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NHTD/TBI Waiver Transition Workgroup Update

The Nursing Home Transition & Diversion (NHTD)/Traumatic Brain Injury (TBI) Waiver Transition Workgroup met on April 11th to cover several issues, including the postponement of the transition to Managed Long Term Care until Jan. 1, 2022, per the newly enacted state budget.

The Department provided several updates on RFPs and RFAs relating to the NHTD and TBI Housing Subsidy program, Regional Resource Development Centers (RRDCs), and Person-Centered Care Training via the Money Follows the Person program. Officials also provided an overview of the Money Follows the Person program and statistics of the NHTD/TBI Waiver Programs.

HCBS Settings Rule

Mark Kissinger, Special Advisor to the Commissioner of Health, provided an overview of the Home and Community-Based Services (HCBS) Settings Rule and indicated that the final rule’s standards apply to all settings where HCBS are provided and where people receiving HCBS live, which must:

  • be integrated in and support full access to the greater community;
  • be selected from among options by the individual (or their representative);
  • ensure an individual’s rights of privacy, dignity, respect, and freedom from coercion and restraint;
  • optimize autonomy and independence in making life choices; and
  • facilitate true choices and options for an individual’s services and who provides them.

In Provider-Owned and Controlled settings, where the HCBS provider owns the individual’s residential service, additional standards apply. Individuals in residential units have legally enforceable agreements giving them the same protections and responsibilities as any tenant living in that jurisdiction, including privacy, freedom, choice, and preferences commonly experienced in a home setting.

Kissinger also reviewed aspects of person-centered planning required by the rule. The Department of Health (DOH) is doing a system-level assessment and will revise and provide more information on regulations, policies, and procedures to assess for and achieve site-level compliance. It will also be providing site-level assessments, though it is unclear at this time how this will be done in home settings for individuals receiving HCBS. DOH is close to approval of this systemic/regulatory assessment plan.

Conflict of Interest Compliance

The workgroup also reviewed the Conflict of Interest Compliance Plan process. DOH is still reviewing the COI plans completed by waiver providers. Presenters indicated that full compliance with COI must occur by Jan. 1, 2019. DOH will be working with plans to build firewalls to ensure compliance. DOH indicated that Service Coordinators cannot have a direct or indirect financial relationship with the other service providers working with/for the waiver participant. Also, current waiver service providers may have to choose to offer either service coordination or other waiver services.

Cost Report Implementation (CFR)

NHTD and TBI waiver providers are required to complete Consolidated Fiscal Reports (CFRs) to communicate annual costs incurred as a result of operating 1915(c) waiver services. Cost reporting is completed using a consistent reporting methodology/format in order for data to be comparable between providers, regions, and services. The Centers for Medicare and Medicaid Services (CMS) is requiring that DOH engage in a retrospective reimbursement reconciliation process using service provider cost of all services compared to the final allowable Medicaid reimbursement rate for each service. DOH will be implementing cost reporting starting from July 1, 2018 to June 30, 2019, and every July 1st to June 30th going forward. Questions should be submitted to 1915CR@health.ny.gov. Slides and a Questions and Answers document from DOH’s cost reporting webinar, held on March 15th, are available here and here.

Assessment Process

The workgroup reviewed the Uniform Assessment System (UAS) process for the NHTD and TBI populations. There have been concerns for years that the UAS does not accurately reflect and assess for cognitive needs. A DOH audit determined that the TBI population exhibits particular needs unique to the condition and likely to differ from issues found in the general long term care population. Due to issues presented by stakeholders and participants and the findings of the audit, DOH has made adjustments to the assessment process for the TBI population, including a second assessment, a requirement for review of patient history, and a third assessment by a physician when eligibility is not clear. For individuals seeking or receiving both NHTD and TBI waiver services: if the first UAS-NY results in a Level of Care (LOC) score of less than five (5), a second UAS-NY may be scheduled. If the individual seeks another assessment, the RRDC and the Service Coordinator will assist the applicant/participant in obtaining a second assessment. A TBI Alternate Route Process for assessment is also now available to appropriately assess and determine adequate care and services for individuals.

To access the NHTD/TBI Waiver Transition Workgroup slides, please click here.

Contact: Meg Carr Everett, meverett@leadingageny.org, 518-867-8871