Promoting and protecting the health and safety of all Idahoans
Español    Idaho.gov    About Us    Contact Us    Careers   
July 16, 2018

Idaho State Transition Plan - Coming into Compliance with HCBS Setting Requirements

 Public Notice and Request for Comment

Post Date: June 1, 2018

Posted for Public Comment until June 30, 2018

Contact: Donny Jardine, Home and Community Based Services Coordinator, Medicaid

208.364.1880


Purpose

The purpose of this posting is to provide public notice and receive public comments for consideration regarding version six of Idaho Medicaid’s Draft Home and Community Based Services Settings Transition Plan. The full Transition Plan can be found by selecting the link in the right-hand resource column titled: Statewide Transition Plan, and selecting Idaho Transition Plan – Version 6.

Transition Plan

The Department of Health and Human Services’ Centers for Medicare and Medicaid Services (CMS) published regulations in the Federal Register on January 16, 2014, which became effective on March 17, 2014, implementing new requirements for Medicaid’s 1915(c), 1915(i), and 1915(k) Home and Community-Based Services (HCBS) waivers. These regulations require the state to submit a transition plan for all the state’s 1915(c) waiver and 1915(i) HCBS state plan programs. This plan sets forth the actions Idaho will take to operate all applicable HCBS programs in compliance with the final rules. It is Idaho’s effort to comply/demonstrate compliance with the regulations around Home and Community Based (HCB) setting requirements. Idaho will be submitting its transition plan to CMS in July 2018. The federal regulations are 42 CFR 441.301(c)(4)-(6). More information can be found on the CMS website.

Copies may be obtained by printing the Transition Plan from this webpage or by pick-up from any Regional Medicaid Office or the Medicaid Central Office located at 3232 Elder St., Boise ID.

Public Comment Submission Process

The state of Idaho’s Department of Health and Welfare, Division of Medicaid is seeking public input on the transition plan. Please take the time to comment on the transition plan and whether or not you believe it includes sufficient activities for the state of Idaho to comply with the new HCBS regulations.
Comments must be submitted by June 30, 2018. Comments and input regarding the draft transition plan may be submitted in the following ways:

  1. On this webpage in the right hand column you will see an “Ask the Program” section. There you can use the Email the program tab to email your comments directly to the program.
  2. By e-mail: HCBSSettings@dhw.idaho.gov
  3. By written comments sent to:
    HCBS
    Division of Medicaid, Attn. Transition Plan
    PO Box 83720
    Boise, ID 83720-0009
  4. By FAX: (208) 332-7286 (please include: Attention HCBS)
  5. By calling toll free to leave a voicemail message: 1-(833) 201-7468

All comments will be tracked and summarized. The summary of comments in addition to a summary of modifications made in response to the public comments will be added to the Statewide Transition Plan. In cases where the state’s determination differs from public comment, the additional evidence and rationale the state used to confirm the determination will be added to the Transition Plan as well. The Transition Plan will then be submitted to CMS. Once it is submitted to CMS, the updated Transition Plan will be reposted on the HCBS webpage listed above.

Transition Plan Summary

Idaho completed its systemic assessment of its residential and non-residential HCBS service settings in late summer of 2014. This analysis identified program areas where the new HCBS regulations are currently supported in Idaho as well as areas that will need to be strengthened to align Idaho’s HCBS programs with the regulations. Actions necessary for Idaho to come into full compliance are identified in the Transition Plan along with a timeline for completing them.

States must determine whether settings have the qualities and characteristics of an institutional setting as described by CMS’s final HCBS rule. Idaho completed the analysis of all HCBS provider owned or controlled residential settings against two of the three characteristics of an institution, as identified by CMS, in the fall of 2014. In August 2016, the institution analysis was repeated with questions added related to isolation. Medicaid received information from Licensing & Certification regarding Residential Assisted Living Facility (RALF) settings that may potentially isolate individuals. Due to setting location or Licensing & Certification staff not recently surveying the setting, 113 RALFs and three Certified Family Homes (CFHs) were assessed using an isolation addendum in addition to the Provider Self-Assessment Tool. Idaho identified four residential service settings in a publicly or privately-owned facility providing inpatient treatment or on the grounds of, or immediately adjacent to, a public institution.

Idaho completed the analysis of all non-residential HCBS against two of the three characteristics of an institution, as identified by CMS, in 2015. There were no non-residential service settings in a publicly or privately-owned facility providing inpatient treatment or on the grounds of, or immediately adjacent to, a public institution. In April 2016, the process was repeated with questions added related to isolation. This assessment again found no non-residential service settings in a publicly or privately-owned facility providing inpatient treatment, or on the grounds of, or immediately adjacent to a public institution. Additionally, there were no sites identified as potentially having the effect of isolating individuals from the broader community of individuals not receiving Medicaid HCBS.

Additional administrative rule (IDAPA) support for the HCBS requirements was promulgated during the 2016 legislative session and became effective July 1, 2016. Assessment of settings were completed January 4, 2018. The plan for provider remediation and for relocation of impacted participants is included within this Transition Plan.

The state has archived all versions of the Transition Plan and will ensure that the archived versions along with the most current version remain posted on the state’s HCBS webpage and available for review for the duration of the state’s transition to full compliance.



Process Updates: Requests for Corrective Action Plans

This communication impacts all Medicaid Home and Community-Based Services (HCBS) providers, including Certified Family Homes (CFH), Residential Assisted Living Facilities (RALF), Adult Day Health (ADH), Developmental Disability Agencies (DDA), Supported-Living providers, Personal Care Services (PCS), Supported Employment, and any other entity providing HCBS.

Any time a Medicaid provider is found to be in violation of IDAPA rules and requirements, they may be asked to complete a Corrective Action Plan (CAP) explaining how the violation will be corrected and prevented in the future.  Previously, each program providing oversight to the various provider types had their own process related to CAPs.

In order to simplify the procedure and provide consistency across all provider types, Medicaid's Bureau of Developmental Disability Services (BDDS) and Bureau of Long-Term Care (BLTC) have collaborated with the Division of Family and Community Services (FACS) to develop a single CAP process. 
 
The new process includes standardization of time frames and documentation.  This will allow providers sufficient time to make needed correction.  Additionally, this will give the Department time to provide any needed technical assistance to help providers reach compliance.  

Changes to the process 

If a provider receives a request for a CAP, the provider is expected to develop and implement an acceptable CAP within 45 days. Department Quality Assurance/Quality Improvement staff can help the provider by offering:
• Technical assistance
• An onsite meeting
• Reasonable support to help the provider comply

Once the CAP has been accepted, the provider will need to submit evidence demonstrating the CAP was successfully implemented.  

If a provider is unable to supply an acceptable CAP, or provide proof of successful implementation, action(s) against their Medicaid Provider Agreement may be recommended.  Provider Agreement Enforcement Actions can be found in IDAPA 16.03.09, “Medicaid Basic Plan Benefits,” subsection 205.03. 

These changes will be effective May 15, 2017. 

Initial Approval of the Statewide Transition Plan

Idaho Medicaid’s Home and Community Based Services (HCBS) project team is pleased to announce that Idaho has received initial approval of the Statewide Transition Plan (STP) from the federal waiver authorities. Initial approval of the STP means that Idaho has completed a systemic assessment of residential and non-residential HCBS service settings. Using the systemic assessment, Idaho identified gaps between Medicaid program areas and federal HCBS regulations in order to plan the remediation actions Idaho will take. Finally, Idaho identified the timeframes that the state will use to fully comply with the federal HCBS regulations. The Centers for Medicare and Medicaid Services (CMS) has reviewed Idaho’s STP and determined that the systemic assessment, remediation actions, and the timeframes are appropriate to comply with the federal timeframes and issued Idaho an initial approval.  

Idaho has much work to do in order to receive final approval of the STP.  Idaho must complete the following actions in order to obtain final approval:

  • Complete site-specific assessment of all HCBS settings
  • Develop a remediation plan for providers that do not comply with the HCBS regulations
  • Validate documentation from providers who have undergone remediation
  • Identify and assess settings that are presumed to have institutional characteristics
  • Identify a plan for participants who live in non-compliant setting to transition to compliant HCBS settings

Establish a plan for ongoing monitoring of HCBS settings in IdahoThe HCBS project team is working diligently to ensure that Idaho is working toward final approval of the STP. Idaho will continue to work closely with CMS to ensure that their concerns and expectations are addressed. Idaho’s initial approval letter is located on this site, under the Resources tab.

HCBS Provider Toolkit

The Division of Medicaid with the Department of Health and Welfare has developed a provider toolkit to assist all Idaho providers of Home and Community Based Services (HCBS) to comply with the new HCBS federal regulations and HCBS-related IDAPA rules. The provider toolkit gives Medicaid providers guidance about how to come into and remain compliant with the regulations and rules.  This toolkit contains information about the HCBS IDAPA rules, the intent of the HCBS IDAPA rules, best practices for compliance with HCBS IDAPA rules, and the Assessment documents that providers will be required to complete.  The toolkit also includes a glossary of terms that relate to HCBS settings, a participants right document,  sample policies and procedures for certified family homes, as well as additional resources for providers. 

The HCBS provider toolkit can be located on this page under the “Provider Toolkit” section in the right hand column. A hard copy of this document can be accessed at the regional Medicaid offices throughout the state.  The locations of the regional Idaho Medicaid offices are: Coeur D’ Alene, Lewiston, Caldwell, Boise, Twin Falls, Pocatello, and Idaho Falls.  

An updated training schedule has been included on this page as well.  This training schedule is entitled “Home and Community Based Setting training”.  This document is located under the “What’s New” section on the right hand side of this web page.

HCBS Rules

Medicaid Home and Community Based Services (HCBS) went into effect Friday, July 01, 2016. The Medicaid HCBS rules are contained in the Medicaid Enhanced rules in IDAPA 16.03.10 and the Consumer-Directed Services rules in IDAPA 16.03.13 which are published on the Idaho Department of Administration Website.  A direct link to these two sections of rules is posted on this page, under the “What’s New” section.

The Medicaid HCBS rules implement requirements to ensure that individuals receiving Medicaid Home and Community Based Services are integrated in and supported to gain full access to their community. Idaho Medicaid is currently working with stakeholders to establish a resource toolkit that will  assist Idaho providers of Medicaid HCBS services to come into compliance with the new HCBS IDAPA rules.  

Home and Community Based Settings 

The Department of Health and Human Services’ Centers for Medicare and Medicaid Services (CMS) published regulations in the Federal Register on January 16, 2014, which became effective on March 17, 2014, implementing new requirements for Medicaid’s 1915(c), 1915(i), and 1915(k) Home and Community-Based Services (HCBS) waivers. The purpose of the regulation is to ensure that individuals receive Medicaid HCBS in settings that are integrated in and support full access to the greater community and that the individual’s role in service planning is optimized. This includes opportunities to seek employment and work in competitive and integrated settings, engage in community life, control personal resources, and receive services in the community to the same degree as individuals who do not receive HCBS.

CMS expects all states to develop a HCBS transition plan that provides an assessment of potential gaps in compliance with the new regulation, as well as strategies and timelines for becoming compliant with the rule’s requirements. CMS further requires that states seek input from the public in the development of this transition plan.

Idaho has completed its’ fourth version of the state plan. This plan sets forth the actions Idaho will take to operate all applicable HCBS programs in compliance with the final rules. It is Idaho’s effort to comply/demonstrate compliance with the regulations around Home and Community Based (HCB) setting requirements. To access the updated Idaho Transition Plan, please go to Resources in the right hand column, Idaho Transition Plan – Version 4.

 

Ask The Program

We are interested in receiving your comments, recommendations, and questions as we work to move to full compliance with the new HCBS setting requirements. The State’s Transition Plan - Version 4 is posted here under Resources.  If you have any questions or comments about the plan or the new requirements (see Final Regulation under Resources) please send us an email and we will get back to you as soon as possible.

Email the program