Director’s Blog

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Delaware Statewide Transition Plan – Summary and Deadlines

In response to the Home and Community Based Services (HCBS) setting requirements contained in the Final Regulation issued by the Centers for Medicare and Medicaid Services (CMS-2249-F/CMS-2296-F), the Delaware Department of Health and Social Services submitted a Statewide Transition Plan to CMS on March 17, 2015. All transition activities must be completed by March 17, 2019.

The plan is comprised of six phases:

Phase 1 – Work groups convened by the Advisory Council to DDDS will develop survey instruments and processes to assess compliance with the HCBS setting requirements. For DDDS-funded services, this process will begin on April 6, 2015 and is scheduled to be completed by June 30, 2015. The survey process encompasses a review of state laws, regulations, administrative policies, and funding mechanisms, as well as a review of provider services and settings.

Phase 2 – Providers and the work groups convened by the Advisory Council to DDDS will use the survey instruments and processes to assess compliance with the settings requirement. There will be two kinds of assessments completed: a provider self-assessment survey and a “look behind” visit to selected sites conducted by the work groups, which will involve verification of provider self-assessment surveys. These assessments will begin as soon as July 1, 2015 and will be completed by December 31, 2015.

Phase 3 – DDDS will create an inventory of services and settings based on the work done in Phases 1 and 2, identifying which comply, which might comply with “heightened scrutiny” by CMS, and which do not comply. This is the decision-point that will lead to the development of remediation strategies, which could result in new requirements for providers and possible down-sizing or elimination of certain program options. This process is scheduled to begin on January 1, 2016 and will be completed by February 29, 2016.

Phase 4 – DDDS will develop remediation strategies to bring settings that do not comply into compliance with the HCBS settings requirements. These strategies will need to be reported to CMS, and therefore could result in the need for JFC to appropriate additional funding based on assurances that the Delaware HCBS waivers that cover DDDS-funded services will comply with the settings requirements by the March 17, 2019 deadline. This is why DelARF has been advocating for legislative participation in the work groups and general oversight of the Plan. Development of the remediation strategies is scheduled to begin on March 1, 2016 and will be completed by July 31, 2016.

Phase 5 – DDDS will implement remediation strategies. Providers will be given approximately 33 months to make changes in the non-compliant settings, from August 1, 2016 to March 17, 2019.

Phase 6 – DDDS will monitor ongoing compliance, beginning March17, 2019.

As DelARF’s Executive Director, I was actively involved during the focus group meetings that the Division of DD Services held on January 21st and 28th, which gave us an opportunity to give input into the design of the Plan. Several provider organization representatives named by DelARF also represented the interests of our association during the focus group meetings (Jayson Crouch, KSI; Chuck Sipe, Mosaic; Melinda South, Bancroft; and Cindy Sterling, ServiceSource). Other participants included the Advisory Council to the Division of DD Services, the Delaware DD Council, Families Speaking UP!, the Governor’s Advisory Council on Services for Aging and Adults with Physical Disabilities, and The Arc of Delaware.

In the testimony I gave at the public hearing that DMMA held in Newark on February 23rd, I called for “both sides” that emerged since the HCBS settings regulation was published to try to reach consensus about the rights of individuals and families to choose the most integrated setting appropriate. I emphasized the critical importance of finding common ground during Phase 1 of the Plan. DelARF has nominated representatives from day program and residential settings to participate in the work groups being convened by the Advisory Council to the Division of DD Services. I will continue advocating for a full array of service options through the “heightened scrutiny” review process offered in the regulation (for more information about this kind of review, see strict scrutiny). I will use this blog to provide ongoing reports on the work group meetings and other important developments in the months to come.

As I stated most recently in the testimony I gave on the Division of DD Services’ budget, DelARF understands that the requirements for HCBS settings are the biggest change in the administration of federal Medicaid waivers since their inception in the 1980s. Maintaining the status quo is not an option. There is no turning back from the federal mandate for people with disabilities to receive services in the most integrated setting appropriate, as determined by their person-centered planning teams. DelARF wants to partner with families, advocacy organizations, and government officials in the assessment of settings for compliance with the regulation. We support moving forward with any changes that may be appropriate to bring Delaware’s service system into full compliance with the setting requirements, while not abandoning service options that meet the needs of Delawareans with disabilities.

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