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DOH Conducts Webinar on HCBS Settings Rule Transition Plan

On Aug. 18th, the Department of Health (DOH) provided an update to the public on the state’s progress in bringing the many Medicaid-covered home and community based programs into compliance with the federal home and community based settings (HCBS) rule. A revised State Transition Plan (STP) is available for review, and public comment will be accepted until Sept. 9, 2016. LeadingAge NY is analyzing the STP and will be providing comment on behalf of our members.

The webinar on Aug. 18th provided an overview from all of the relevant state agencies regarding their aspects of the plan to bring respective providers and settings into compliance. DOH’s aspect of the plan reported on the activities underway to ensure compliance with services provided under the waiver programs and those services provided under the 1115 demonstration waiver. This encompasses the:

  • Nursing Home Transition and Diversion (NHTD) Waiver;
  • Traumatic Brain Injury (TBI) Waiver;  
  • Care at Home (CAH) Waivers I and II;
  • Medicaid Managed Care (MMC);
  • HARP and Non-HARP HCBS;
  • Managed Long Term Care (MLTC);
  • Medicaid Advantage Program (MAP); 
  • Partial Capitation (Partial Cap); and
  • Fully Integrated Duals Advantage (FIDA).

In addition, some services that are or will be provided under contract with managed care are affected, including:

  • Social Adult Day Care;
  • Adult Day Health Care (ADHC); and
  • the assisted living program (ALP).

DOH reports that the CAH, TBI, and NHTD Waivers have a high degree of compliance because the recipients live in their own home, or the home of a family member, friend, relative, or guardian. The TBI Waiver regulations, however, will need to be revised by 2018 to reflect HCBS compliance.

Those services provided under the 1115 Waiver, which include services provided under Mainstream Medicaid Managed Care (MMC), have a “partially compliant” degree of compliance in applicable areas and will be updated by the end of 2018 in order to be compliant with the HCBS final rule.

FIDA, MAP, and Partial Plan Contracts have some “compliant” and “non-compliant” areas; applicable regulations will be revised to be compliant prior to March 2019.

DOH has asked the ALPs to conduct a self-assessment regarding compliance, and will share information regarding assessment by Sept. 23, 2016. DOH will start outreach to those identified as requiring heightened scrutiny by Oct. 3, 2016. From January to March of 2017, DOH will develop ALP survey protocols, conduct training, and then implement the new protocols. Some regulatory changes will be required to both adult care facility and ALP regulations to be in compliance with the federal rule, and will be discussed in the Regulatory Reform workgroup, of which LeadingAge NY is a member.

DOH reports that Social Adult Day Care and ADHC regulations are primarily indicated as “compliant” or "partially compliant." A significant number of ADHC sites will trigger the “heightened scrutiny” standard, and DOH will be planning a meeting, likely in June of 2017, with providers to review aspects of the rule and implications for the ADHC providers. In addition, the state plans to update and revise tools utilized on survey to ensure compliance with the rule. Lastly, DOH anticipates some revisions to regulations to be in compliance with the rule.

Click here to access the slides that were presented during the webinar on Aug. 18th. Click here for more information on the federal HCBS settings rule and the state’s activities to come into compliance with the rule.

LeadingAge NY and the Adult Day Health Care Council have been actively engaged in conversations with DOH and the Centers for Medicare and Medicaid Services (CMS) regarding the rule. We will communicate concerns and questions about implementation on behalf of our members and the people you serve in the public comment process. Members are strongly encouraged to provide comment on the STP as well. Comments should be emailed to HCBSrule@health.ny.gov; please consider sharing a copy of your comments with us.

Contact: Diane Darbyshire, ddarbyshire@leadingageny.org, 518-867-8828