We recently attended the Disability Policy Seminar* (DSP) in Washington D.C. along with about 700 other attendees. Each with their own personal stories and issues. Presentations at DPS discussed the status and challenges experienced by states implementing federal regulatory and policy changes for Home and Community-Based Settings Rule (HCBS) in the light of Olmstead, and the Workforce Innovation and Opportunity Act, both of which are having a radical impact on the landscape of IDD supports and services. The HCBS rule mandates that people receiving federal waiver funds must have choice in care and in the setting of care.
Traditional providers are feeling the heat. In states implementing new HCBS programs and wrestling with other new federal rules over the next three years, existing provider systems will need to make big changes, and will need the technology to adapt and successfully manage consumer control/access, reporting, mobility, billing and configurability. Change is coming. Successful organizations need flexible, person-focused technology that can grow with them as policy and funding needs evolve.
Here are some highlights from a general session about the future of Medicaid Home and Community-Based Waivers. Presenters included Karen Summar, Health Policy Director for Senator Charles Grassley’s office; and James Toes, Acting Principal Deputy Director, Administration for Community Living.
- States must implement rules and policies that comply with federal HCBS rules by 2019. Currently, about 19 states are making progress on implementation plans, and the Tennessee state plan was just approved by CMS, but the majority of states have a long way to go.
- States are required to gather significant data about community settings and quality of care. Mitigation plans must be put into place where state rules differ from federal rules.
- There are also fundamental implementation and definitional questions to consider by states implementing the rules, such as: What services or settings would be considered isolating?
- CMS guidance says that a state should include setting and provider requirements that are different from institutional segmented settings. Common programs like Adult day-care, pre-vocational, sheltered workshops, day-habilitation and intermediate care facilities or other settings that isolate people from the broader community, are all impacted.
- A major burden for providers is that additional staff will be required to offer supports in community settings. Providers are concerned that the new HCBS rules will greatly increase cost, while public funding levels remain constant.
- Overall there is a nationwide shortage of affordable housing, and a critical shortage of accessible affordable housing available for people who are newly moving into the community from institutional settings.
- Another implementation challenge: Private managed care companies that are contracted by states to manage disability services, have not worked with IDD populations before, so historical data about the cost for inclusive community-based care is lacking.
Click here to learn more about the Disability Policy Seminar and how policy changes may impact your state.
• American Association on Intellectual and Developmental Disabilities
• The Arc
• Association of University Centers On Disabilities
• National Association of Councils on Developmental Disabilities
• Self-Advocates Becoming Empowered
• United Cerebral Palsy
*DSP was presented by prominent disability advocacy organizations. Sponsoring networks include:
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