Transcript HCBS Rules in a Nutshell:

Division of Quality
Improvement Updates
< New
<
Review Protocols
Update HCBS Settings Regulations &
Related Activities
Barbara Van Vechten
Ellie Smith
Alicia Matulewicz
DQI - Continuous Quality Improvement
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New Regulatory
Survey Protocols
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INCIDENT MANAGEMENT
Part 624 and Part 625
Two Parts
1. Agency Level Central
Review
2. Site/Service Level Review
Incident Management
Protocol
Agency Level
Central Review
Overview: Central Review - BPC Verification
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Required Notifications occurring
Jonathan’s Law activities implemented
IRC membership and activities appropriate
IRMA Compliance
Integrity of information in IRMA
Agency analyzes and documents events, trends,
and root causes
• Agency identifies needed systemic changes
• Agency implements needed systemic changes
Agency/Central Review
When Implemented
Agency Visits
Flexible Frequency
• At least annually (more frequently if necessary)
• Consider size, locations, organization and workload
Complaints & other Special Visits
Key Agency/Central Review Activities
Before Agency Visit:
• Internal Communication with IMU
• Review of IRMA Information
During Agency Visit:
• Sampling of incidents, occurrences,
events
• Documentation review
• Interview
Scheduled Review (in most cases*)
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Ensure access to the documentation
needed
Ensure people who can provide
information regarding agency
processes and implementation
available
Facilitate access to IRC members
Central Agency Sampling
CLASSIFICATION
Sample Size
Reportable Incidents
20%
Minimum all or 5, whichever is smaller
Maximum 25
Serious Notable
Occurrences
20%
Minimum all or 5, whichever is smaller
Maximum 25
Minor Notable
Occurrences
10%
Minimum all or 5, whichever is smaller
Maximum 15
Part 625 Events
10%
Minimum all or 5, whichever is smaller
Maximum 10
Agency Events
Agency Reportables
Minor Events
(events by agency policy required to
be reported and documented that do
not require reporting per 624 and
625)
Medication Errors: 10%
Minimum all or 10 whichever is smaller
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"Other" Minor Events: 5%
Minimum: 5
Maximum: 10
Documentation Needed
Hard copy or electronic format. Not meant to mean IRMA.
• OPWDD 147 - Reportable incident and Notable Occurrence reports
• OPWDD 148 - Report on Actions Taken in Response to an Incident
• OPWDD 149 – Investigative Reports
• OPWDD 150 – Report of Event Situations (or PA doc. for Part 625 events)
• “Non-reportable“ events reported per agency policy
• All related attachments and supporting documentation
• Documentation of required notifications
• Documentation demonstrating compliance with Jonathan's Law
• Incident Review Committee (& subcommittee) review minutes
• Evidence of implementation of actions re: recommendations
• Actions w/ employees implicated in substantiated cases of abuse
• Governing Body meeting minutes: 12 months or since last review
• Trend review and analysis reports
Agency/Central:
Requirements Reviewed:
Effective agency communication of P
& P as requested to:
• individuals
• family/guardian/advocate prn
• agency employees, interns,
volunteers, consultants, contractors,
& family care providers
Agency Level: Reporting Requirements
• Incidents, occurrences, events were identified and
reported
• Incidents, occurrences, deaths and events were
reported to CEO, OPWDD, Justice Center
• Reporting within time frames
• Reporting documented in IMRA
• Reporting as required to VPCR – agency has
process to ensure
• IRMA Entry and Updates
• Assurances that reporting occurred as entered into
IRMA- IRMA integrity
Agency Level: Notifications
• MHLS, BOV, Coroner, Law Enforcement
• Verbal and document communications per
Jonathan’s Law
• Resignations and Terminations to the JC
• Service Coordinator notifications and
provision of additional info assist in
assurance of necessary actions
• IRMA closure and final reports
Agency Level:
Incident Review Committee
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Membership
No Conflict of Interest
Training and Ethics
Meetings
Review and monitoring
Recommendations and follow-up
Minutes
Agency Level: Trending
• Trending conducted
• Analysis of trends
• Recommendations to address
• Recommendations implemented
Agency Level: Part 625
• Reporting as required
• IRMA entry
• Interventions and actions taken by
agency as needed are appropriate
and accurate based on IRMA
information
PROTOCOL:
INCIDENT MANAGEMENT
PROTECTIONS
SITE/SERVICE REVIEW
Focus of
Protocol
Review
Requirements
most closely
related to
ensuring the
protection of
individuals
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Requirements Reviewed
• All events are reported (RI, NO, Events)
• Needed immediate care and protection
is provided and documented
• Investigations thorough, timely,
documented
• Recommendations & preventive
measures implemented at person-siteservice level
When implemented
Site Visits & Reviews
Certification Visits
Annual Visits
WBCM reviews
Complaints & other
Special Visits
Services Reviews
HCBS Waiver Services
MSC Services:
including DOH sample
Complaints & other
Special Visits
INCIDENT SAMPLE SELECTION
Any IRA & CR,
Day Prog <20
• All for Survey sample for “Recert”
• All for WBCMs reviewed
• Annual MHL Visit: 5 most recent RIs
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3 most recent NOs
• All for persons in DOH MSC sample
Day Prog >20, Waiver • 10% of Reportable Incident, max. 10
Services, MSC Service • 5 most recent Notable Occurrences
Surveyor
Judgment & AD
Direction
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Trends in person or classification
Information discovered during review
Agency Hx known to BPC or IMU
Other visit: Complaint, Monitoring, CSE,
etc.
Activities
1. Communication with IMU
2. Review of IRMA
Documentation:
Events reported
Review Investigations for sampled
Identify items to verify/validate:
 Immediate care & protections
 Corrective & preventive measure
On-Site Activities
VERIFY
 Events meeting 624 or 625 definitions were
reported
 Initial actions documented as implemented were
implemented
 Items recommended & agreed upon were
implemented (as they relate to the site/service)
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Plan revisions & resultant changes to services & supports
Staff changes, training, supervision
Equipment and renovations
Monitoring actions
Recommendations from OPWDD: OIIA investigation
(IRMA); IMU (as informed)
– Justice Center Corrective Action Plans (CAPs)
Behavior Services
Part 633.16
3 Tools for Behavior Services Review
1. “Routine Review” Protocol
2. “Agency Level” Review Protocol
3. Time Out Rooms supplement as
part of Physical Plant review
Behavior Services “Routine Review”
•Reviews the practical application of
the regulations.
• Evidenced in the planning and
implementation of Behavior Services
for individuals
•Review implemented in conjunction
with reviews of sites and services
Behavior Supports
“Routine Review” Application
• All residential facilities certified or operated by
OPWDD, (including family care homes); for this
protocol, only staff are referenced.
• All facilities certified by OPWDD: (Day Programs)
except: free standing respite; clinic treatment
facilities; and diagnostic and research clinics
• Day habilitation services (whether or not
provided in a certified facility);
• Prevocational services (whether or not provided
in a certified facility); and
• Community habilitation (low frequency)
When Used
• Recertification Visits/Full reviews
– At applicable certified programs
– where Behavior Services are provided
• Review of services to WBCMs in
IRAs
• Review of services for the individuals
in the DOH Sample receiving
applicable services
Sampling
• All WBCMs in IRAs
• All DOH sample individuals
receiving applicable services
• Sub-Sample of individuals in
Certified residences and day
programs
Section 1-General Requirements
• Applies to all Behavior Support Plans
regardless of the specific strategies
• Functional Behavioral Analysis
• BSP Development: Who involved
• BSP Content
Section 2: Plans w/ Restrictive,
Intrusive or Rights Limiting Strategies
• Ensure development by Licensed
Psychologist or CSW or BIS
supervised by same
• Written Informed Consent
• HRC approval
Section 2: Plans with
Restrictions/Limitations
Plans describe:
– Necessity of restriction
– Previously attempted but unsuccessful
strategies
– Guidance for postponement of activity
– Plan for fading or elimination of restrictions
– How to document intervention use
– Plan to review/analyze use of interventions
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Section 3: Mechanical Restraints
Justification
Staff Actions
Use Criteria: application, removal
&duration
Monitoring the person’s needs, comfort,
and safety
Reduction/elimination of use
Physician's order
Full documentation of implementation
Device Modification
Section 4: Medications
4a. General Medication Requirements
4b. PRN Medications
4c. Medications for Symptoms of cooccurring diagnosed psychiatric
disorder
4a. General Medication Requirements:
Written Informed Consent is Required
Requires Review for Effectiveness with
prescriber participation
A Written Plan must be in place if
Medications are prescribed to:
• Address Challenging Behavior
• Address symptoms of a diagnosed cooccurring psychiatric disorder
4a. Medication General Requirements
Plan
must be
Behavior
Support
Plan if:
• Medication addresses a
challenging behavior, not a
symptom of a diagnosed cooccurring psychiatric disorder
• and/or
• Restrictive, intrusive or right
limiting interventions are
included as a strategy
4a. Medication General Requirements
Plan may be a Monitoring Plan if:
Medication is prescribed only to address symptoms
associated with a diagnosed co-occurring psychiatric
disorder, BUT
No other challenging behavior, AND
No restrictive/intrusive interventions or
rights limitations are necessary
Section 4b:
PRN Medication
• Documented hx of the behavior or
symptom for the past 12 months
• Conditions for use per Dr. orders
• Results/effectiveness
• Adverse and Side Effects reported
Section 4c: Meds for symptoms of
diagnosed co-occurring psychiatric
disorder
• Documentation of connecting symptom to
psychiatric diagnosis to medication
• Plan clearly identifies target symptoms to be
addressed by medication
• Plan clearly identifies how to evaluate and
document symptoms and absence of same to
measure improvement
• Plan includes strategies in addition to medication
• Plan developed by qualified person
BSP Implementation & Safeguard
Requirements
Organized by Behavioral
Interventions/Strategies:
5a
5b
5c
5d
5e
Physical Interventions
Mechanical Restraints
Medication use and review
Rights Limitations
Time-Out Rooms
Section 5 a-e Monitoring & Safeguards for
Use of Intrusive Strategies
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Staff trained in the Plan
Trained in each specific intervention technique
Strategies implemented correctly per the plan
Strategies were terminated per the plan
Strategies were interrupted when necessary for
safety and/or comfort
• Assessment of persons condition, oversight,
monitoring
• Documentation of implementation
• Required notifications
Behavior Services-Agency Level
Two Components:
Annual Review
Ad Hoc Policy
and Procedure
Review
Behavior Services
Agency Annual Review
7 Standards Related to:
• Staff Qualifications
• Staff Training provided and monitored
• Human Rights Committee aka
Behavior Review Committee
– Has required membership
– completes it review activities
Behavior Services
Ad Hoc Agency Review
• Policy and procedure review
• At this time will only be conducted :
– if routine reviews indicate systemic problems
– Complaints
– Other indicators, such a RIA or Incident
Management raise concern
– Consult with Area Director as needed
TIME OUT ROOMS
• Standards added to Safety/Physical Plant
Proto
• Review during walk through at sites with T.O.
room
• ONLY APPLIES TO:
– New or significantly modified T.O. rooms since
April 01, 2013
– However may assist in identify hazards that
should not be present whether or not the room is
new.
Protocols can be found on OPWDD
website:
http://www.opwdd.ny.gov/opwdd_ser
vices_supports/service_providers/
division_of_quality_improvement_
protocols
QUESTIONS
HCBS Settings Requirements
• An Overview for Day
Services Providers
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HCBS Rules in a Nutshell
 Enhancement/Expansion of
Rights—Same as everyone
else
 Requirements for
demonstrated/evidence based
individualized and persondirected service delivery
 People must be supported to
have maximum control over
their lives and day-to-day
decision making
 Feds are raising the bar; not
just CMS, Justice Dept. too,
i.e., Olmstead enforcement
• Over time, this means
DQI will be holding
providers to a higher
degree/expectations
for true personcenteredness in our
future compliance/
enforcement
activities
• OPWDD regulations to
come
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Key Elements
 Final rule - effective March 17th (up to five year
transition plan)
 Consistent definition of ‘community settings’
across all HCBS Medicaid authorities
 Defines person centered planning
requirements and process (effective now)
 Applies to all settings (includes day
settings); CMS guidance for non-residential
settings pending… yet they say don’t wait…..
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General HCBS Settings Requirements
Allowable HCBS Setting:
 is integrated in & supports full access to the
greater community;
 is selected by the Person from among options;
ensures individual rights: privacy; dignity &
respect; freedom from coercion & restraint;
optimizes autonomy & independence in
making life choices;
facilitates choice among types of services &
who provides them.
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Home and Community-Based Setting
Requirements
ALLOWABLE Home and Community-Based Settings:
 Integrated in & support access to greater community;
 Opportunities: to seek employment & work in competitive
integrated settings; engage in community life; control
personal resources;
 Ensure same degree of access for to the community for
HCBS Persons compared with non-Medicaid persons;
 Enable choices by the Individual from among setting
options, (including non-disability specific settings);
 Person-centered service plans document the options
based on the Individual’s needs & preferences.
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New HCBS Settings Requirements Ensures RIGHTS of
ALL people receiving HCBS = same RIGHTS of All
Citizens
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Modification to the additional
requirements (RIGHTS) must be:
Supported by specific assessed need;
Justified and documented in the PersonCentered Service Plan;
Meet the additional specific criteria
outlined in the regulations
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Revisions to ADM
Development of
Assessment Tools
Stakeholder Info
Sessions
Regulatory Reform
Stakeholder Subgroup
Met - 2013 re: ADM
submitted to CMS in
Nov. 2013
Reconvened - July
2014
DQI Assessment
Begins –
Residential Sites:
this Survey Cycle
11/2014-9/2015
OPWDD HCBS
Compliance/
Transition
Plan
Updates to the
Transition Plan
based upon
Assessment
analysis
Program
Enhancements &
Strategies to
Address
Identified
Challenges
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Revised HCBS Settings
ADM Sets Stage For:
 Implementation of HCBS
Settings Assessment Tool
(residences);
 Interpretation and
Understanding of the HCBS
Settings Standards; and
 OPWDD’s promulgation of
Future Regulations on this
topic
• Challenges:
 Interpretation of CMS
regulations in order to “assess”
the standards
 Practical realities of the service
system vs. need to “push the
envelope” We are pushing
the envelope for the
assessment
 The person’s experience in
the setting is a major
determining factor according
to structure of CMS
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exploratory questions
HCBS Settings ADM
 The ADM describes the quality principles and standards
that OPWDD will be assessing beginning November
2014
 It is expected that providers will use the following to
actively plan and develop approaches to work towards
maintaining full compliance with the HCBS Settings
federal requirements:
 ADM #2014-04
 OPWDD’s HCBS Setting Assessment Tools
 CMS guidance and Exploratory Questions.
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HCBS Settings ADM
The standards in the ADM specifically
address:
 the person-centered habilitation planning process;
 delivery of person-centered HCBS funded supports and
services in integrated settings;
 promotion and support of informed choice and rights;
and,
 standards applicable to the nature and experience of
each person’s living situation.
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HCBS Settings ADM: A. Guidance on Hab
Planning Process and Service Delivery
 Federal PCP regulations are weaved in where
applicable;
 PCP Process not end goal—designed to result in
outcomes to ensure the person has more choice and
control in his/her life;
 Habilitation Plans are a required attachment to the
Person-centered Plan (i.e., ISP) and must be
coordinated with the ISP. As such the Habilitation Plan
is encompassed in the person’s service plan;
 Habilitation Plans are person-centered/person-directed,
individualized, and include activities and interactions
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that are meaningful to the person;
A. Guidance on Hab Planning
 Habilitation supports/services should focus on developing skills that are
needed in order to facilitate greater degrees of choice,
independence, autonomy and full participation in community life;
 Exploration of new experiences is an acceptable component of the
Habilitation Plan.
Learning about the community and forming relationships often require a
person to try new experiences to determine life directions.
o This trial-and-error process eventually enables the person to make informed
choices
o To identify new valued outcomes that then become part of the ISP and Hab
Plan;
o
 The Habilitation Plan (or alternative documentation that becomes part of
the habilitation/service plan) should reflect:
o the personally meaningful community inclusion/integration activities,
o the timing and desired frequency/duration of these activities, and
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o the supports needed for the person to fully participate
A. Guidance on Hab Planning
 Whenever possible, supports are provided in a way that maximizes
use of natural and peer supports in the community, not just paid staff
and providers;
 The Habilitation Plan must be updated in accordance with ADM
#2012-01, when the individual’s circumstances or needs change, or
at the request of the individual.
 Residential providers should ensure that individuals are aware of
their right to request a Habilitation Plan change. Residential
providers are expected to take timely action to honor these requests.
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HCBS ADM:
B. HCBS Waiver Service Provision Is Required to Support
Full Access to the Greater Community to the Same Degree
of Access as Individuals Not Receiving HCBS:
 HCB services, supports, and settings must be designed to:
 facilitate full access to engage in community life;
 seek employment and work in competitive integrated settings; engage in
meaningful activities;
 explore meaningful relationships and social roles;
 reside in the home of choice;
 share in other hallmarks of community living in accordance with
individualized needs and preferences identified in the person’s
habilitation/service plan and to the same degree of access as individuals
without disabilities.
 HCBS settings (and services and supports) must seek to optimize and
not regiment individual initiative, autonomy, and independence in
making life choices
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B. HCBS Waiver Service Provision Is Required to Support
Full Access to the Greater Community to the Same
Degree of Access as Individuals Not Receiving HCBS,
(Cont.)
• For “same degree of access” to life in the
community, we need to ensure that people
with disabilities are not segregated or
isolated from people without
disabilities and ensure that support and
service delivery practices are not
“institutional” in nature.
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HCBS Waiver Service Provision Is Required to Support Full
Access to the Greater Community to the Same Degree of
Access as Individuals Not Receiving HCBS, (Cont.)
 Facilitate Informed Choice and Protect Rights:
Encourage and support individuals to choose and control
their own schedules and activities including both scheduled
and unscheduled activities
 The provider/site must ensure that sufficient support is
available based upon peoples’ priorities in their Plans for
scheduling and activity preferences.
 Spontaneity in choice of activities encouraged and supported
whenever possible, no different than non-disabled
 May need to consider use of natural supports and creative resources
 a person may not be able to participate in a regularly
scheduled/planned activity due to illness or other reason—this must
also be supported by the provider.
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HCBS Waiver Service Provision Is Required to Support Full
Access to the Greater Community to the Same Degree of
Access as Individuals Not Receiving HCBS, (Cont.)
 Facilitate Informed Choice and Protect Rights:
 Support informed choice by exploring with the person the potential
consequences and responsibilities of decision making
 Employ positive approaches w/ safeguards and honor “dignity of risk”
 Protect individuals from coercion, and unnecessary use of restrictive
interventions
 Provide mechanisms for people to file anonymous complaints
 Encourage, respect and support peoples’ observance of cultural,
religious/spiritual, and other preferences
 Ensure that individual freedom and independence is not abridged
through administrative operations
 Use plain language and accessible communication
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What about circumstances where
a person’s needs may dictate that
he/she cannot safely access the
HCBS Settings Rights?
Rights must not be modified outside of the
person centered planning process or
without the informed consent of the
person or authorized surrogate unless
there is an immediate, serious and
credible threat (this is a high bar).
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Federal Requirements if Rights
Modification is Necessary
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Must be supported in the Plan as follows:
1. ID of specific assessed need
2. Documentation of positive interventions and supports used prior to
modification
3. Documentation of less intrusive methods tried
4. clear description of condition in direct proportion to the assessed need
5. Inclusion of regular collection/review of data to measure effectiveness of
modification
6. Established timeframes for periodic review
7. Informed Consent of the person
8. Assurance that interventions/supports will cause no harm to the person
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Why is DQI doing an HCBS Settings “Assessment”
for Certified Residential Settings?
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Part of OPWDD’s HCBS Settings Transition Plan
To Collect Baseline Information
To Identify Major Challenges that OPWDD Must Address
Systemically to Work Towards Full Compliance
After the Assessment, the OPWDD Transition Plan will
need to be revised to include the specific activities to
ensure full compliance (i.e., programmatic changes,
reinvestment strategies, etc.)
An opportunity for providers to learn, grow, and enhance
person centered practices during the transition period
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General Implementation Information about
DQI’s Assessment
The HCBS Assessment for IRAs and
CRs will begin in November 2014 and
run through September 2015 (the end
of DQI’s survey cycle)
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General Implementation Information
 “No’s/Not Mets” are not a bad thing for the
Assessment—rather, they will help OPWDD to
identify where to focus in transition planning
It is an opportunity for the provider to grow,
learn, make enhancements and changes for the
better.
OPWDD will use a conservative approach to
selecting Yes for any assessment standard i.e.,
in most cases evidence of a Yes is necessary,
otherwise, standard is “Not Met/No”
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General Information
For the Assessment, a YES means that THIS
PERSON IS TRULY RECEIVING SUPPORTS
IN A PERSON CENTERED MANNER AND
ENVIRONMENT
• Assessment Tool is designed for use with
the Guidance Document to help determine
the criteria that leads to whether a standard
is a “Yes” or a “No”.
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Implementation Methodology and
Guidance Document
YES
Select Yes if, all of the
following; majority of
the following;
evidence of x and Y
Select No if any
of the following
NO
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General Implementation
Information—Key Themes of the
Assessment
 The final rules establishes an outcome oriented
definition that focuses on the nature and quality
of individuals’ experiences
 The new standards are “experiential” and
about “qualities” of the setting
 The regulations focus on whether individuals
supported have the “same degree of access”
as others in the community
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Person
Centered
Review (Part I)
Site Review
(Part II)
• Individual’s experience and outcomes
• Most substantial component of Assessment
• 1 Individual from each Site in the recertification
sample
• Physical characteristics
• Operational components that have biggest impact
on “full access to broader community” and
person’s experience as a resident of the home
• Short Component—interview with staff and
observation
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 Will aggregate results by domain area/section:
Percentage of sites that have achieved standards
Percentage moving towards standards achievement
Percentage likely to achieve during transition period
Percentage unlikely to achieve standards during
transition
 Actual results will help OPWDD Target areas/action plan
for training and quality improvements at systems level to
finalize the OPWDD Transition Plan.
 Data aggregation over time will help target quality
improvement strategies and identify successes
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Next Steps and
What You Can Do to Prepare:
Agency Survey
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So what to do….

http://www.opwdd.ny.gov/node/5553
? Was the Individual given a choice of available options
regarding service options and environments?
 Were the different services and service mechanisms explained?
o Day Hab, Community Hab, Pre-Voc, PTE, SEMP, Volunteer?
 Opportunity to talk with people who receive services differently?
? Was the Individual given opportunities to visit other settings
and service providers?
 Visits/Experiences: varied day hab services & activities;
volunteer sites; college campuses; observe jobs at local
employers; fitness centers, etc.
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? Does the individual chooses from whom they receive
services and supports?
 Were options regarding provider agencies provided?
 Can the individual identify other providers who render the
services s/he receives?
 Does the individual express satisfaction with the provider
selected ?
 Does the individual know how and to whom to make a
request for a new provider?
? Does the setting/service reflect the Individual’s needs &
preferences?
 A Person Centered Planning methodology used to identify
needs/preferences reveals ideal service settings
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? Is the individual is employed or active in the community
outside of the setting?
 Does the individual work in an integrated community setting?
 If the individual would like to work, is there activity that ensures
the option is pursued?
 Does the individual participate regularly in meaningful non-work
activities in integrated community settings?
The setting does not isolate individuals supported from
individuals in the broader community (those not receiving
HCBS).
 Is the setting in the community?
 Is there sufficient transportation available to access the
community?
 Is there sufficient support to access the community?
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? Are individual choices incorporated into the services and
supports received?
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Do staff ask the individual about needs and preferences?
Does the individual express satisfaction with the services?
Are individuals aware of how to make a service request?
Is individual choice facilitated in a manner that leaves the
individual feeling empowered to make decisions?
? Is/are the Individual/chosen representative(s) actively
involved in Person-Centered Planning meetings?
 Person is part of or directs meeting time, location, invitation
process and frequency
 Was the Individual present during the planning meeting?
 Did/does the planning meeting occur at a time and place
convenient for the individual to attend?
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Agency Survey
Provider agencies and DDROs will be asked to
complete a survey through survey monkey
The purpose of the agency survey is to
gather contextual information on
organizational systems and provider
preparations for HCBS Settings Transition
and Compliance
 The survey will also ask for information on
homes that may trigger “heightened scrutiny” so
that OPWDD can begin an inventory for
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transition planning activities
Involve your Stakeholders:
 Engage the Board of Directors in the direction,
oversight, and approval of transition strategies/activities,
review of data/surveys, and quality improvement
approaches
 Actively communicate with staff and people supported
and their family members and advocates on these
standards, compliance strategies and changes
necessary and involve them in the improvement process
 Solicit feedback from individuals served and their
advocates on how to do better through satisfaction
surveys, focus groups, residence meetings, and other
applicable forums.
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Review All Organizational and Site/Program
Policies, Procedures, Practices, Training
Materials, Forms, etc.
Ensure consistency with HCBS Settings
requirements;
Ensure no blanket
rules/restrictions/practices that limit
individual choice, autonomy or rights;
Ensure that materials for people are
written in plain language and are
accessible
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Enhance Training & Communication Approaches
to Integrate HCBS Settings Principles
 Training,
orientation, etc. should reflect
these expectations
 Reinforce with staff how to support
individuals to exercise control and choice
in their lives
 Cultural competency training
 Adopt and implement Direct Support
Professional Competencies
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Implement Organizational Self-Assessment
Practices for HCBS Settings and Person
Centered/Directed Service provision
 Use the OPWDD HCBS Settings
Assessment Tools and Guidance
Document and the CMS Exploratory
Questions to assess the homes that you
operate
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Enhance Person Centered/Directed
Planning and Service Delivery Practices
Systemically Throughout the Organization
and its Services and Support Delivery
infrastructure
Use OPWDD’s optional Strengths and
Risks Inventory when planning with
people
http://www.opwdd.ny.gov/node/5521
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The HCBS federal regulations specify:
“the written plan must reflect risk
factors and measures in place to
minimize them, including
individualized back-up plans and
strategies”.
[CFR 441.l301 (C)(2)(vi)]
•
Some of NYS OPWDD’s Major System Challenges

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OPWDD’s Infrastructure/service delivery dollars heavily
invested in facility based service delivery
‘Bundled’ rate setting methodologies
Large residences (many former ICFs) vs CMS’s 2008 NPRM
re homes of 4 beds or less
Balancing ‘Protection’ vs. Individual Choice and Autonomy
i.e., Justice Center/ provider/staff fear of liability
Staffing/Resource/Transportation
Unmet training needs re truly person centered planning &
supporting people to maximize their control over their lives
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The Bottom Line
• “The new rule seeks to improve quality of
life for people with disabilities by ensuring
• that HCBS funding is used only for
services in settings that are truly
integrated, as opposed to those that
replicate institutional environments in
all but name.”
•
ASAN Policy Brief, “Defining Community: Implementing the new Medicaid
HCBS Rules”, 9/2014
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 OPWDD Transition Plan materials and
response to public comments
 Link to NYS Transition Plan and materials
 Link to CMS Resource Materials and Tool
Box
 OPWDD HCBS Settings Tool Box
 Materials from Stakeholder Work Group
Meetings
• Feedback and suggestions are welcome and
appreciated!
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QUESTIONS?
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