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Since the announcement from Centers for Medicaid Services in 2014 to implement revisions to the Administrative Code regarding integration in the community and service provision, there has been a heightened interest in how the state of Ohio would respond for Home and Community Based Services (HCBS). All states have been required to submit transition plans to CMS stating how they will shift their current rules to meet the new standards. Ohio moved quickly to develop a plan. In March 2015 a draft plan was submitted to CMS, and, based on feedback from CMS, an updated plan was submitted in October 2015. As of June 2, 2016, Ohio joined just 2 other states (Kentucky and Tennessee) receiving initial approval from CMS for their Transition Plan regarding Home and Community Based Waivers. Let’s take a closer look at how Ohio is proposing to revise current regulation to meet new guidelines.

Community Living  

Initially rules and regulations were based on individuals with disabilities living in institutional settings and did not have revised language that supported person centered planning. The Ohio Department of Developmental Disabilities states this:

In March 2014, the Centers for Medicare and Medicaid Services (CMS) implemented new regulations to ensure that individuals receiving services and supports through Medicaid HCBS programs are assured full access to community living, and required all states to submit a transition plan describing the actions that will be taken to ensure compliance with the new regulations.

The Transition Plan is based on the premise that individuals with disabilities will be assured full access to the community; at home, at work and at play.  I have paired down the plan to highlight changes Ohio feels are necessary to assure this vision can be fulfilled.

  • The Individual Plan will determine the level of integration into the community that the individual and their family desire.
  • There is a proposed change to the service title of “Adult Foster Care” to “Shared Living” to reduce the stigma that was associated with receiving a foster care service for adults.
  • A recommendation was also made to modify the existing Homemaker/Personal Care definition in both the Individual Options and Level One waivers to expand upon the ability for this service to be utilized to support individuals in integrated community settings.
  • Due to the existing Adult Day Waiver services, including Adult Day Support and Vocational Habilitation, having a significant bias toward facility-based supports, a workgroup was formed to redesign the adult day array of services. This has since promoted the revisions to the rules surrounding Adult Day Services and Community Employment.
  • There will be a phase-out plan submitted to CMS regarding the Transitions waiver. It will include plans to enroll those individuals into another waiver operated by DODD.
  • Multiple revisions will be made to the provider compliance tool.

For Providers of Service

  • Opportunities will need to be made available for individuals to get involved in their community. This can include both community employment and/or social activities in the community.
  • Services offered will need to be meaningful to the individual and based on their personal desires.
  • Providers will be required to ensure that when in the community, individuals are supervised at their specific level of supervision needed.
  • Ongoing training and communication will be made available by the State to ensure compliance with new rules.
  • Rate and fee structures have gone under recent revision to address individual needs with integration.
  • Settings where individuals reside will be required to come into full compliance and demonstrate compliance with the revised code.
  • If a setting has the ‘presumed effect of isolating individuals’ they will be subject to a higher level of scrutiny by the state.
  • The overall statement for settings where services are provided states

    In the event a setting, which previously demonstrated evidence of compliance but subsequently cannot (or does not) produce acceptable evidence of compliance, the State’s established relocation team, led by the State Long-Term Care Ombudsman, will work with individuals to transition them to a setting of their choice, which meets the HCBS characteristics.

In Review

First, the state of Ohio should be congratulated for their efforts thus far and obtaining the initial approval from CMS for their Transition Plan. Ohio has until 2019 to come into full compliance, however many tasks are already underway to get Ohio in alignment with the revised code. With 2016 already half way over, this really just leaves about two years for compliance. I will continue following the Transition Plan and how the implementation is effecting services for individuals with Developmental Disabilities in the state of Ohio.

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