ADDP NEW BANNER 2011
Final CMS Rule on HCBS Residences Refines Definition of Community
ADDP Will Study HCBS Final Rule 
 
ADDP is studying the HCBS Final Rule (42 CFR Part 430, 431 et al.) and recommends that interested ADDP members contact ADDP in order to learn more about the rule, and to discuss the position of our national association (ANCOR). ANCOR members may download the ANCOR analysis of the CMS Final Rule on HCBS free of charge from ANCOR. 

CMS has expressed that they will be working with states to help bring state waivers and transition plans into compliance with the new rule, and may allow a transition period of up to five years for states to comply with the rule under certain circumstances.

Key elements of the state's implementation will be the opportunity for programs to be able to validate the amount and opportunity of community engagement available to people living in HCBS settings.
Tara Hopper Zeltner
Key ADDP contacts for additional information on this issue include Tara Hopper Zeltner, ADDP Director of Governmental Affairs and Attorney, as well as former ADDP Chair, Gail Brown, CEO of New England Village.

 
Feds Focus on Tying Federal Money to ADA

 

Since the passage of the Americans with Disabilities Act in 1991, and the U.S. Supreme Court Court Olmstead decision in 1999, (Olmstead v. L.C., 527 U.S. 581 (1999)) the federal government has been working to align its funding policies with a strong effort focused on persuading states to move aggressively away from congregate living and unnecessary segregation of people with disabilities in both residential and now increasingly in employment settings as well.

This effort has been most prominent in the effort to close state institutions serving people with developmental disabilities.

CMS logo After an internal review and hearing process over the last five years, the Center for Medicaid and Medicare Services (CMS) has published the HCBS Final Rule, advising states of its intention to support further efforts towards community integration, however CMS has declined to offer specific implementation instructions to states.

On May 20, the National Association of Medicaid Directors (NAMD), the National Association of State Directors of Developmental Disabilities Services (NASDDDS), and the National Association of States United for Aging and Disabilities (NASUAD) sent a letter to CMS concerning implementation of the new regulation. While acknowledging CMS' extensive effort to promote integrated living in the community, the letter raises several concerns regarding CMS' expectations for state implementation plans and ongoing compliance activities. The letter recommends two overarching steps that could facilitate a more efficient transition process for states, and ultimately to ensure Medicaid clients will be able to fully integrate into their communities. These steps are:

  • Consistent coordination with several entities within the Department of Health and Human Services (HHS); and
  • Ongoing collaboration with state agencies responsible for overseeing and administering home and community-based systems.

The letter goes on to offer more detailed explanations and recommendations in the following four areas: 

  • Develop a systemic approach to implementation;
  • Convene with states to enhance the understanding of the settings requirement;
  • Ensure consistent messaging from all HHS entities; and
  • Educate audit and program integrity entities. 

The HCBS rule went into effect on March 17, 2014, and states are currently at various stage in implementation and transitioning to the requirements of the rule.  

 

Massachusetts DDS Commissioner Elin Howe is expected to appoint a stakeholder panel to study the impact of the final rule.