From the website: 

In an effort representing years of effort by the Center for Medicare and Medicaid Services, the federal government is calling upon each state to revise its Home and Community Based programs to create a more outcome based definition of home and community based settings.

What this means is the the federal government plans to limit the use of Medicaid Waiver funds unless residential settings can prove that they comply with CMS's new FINAL RULE that seeks to insure that community programs:

• include full access to the greater community
• provide choice within the context appropriate for the individual
• ensure the protection of privacy, dignity and freedom from coercion or restraints
• optimization of autonomy & independence

While many applaud the efforts of the federal and state governments to close state institutions, many wonder the extent to which CMS and DDS will interpret this new FINAL RULE from CMS.

 

All residential programs, including state operated properties, are expected to comply with the following no later than March 16, 2019:

• lease agreements for residents
• lockable bedroom doors and privacy for residents, unless proven clinically inappropriate
• choice in determination of roommates
• the ability to have visitors
• a physically accessible setting if needed by the resident

The state transition plan, released by Mass Health and DDS, cites 14 providers, with a total of 58 settings that may face greater challenges requiring more substantive changes to their programs in order to comply with the CMS Final Rule by March 16, 2019.

 

The 14 providers are programs that are viewed as having campus or congregate living arrangements which may be in conflict with the CMS Final Rule.  The extent to which it is in conflict is a subject of contention between these 14 providers and the state and potentially CMS.

 

Many of the 14 providers are asking both DDS and CMS for greater clarification with regard to the FINAL RULE. Some believe that CMS's outcome oriented definition does not necessarily focus as much on residential settings as it does on total community involvement and integration.  Simultaneously, it appears that state officials believe that CMS may prohibit Medicaid funding of the 14  programs unless these programs restructure.

 

Restructuring could range from extreme measures including closing residential sites with more than five people living together to ceasing operations.   

 

ADDP has established a workgroup headed by New England Village CEO Gail Brown and staffed by ADDP Attorney Tara Hopper Zeltner that is trying to determine the scope of what may be allowed or required by both DDS and CMS in order to maintain operations, federal funding and quality community services for the 58 settings cited by DDS; and determining the likely opportunity for people to remain in their homes and maintain choice of settings. Whether this can be accomplished is in the hands of both the state and federal governments. 

 

The 14 programs are required by DDS and CMS to submit an individual transition plan by September 30, 2015 that outlines how the 58 settings will come into compliance with the FINAL RULE by March 16, 2019.

 

DDS, at the request of ADDP, has agreed to establish as part of the state's transition plan, a workgroup to assist providers in implementing their transition plan.  Providers are concerned about the cost of restructuring, the right of consumer choice and the extent to which CMS interprets and clarifies its FINAL RULE regarding settings.