Home & Community-Based Services Rule Overview

Home & Community-Based Services Rule Overview


Welcome! My name is Heidi Hamilton and I work
in the Disability Service Division at the Department of Human Services. The purpose
of this video is to help people understand the new federal Home and Community-Based Services
rule. In this video, we will be going over the concepts in the new rule, with a focus
on conflict-free case management, person-centered planning and the home and community-based
setting requirements. We will talk about the federal requirements, how Minnesota plans
to comply with the rule, and what the impact may be on people who receive services and
providers who support those people. What are Home and Community-Based Services?
Home and Community-Based Services support people living in the community who would otherwise
live in an institution. An institution could be a nursing home, hospital, institution for
mental disease, or an intermediate care facility for people with developmental disabilities.
Home and community-based services allow people to receive the support they need to live,
work, and socialize in the community. In Minnesota, the new federal rule applies
to the five home and community-based services waivers. They are the Brain Injury or BI waiver,
the Community Alternative Care or CAC waiver, the Community Alternatives for Disabled Individuals
or CADI waiver, the Developmental Disabilities or DD Waiver, and finally, the Elderly Waiver
or EW. This rule also applies to Community First
Services and Supports, which is the program that will be replacing personal care attendant
services. The rule does not apply to other services funded through Medical Assistance
or state grant programs, although many of the concepts in the rule may benefit other
groups of people and programs. Research shows that people with disabilities who are engaged
in their community have a better quality of life than people who live in institutional
or larger congregate settings. People receiving services and providers may want to think about
whether they want these concepts to apply to their services, regardless of where the
funding comes from. Hello, I’m Lucinda Jesson, the Commissioner
of the Department of Human Services. We put together this video to provide information
about the new federal Home and Community-Based Services rule, which may change the way seniors
and people with disabilities receive services in their homes and communities. The new rule
focuses on improving the quality of life of seniors and people with disabilities who receive
home and community-based services. This new federal rule complements other efforts Minnesota
has been working on that increase the opportunity for seniors and people with disabilities to
live, work, and have meaningful relationships with people who aren’t paid staff. Minnesota has long been a leader in supporting
people with disabilities in the community, including the creation of parent advocacy
organizations in the 1950s and 1960s; and the deinstitutionalization efforts that began
in the 1970s and 1980s. More recently, as part of the Jensen settlement agreement, Minnesota
is commited to develop and implement Minnesota’s Olmstead Plan. The Olmstead Plan is an effort
to ensure that Minnesotans with disabilities will have the opportunity, both now and in
the future, to live close to their families and friends, to live more independently, to
engage in productive employment and to participate in community life. As a state, we are committed
to aligning the state and federal efforts to increase the quality of life of people with disabilities
and assure they are living and working in the most integrated settings possible. The new federal rule has several parts. This
portion of the video will focus on three important areas of the rule – conflict-free case management,
person-centered planning, and home and community-based setting requirements.
Conflict-free case management The new rule requires states to provide conflict-free
case management. This means that people need to receive services from a case manager that
does not have a direct or indirect interest in the choices made regarding the delivery
of services. People need to know that their case manager will not influence their choice
of providers or services because of another relationship. The new rule requires that everyone has a
person-centered plan. The planning process must be driven by the person receiving services,
and includes people chosen by the individual. The person needs to have the necessary information
and support to help them direct the process. The written plan must reflect a person’s
cultural considerations and use plain language, so the person, and the people who support
that person, can understand the plan. The new rule does recognize a guardian’s legal
responsibility to make decisions on behalf of the person, when indicated in the person’s
guardianship papers; however, these decisions must take into account the person’s preferences
and goals. The rule also requires that the planning process include strategies for solving
disagreements among any of the team members, in order to address any concerns people have,
but still have the person driving the development of their plan.
The plan must identify the person’s opportunities to seek employment and work in competitive,
integrated settings. The plan must identify the settings a person is choosing to receive
services in, and how that setting supports full access to the greater community. The
plan must also identify the person’s opportunities to engage in community life, and control personal
resources. With any of these choices, the plan must include any risk factors that are
identified and how the person is choosing to minimize those risks, including the role
others will play in minimizing those risks. The rule gives criteria on where people can
live, work and spend their time when they receive home and community-based services
through Medical Assistance. The rule requires that these settings must meet criteria that
help people engage in their community. Some of the requirements are specific, especially
for settings where a service provider owns and controls the setting where services are
delivered, such as a foster care home or some apartment settings. Other requirements are
not as specific and give states the opportunity to come up with some implementation strategies
specific to that state. Compliance with the setting requirements is the one area where
states are allowed to have a transition plan. The transition must be completed by March
17, 2019, and be based on a timeline and strategies the state identifies in the transition plan.
This plan must be approved by the Centers for Medicare & Medicaid Services (CMS).
The rule identifies settings that are not home and community-based, because they are
considered institutions. These include nursing homes, institutions for mental disease, intermediate
care facilities for people with developmental disabilities, and hospitals. Home and community-based
services cannot be provided in these settings. The rule also identifies settings that are
presumed not to be home and community-based, and require the state to submit evidence to
Centers for Medicare & Medicaid Services to show how these settings are, in fact, home
and community-based. The settings presumed not to be home and community-based
include settings that are in a publicly or privately-owned facility providing inpatient
treatment; settings that are on the grounds of, or adjacent to, a public institution;
and settings with the effect of isolating individuals from the broader community of
people not receiving home and community-based services funded through Medical Assistance. Aside from the settings that are not home
and community-based, and the settings that are presumed not to be home and community-based,
the rule identifies qualities that all home and community-based settings must have. These
qualities must apply to where a person lives, where a person works, and where they spend
their time. These qualities include helping a person have access to the greater community;
and providing opportunities to seek employment and work in competitive integrated settings,
engage in community life, and control personal resources. The settings must make sure a person
has privacy, dignity, respect, and freedom from coercion and restraint. The settings
must encourage independence in making choices, and help support those choices. The settings
must be chosen by the person from a range of options, including non-disability specific
settings and an option for a private unit in a residential setting. This doesn’t mean
all settings need to provide these options, but, as a state, Minnesota needs to have a
variety of options available for a person to choose from. Some options that a person
chooses may not be eligible for home and community-based services funding. The waiver will not be able
to fund services in those settings, and can only fund services provided in settings that
meet the requirements of the rule. The rule includes some additional requirements
when the place a person lives is owned or controlled by a residential service provider.
The person needs to have a lease, or an agreement with the same protections and responsibilities
as are included in a lease. Every person needs to have privacy in their bedroom or apartment,
depending on the type of setting they live in. All apartments, or bedrooms, must have
a lockable door, with the person and appropriate staff having keys. People must have a choice
of roommates, if they’re sharing an apartment or a bedroom. People need to be able to decorate
their bedroom or apartment like they want. People need to control their schedules, have
access to food at any time, and have visitors at any time. The provider cannot restrict
these as a policy of the building or setting. In some situations, a person may have an assessed
need for modifications to some of these requirements. In that case, it must be addressed in the
person’s plan, including what the modification is, how it will be reviewed, and that it is
the least restrictive option for that person. Each person’s situation needs to be looked
at individually. Now that we’ve given you an overview of
the rule, the remainder of this video will focus on Minnesota’s transition plan to
come into compliance with the home and community-based settings portion of the new federal rule.
Minnesota’s Transition Plan Hello, I’m Alex Bartolic. I am the Director
of the Disability Services Division at the Department of Human Services. We understand
that change is hard, and it is difficult when you don’t know exactly what these changes
mean as we implement the new rule. Some of you may be excited about the opportunities…
others may be nervous about the impact on them… and many are probably a little bit
of both. We believe that the changes to our system that will happen because of the rule
will benefit people who receive home and community-based services. We want to work with you… people
with disabilities, seniors, family members, counties, tribes, health plans, providers,
advocates… all of you who care about how we implement this rule, to make sure the transition
is as smooth as possible. As you have been hearing, there are different
sections of the new rule. For many people, there won’t be any changes needed as a result
of the provisions that define the characteristics of home and community based services. For
example, most people who live in their own home or with their family, or work in a community
business already are receiving services in a way that is consistent with the new rule
requirements. Many providers, after learning more, will be able to make changes to their
policies or practices that respond to the requirements. There may be some situations
where a certain setting cannot meet the home and community based service standards. It
is the reason there is an extended transition period to allow time for exploration of options,
and implementation of a thoughtful plan. We will learn more through a process we are
going through over the next six months with providers to address their ability to meet
the new rule requirements. This is an opportunity for residential and day service providers,
who also have some control or ownership of settings where people live, work and spend
their day, to consider what changes in a particular setting may be necessary, and how they will
make them. The results of the self-assessment will give us information we need in order
to plan our next steps, including on-site reviews.
If you receive services, we want you to have good information about the new rule,
so that you have the facts to understand what this can mean for you. This rule, with its
requirements for person centered planning, case management, and the characteristics of
home and community based services, is focusing on services that support what is important
to you, gives you more control over your life, and helps you participate in community life.
Over the next months and years, we want to hear from you on about how well services are
supporting what is important to you in a way that promotes inclusion in community life.
This information is an important way for us to understand if Minnesota is meeting the
intent of the rule, and our own state policy. We see the new home and community-based rule as an opportunity to improve our system in
order to support seniors and people with disabilities in the community. We know it may be a difficult
transition, and we are committed to working closely with the people who will be impacted,
as we address any concerns that come up during the transition.

2 thoughts on “Home & Community-Based Services Rule Overview

  • If a resident wants an opposite sex late night visitors, what if the other residents in the house want it more quiet than what occurs with a late night visitor and also if the other residents want to walk around the house in their pajamas and don't feel comfortable with the opposite sex seeing them in the house?

  • As a person with a disability who depends on these types of services, I am especially concerned about how the state of Minnesota will address the shortage of people who work as direct care staff, PCAs, DSPs, etc. I may have the right to choose where I want to live, how I want to be involved in my community, pursue employment opportunities, etc., but all of this becomes mute when I can't even get out of bed in the morning because of staff shortage. I hope, and trust, Minnesota DHS will successfully address these concerns as part of the transition plan.

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