lifespan.
The Disability and Health Data System (DHDS) is an online tool that provides instant access to state-level health data on adults with and without disabilities. Users can view over 70 indicators such as obesity, smoking, and access to healthcare. The data comes from the Behavioral Risk Factor Surveillance System. DHDS identifies differences in health outcomes between those with and without disabilities, and can help organizations develop programs to improve health for people with disabilities.
The document discusses how federal agencies like the Administration for Community Living (ACL), Centers for Disease Control and Prevention (CDC), and Health Resources and Services Administration (HRSA) influence state-level discussions and the role of Developmental Disabilities (DD) Councils in shaping state actions. It provides an overview of each agency's mission and priorities and poses discussion questions for DD Councils around collaborating with these agencies on issues like aging services, health data, obesity prevention, maternal/child health programs, and healthcare transitions. The document aims to facilitate conversations between federal agencies and DD Councils on aligning efforts to support individuals with intellectual and developmental disabilities.
This document discusses various strengths-based frameworks that can be used for community planning, including asset-based community development, appreciative inquiry, and essentialism. It provides an overview of each approach and how they emphasize identifying community strengths and assets, envisioning positive futures, and focusing efforts on a few high-impact areas. The document proposes using an appreciative inquiry process to develop values and beliefs, engage with stakeholders, and create a new five-year plan that applies these frameworks.
The document discusses the Oregon Consortium of Family Networks and supporting families of children with intellectual and developmental disabilities (IDD). It notes that families will continue to be the primary support for children with IDD and that families must receive support to have the capacity to provide that support. It emphasizes empowering both families of children with disabilities and communities to support those families and children. It promotes a vision of full life in the community for individuals with disabilities through a person-centered planning approach.
This document discusses supported decision-making as an alternative to guardianship for people with disabilities. It defines supported decision-making as relying on trusted relationships to help individuals make and communicate their own decisions. The document outlines goals to increase awareness and availability of supported decision-making, such as establishing a task force and improving protections for supported decision-making options. It also notes limitations of guardianship laws in Washington State and the need to better monitor guardians and respect individuals' choices.
The National Center on Birth Defects and Developmental Disabilities (NCBDDD) at the Centers for Disease Control and Prevention (CDC) was established in 2001 to promote health and enhance lives of those with disabilities. It conducts research and surveillance on conditions like autism and intellectual disabilities through programs such as the Autism and Developmental Disabilities Monitoring Network. The NCBDDD aims to understand risk factors and improve early identification and intervention to help individuals live fulfilling lives.
This document discusses the National Center for Prenatal and Postnatal Down Syndrome Resources at the University of Kentucky's Human Development Institute. It provides summaries of two families' experiences receiving a Down syndrome diagnosis, noting that accurate and balanced information is not always provided. It also outlines the center's efforts to promote state laws requiring medical providers give expectant parents information on Down syndrome diagnoses, including websites, materials, and recommended organizations. The center works to shift to a more balanced medical model surrounding Down syndrome and supports expectant parents through difficult diagnosis experiences.
The document summarizes the Department of Justice's enforcement of the Olmstead decision, which found unjustified segregation of people with disabilities to be a form of discrimination under the Americans with Disabilities Act. It discusses DOJ's objectives to promote community integration and informed choice. It provides examples of DOJ's enforcement actions in different states through investigations, litigation, and settlement agreements requiring expansion of community-based services and supports. It also discusses DOJ's efforts related to employment and day services for people with disabilities.
The document discusses the Convention on the Rights of Persons with Disabilities ("Disabilities Treaty"), an international agreement that aims to protect the rights of Americans with disabilities when traveling abroad. Ratifying this treaty would help promote accessibility standards globally and provide the same protections for people with disabilities internationally as are required domestically by the Americans with Disabilities Act. Ratification would create new markets for U.S. businesses abroad and reinforce America's global leadership on disability rights issues. Both Republican and Democratic senators have urged supporting the treaty to further equality, access, and inclusion for Americans with disabilities both in the U.S. and internationally.
This document discusses opportunities for state councils on developmental disabilities (DD Councils) to engage with initiatives related to home and community-based services (HCBS). It outlines key issues with managed long-term services and supports (MLTSS) programs and the role DD Councils can play in stakeholder engagement, promoting choice, and ensuring consumer protections. The document also discusses the Community First Choice Option and opportunities for DD Councils to engage with the further development of Aging and Disability Resource Centers.
1) New Jersey has established a managed care system for over 10 years for children's behavioral health services and more recently expanded this to include children and youth with intellectual and developmental disabilities (I/DD).
2) PerformCare is the administrative service organization that manages access and funding for services for children through the Children's System of Care, including respite care and summer camps.
3) Concerns have been raised about whether managed care organizations provide adequate care coordination for individuals in the system who receive services from multiple providers and about lack of consistent support for families from PerformCare.
This document summarizes the key findings from focus groups with adults with developmental disabilities living in small cities and towns in Arizona. The focus groups aimed to understand their daily lives and unique challenges. Many participants reported difficulties with transportation and access due to physical barriers and lack of transportation options. They also experienced limited social networks and leisure activities due to where they lived and reliance on staff. While satisfied with their living situations, many expressed a desire for more independent housing options. Barriers to employment included employers' biases, negative perceptions of their abilities, and fears about losing benefits. Participants advocated for more local self-advocacy and information to gain independence and have their voices heard. Next steps discussed how to expand support networks and opportunities outside of the
This document summarizes Kansas' transition to a managed care system called KanCare from 2014. It discusses the previous fee-for-service system and outlines concerns with the KanCare pilot program. Key points include that the pilot was not a true test of the capitated, integrated managed care model and had issues with billing and payment. It also notes advocacy efforts that helped address some concerns but that continued monitoring is still needed to ensure the system works well and does not harm those it serves.
The document provides an overview of efforts by several states - Connecticut, Missouri, Tennessee, and Washington - to support families who have members with intellectual and developmental disabilities (I/DD) through the lifespan as part of a national Community of Practice. The states are working on initiatives like reframing their messaging to focus on supporting families, developing tools and materials to help families navigate services, and enhancing cross-agency collaboration to provide integrated supports. They are also gathering input from families to inform their efforts. The Developmental Disabilities Councils in these states are involved in the work by providing resources, disseminating information, and engaging stakeholders.
The document discusses managed long-term supports and services (MLTSS) in Louisiana. It recommends that MLTSS in Louisiana include all populations, have any savings invested in reducing the long waiting list for services, include employment supports, and allow members to retain their current providers during initial enrollment. Additionally, it recommends MLTSS integrate long-term services and supports with primary, acute, and behavioral health services and include accountability standards for managing care organizations. The document also provides updates on Louisiana's development of MLTSS, including the state's plans to pursue Medicaid waivers and procurements.
More from National Association of Councils on Developmental Disabilities (20)
2. Overview of CMS 2249-F and 2296-F
Title:
Medicaid Program; State Plan Home and Community-Based
Services, 5-Year Period for Waivers, Provider Payment
Reassignment, and Home and Community-Based Setting
Requirements for Community First Choice (Section 1915(k) of
the Act) and Home and Community-Based Services (HCBS)
Waivers (Section 1915(c) of the Act)
• Published Federal Register 1/16/2014
3. Highlights
• Defines, describes, and aligns home and community-based
setting requirements across three Medicaid authorities
1915 (i) (c) (k)
• Defines person-centered planning requirements for
persons in HCBS settings under 1915(c) HCBS waiver and
1915(i) HCBS State Plan authorities
• Implements regulations for 1915(i) HCBS State Plan benefit
4. What CMS intends
• The home and community-based setting requirements
establish an outcome oriented definition that focuses on
the nature and quality of individuals’ experiences
• The requirements maximize opportunities for individuals to
have access to the benefits of community living and the
opportunity to receive services in the most integrated
setting
• Implementation should enhance the quality of HCBS and
provide protections to participants
5. The Main ideas
• HCB Settings Characteristics
– What are NOT home and community-based
– What are presumed not to be HCBS
– What are the mandatory requirements for HCBS, including
Secretarial discretion to determine other qualities
• Person-centered service planning now in code
• Conflict-free case management now in code
• Transition planning to come into compliance with the HCB
settings requirements
6. What is NOT HCBS is a short list
• Settings that are NOT Home and Community-based:
– Nursing facility
– Institution for mental diseases (IMD)
– Intermediate care facility for individuals with
intellectual disabilities (ICF/IID)
– Hospital
7. Settings PRESUMED not to be HCBS
• Settings in a publicly or privately-owned facility providing
inpatient treatment
• Settings on grounds of, or adjacent to, a public institution
• Settings with the effect of isolating individuals from the broader
community of individuals not receiving Medicaid HCBS
These settings may NOT be included in states’ 1915(c), 1915(i) or
1915(k) HCBS programs unless:
• A state submits evidence (including public input) demonstrating
that the setting does have the qualities of a home and
community-based setting and NOT the qualities of an institution;
AND
• The Secretary finds, based on a heightened scrutiny review of
the evidence, that the setting meets the requirements for home
and community-based settings and does NOT have the qualities
of an institution
8. Qualities of an HCBS Setting
The Home and Community-Based setting:
• Is integrated in and supports access to the greater
community
• Provides opportunities to seek employment and work in
competitive integrated settings, engage in community life,
and control personal resources
• Ensures the individual receives services in the community
to the same degree of access as individuals not receiving
Medicaid home and community-based services
9. Mandatory qualities
• The setting is selected by the individual from among setting
options, including non-disability specific settings and an
option for a private unit* in a residential setting
• Person-centered service plans document the options based
on the individual’s needs, preferences; and for residential
settings, the individual’s resources
• *States must have options available for individuals to potentially choose a
private room
• Does NOT mean all providers must now offer or provide private rooms
• Note above, planning can take into effect the “individual resources”
10. Further qualities
• Ensures an individual’s rights of privacy, dignity,
respect, and freedom from coercion and restraint
• Optimizes individual initiative, autonomy, and
independence in making life choices
• Facilitates individual choice regarding services and
supports, and who provides them
• These requirements exist for services provided in the
individual’s own home as well.
11. Home and Community-Based Setting Requirements for
Provider-Owned or Controlled Residential Settings
• Specific unit/dwelling is owned, rented, or occupied under
legally enforceable agreement
• Same responsibilities/protections from eviction as all
tenants under landlord tenant law of state, county, city or
other designated entity
• If tenant laws do not apply, state ensures lease, residency
agreement or other written agreement is in place providing
protections to address eviction processes and appeals
comparable to those provided under the jurisdiction’s
landlord tenant law
12. Other requirements in provider owned or controlled
• Each individual has privacy in their sleeping or living unit
• Units have lockable entrance doors, with appropriate staff
having keys to doors as needed
• Individuals sharing units have a choice of roommates
• Individuals have the freedom to furnish and decorate their
sleeping or living units within the lease or other agreement
• Individuals have freedom and support to control their
schedules and activities and have access to food any time
• Individuals may have visitors at any time
• Setting is physically accessible to the individual
13. Rules cover Non-Residential services as well
• CMS will release guidance for bringing
non-residential services and settings into
compliance at a later date
• This guidance will include day services, day
habilitation, adult day care, pre-employment
services, sheltered work, and other day and
employment services.
14. Transition Planning
• For NEW 1915(c) HCBS waivers or 1915(i) HCBS State Plan
benefits to be approved, states must ensure that HCBS are only
delivered in settings that meet the new requirements. [(K)
approvals were expected to be compliant upon submission]
For renewals and amendments to existing HCBS 1915(c) waivers
submitted within one year of the effective date of final rule:
• The state submits a plan in the renewal or amendment request
detailing necessary actions to achieve or document compliance
with setting requirements for the specific waiver or amendment
• Renewal or amendment approval will be contingent upon
inclusion of an approved transition plan for that waivers services
15. 1915(i) state plan amendments
For renewals and amendments to existing 1915(i) state plan
benefits submitted within one year of the effective date of
final rule:
• The state submits a plan in the State Plan Amendment
(SPA) or renewal (for 1915(i)s that target) request detailing
any actions necessary to achieve or document compliance
with setting requirements for the specific waiver or
amendment
• SPA approval or renewal of the 1915(i) will be contingent
upon inclusion of an approved transition plan
16. Statewide Transition Plan
For ALL existing 1915(c) HCBS waivers and 1915(i) HCBS State
Plan benefits in the state, the state must submit a plan:
• Within 120 days of first renewal or amendment request
detailing how the state will comply with the settings
requirements in ALL 1915(c) HCBS waivers and 1915(i)
HCBS State Plan benefits
• The level and detail of the plan will be determined by the
types and characteristics of settings used in the individual
state
17. By March 16, 2015
When a state DOES NOT renew or amend an existing 1915(c)
HCBS waiver or 1915(i) HCBS State Plan benefit for HCBS
within one year of the effective date of the final rule, the plan
to document or achieve compliance with settings
requirements must:
• Be submitted within one year of the effective date of the
final rule (March 17, 2014)
• Include all elements, timelines, and deliverables as
required
18. Approaching Transition Planning
• CMS has not released guidance on developing the Transition Plan. So
what are states doing? Where can they start?
– Each state’s waiver and state plan service system has structure –
service definitions, reimbursement rates, certification and
licensure requirements, quality standards, etc. that establish
expectations, provide guidance and measure performance in
the services.
– A good first step would be to review and assess these state
standards, policies and practices to determine whether they are
aligned with the Federal requirements and then plan to make
the necessary modifications.
19. Stakeholder involvement
• The process of self-assessment is best conducted with
stakeholders including self-advocates, families, advocates and
providers.
– The rule does not require public or stakeholder
engagement in this review process. However, CMS
has said stakeholder engagement “early and often” is
helpful to the state in preparing a solid transition
plan.
• This process of involvement can help to build support for needed
changes and prepare providers to make necessary changes to their
program.
20. Here are some of the components to consider in assessing
infrastructure and need for modifications:
1. Service definitions
2. Service standards and requirements
Regulations
Provider qualifications
Training requirements
3. Service contracts, rate methodology, billing and adequacy of rates
4. Person-centered planning requirements and documentation
5. Quality Management Practices
Individual plan monitoring requirements – support coordination
UR practices
Provider monitoring – licensing, certification
Performance outcome measurement – using National Core
Indicators
Provider Reporting requirements
6. Information Systems
21. Public Input is Required
• Under 1915(c) rules, waiver amendments and renewals
must be posted for 30 day public comment
• Under the new HCBS Rule, all statewide transition plans
must be posted for public comment for 30 days.
• There is no requirement in the rule for states to engage the
public in the assessment process, but CMS has said that
public engagement “early and often” is encouraged.
• Advocates believe it is necessary to engage on the
assessment activity.
22. Public Comment Requirements
• The state must provide at a minimum 2 statements of
public notice and public input procedures
• Must ensure the full Transition plan(s) is available to the
public for comment
• The state must submit with the Transition Plan evidence of
the public notice; a summary of comments received during
the comment period, reasons why comments were not
adopted, and any modifications made to the plan as a
result of the comments.
• State must retain the public comments in their entirety
23. Person Centered Planning in Official
Regulations
• Person-centered planning has been incorporated in the
delivery of services to older adults and people with
disabilities for many years. For the first time, the HCBS
settings rule puts the requirements for person-centered
planning into regulation – known in the HCBS rule as
“person centered service planning.”
24. Coherence with ACA
• On June 6, 2014 Secretary Sebelius signed guidance to HHS
agencies on standards for person-centered planning and
self-direction of HCBS that should be embedded in all HHS
funded HCBS programs as appropriate. The guidance is
consistent with the final rule from the Centers for Medicare
& Medicaid Services on Medicaid HCBS, and meets the
requirement in section 2402(a) of the Affordable Care Act
for a more consistent administration of policies and
procedures across programs. This guidance is the
Department’s first step in implementing section 2402(a).
25. ACA 2402(a)
• Section 2402(a) of the Affordable Care Act requires the
Secretary to ensure all states receiving federal funds
develop service systems that are responsive to the needs
and choices of beneficiaries receiving home and
community-based long-term services (HCBS), maximize
independence and self-direction, provide support
coordination to assist with a community-supported life, and
achieve a more consistent and coordinated approach to the
administration of policies and procedures across public
programs providing HCBS.
26. 2402(a)
• Outlines the standards for person-centered planning (PCP)
and self-direction (SD) that should be reflected in all HHS
programs that fund or provide HCBS.
• The standards in this guidance should be used in future
program regulations, program policies, funding
opportunities, technical assistance contracts, grant
opportunities, and other programs funding HCBS.
27. 2402(a)
• The guidance for the steps in the PCP process, as well as
the steps that must be taken when a person’s services are
modified in any way mirror the steps in the HCBS settings
rule.
• The settings rule and the 2402(a) guidance can go a long
way toward establishing coherence and consistency in
person-centered planning and self-direction for all
individuals benefitting from HHS services.
28. HCBS Settings Rule: STEPS
• The person-centered plan process has 5 steps:
• Independent evaluation and determination of eligibility (for
state plan services (i)
• An independent assessment (for state plan services)
• The person-centered service planning meeting
• Writing the person-centered service plan
• Reviewing the plan
29. Independent Evaluation / Eligibility
• Evaluation of the individual’s eligibility for the state plan
benefit is performed by an agent that is qualified and
independent.
• Applies the needs-based criteria the state has established
under 441.715(a) (individual’s need for support)
• Includes consultation with the individual and / or the
individual’s representative
• Uses current and accurate information from existing
records
• Must be re-determined at least every 12 months
30. Independent Assessment
• The supports and services the individual needs, how much
they need, and how long they need them is discovered
during an independent assessment.
• May include a standardized functional needs assessment.
• The agent doing the assessment must be qualified and
independent of the service provider
• The assessment must be face to face, or through the use of
health technology provided certain conditions are met.
31. Independent Assessment
• Includes an opportunity for the individual to identify other
persons to be consulted such as spouse, guardian, family,
and other treating professionals
• Examines the individual’s relevant history
• Includes assessment of mental and physical health, needs
for support in areas of cooking, shopping or banking, where
the individual wants to live, their goals, who they would like
to provide services, etc
• If unpaid caregivers will be relied upon to implement any
elements of the plan, a caregiver assessment.
32. Independent Assessment
• Information from the assessment helps the team and the
individual plan services and supports.
• During the planning process the team should find creative
ways to help the individual meet their goals whether or not
there are specific services and supports available.
• The individual must be given the option to self-direct their
services, including getting training or education on how to
self-direct.
33. Person-Centered Planning Meeting
• The individual can invite anyone they want. Interpreters or
communication device should be provided if needed.
• Meeting must be held in a manner that respects the
individual’s culture and is conducted in a language the
individual understands.
• It should be clear how conflicts or differences among team
members will be resolved.
34. Plan Process
• The process should offer the individual choices about the
types of services they want, where they want them
delivered, information on residential options, where they
spend their day, and why those choices were made.
• Include who will provide services, including day service and
living options that are not only with other people with
disabilities.
• The plan can be changed or updated at the individual’s
request, but must be renewed at least annually.
35. The written plan should include:
• Options presented to the individual about where to live and
what was chosen and why.
• Where the individual chose to receive other services, like
supported employment.
• The individual’s strengths, preferences and needs.
• The supports needed, both paid and unpaid.
• Things the individual wants to accomplish (goals) and how
they will know they have achieved them (outcomes).
36. The plan must also:
• Note any risks the individual might encounter and plans to
deal with them.
• Include the name of the person responsible for making sure
the plan is followed.
• Be written in plain language that the individual
understands.
• Include the signatures of everyone who participated, and
everyone should get a copy.
A plan can be modified at any time, at the individual’s request,
or if their circumstances change.
37. When an individual’s setting or service must be
modified
• Sometimes, in order for a person with a disability to be
well-supported and safe in the community, there must be
some modifications made. For example, some people
cannot have unlimited access to food because of the risk to
their health. If an individual needs special supports or
modifications where they live or receive services, those
need to be written into their person-centered plan under a
special set of rules.
38. Requirements for Modifying HCBS service or
setting
• The PCP must identify the specific and individual assessed
need.
• The PCP must document the interventions and supports
that were tried prior to modifying the plan.
• The PCP must describe less intrusive methods of meeting
the need that were tried but did not work.
• The plan must include a clear description of the condition
that is directly proportionate to the specific assessed need.
39. Requirements for Modifying HCBS service or
setting
• The plan is reevaluated regularly to review whether the changes
in the individual’s plan are working to help them meet their
goals (data collection and review of data).
• The plan must include time limits on the restrictions on the
individual’s freedoms. The changes should only stay in their plan
for as long as they are needed.
• The plan must explain to the individual in language they can
understand what the changes are, why the changes are being
made and the individual’s informed consent must be included in
the plan.
• The plan must include assurances that the changes will not harm
the individual.
40. For More Information:
Patricia Nobbie, Ph.D.
Center for Disability and Aging Policy
Administration for Community Living
Patricia.nobbie@acl.hhs.gov
http://HCBSadvocacy.org AUCD Informational Website
www.cms.gov
http://www.medicaid.gov/HCBS All materials generated by
CMS. Where to watch for future guidance.
hcbs@cms.hhs.gov: mailbox for additional questions to CMS
Editor's Notes
16 states have (i) waivers
Under state plan Benefit
These modification refer to individuals residing in provider owned or controlled settings.