State officials have mapped out a three-year plan to bring the state's community-based disabled and elderly care into line with a new federal initiative aimed at standardizing service throughout the nation.
The Department of Human Services has worked for the past year to prepare the Home and Community-Based Services Statewide Settings Transition Plan, which outlines each step in the process to ensure that all recipients of the state's community-based care waivers are able to meet the new standards a year before the federally mandated 2019 deadline.
The state is asking for public input on the required transitional plan at a Monday hearing from 1:30 p.m. to 3 p.m. at the Donaghey Plaza South Building, 700 Main St. in Little Rock.
"This plan is a road map. It's not poured in concrete," said Craig Cloud, director of the Division of Aging and Adult Services. "This is the beginning of a dialog with providers, families and consumers."
The federal Centers for Medicare and Medicaid Services issued the rules in March 2014 to make sure that Medicaid's home and community-based services programs provide full access to the benefits of community living and offer services in the most integrated settings.
The federal regulation requires that all home and community-based settings meet certain qualifications, such as making sure to allow for individuals' full access to the greater community, ensuring individuals' rights of privacy and freedom from coercion or restraint, and increasing individuals' independence in making life choices.
The regulations apply to those receiving funding from five state waivers: ElderChoices, Living Choices Assisted Living, Adults with Physical Disabilities, Alternative Community Services and Partners for Inclusive Communities-Autism.
Amy Webb, spokesman for the Human Services Department, said the state has more than 11,000 individuals receiving the waivers.
The initiative does not affect institutional facilities, such as the state's five Human Development Centers. It affects only individuals or corporations that are providing at-home care or individual care in a group environment -- such as an apartment community -- for the disabled or elderly.
Jim Brader, interim director of the Division of Developmental Disabilities Services, said the majority of the state's providers already meet the standards -- especially home-based care providers, because by nature those individuals are part of the community.
The main objective of the federal initiative is to make sure clients living in a home or community-housing setting are truly living independently without institution-like rules.
"This is a different obligation than health and safety. If there are problems, we have to address that, but this is about true community living," Brader said.
Those in assisted living, adult day care and other group settings that are located on the grounds of or adjacent to inpatient facilities will be held to a higher scrutiny, Brader said. The danger, he said, is that homes close to institutions may be more prone to rely on those inpatient facilities as their "communities" instead of integrating the clients into the outside world.
The new rules require, among other things, that the independent-living settings, such as apartments or other group settings, provide the individuals with leases or other legally enforceable agreements; ensure they have privacy in their units, including locked doors and a choice of roommates; and that the individuals control their own schedules, including allowing visitors at any time.
"It gets down to the individual having a choice in how they live," Brader said.
The first step in the plan is the development of tools to conduct assessments of all the waiver providers and to work with stakeholders and the public to spell out a comprehensive set of standards and rules.
What will follow is a period of remediation to help providers meet the new standards and an educational campaign to inform the public and providers of their rights under the regulations.
The providers will not only be involved in the full process if they choose but will also be helped to meet the transition requirements. Cloud said if a provider does not currently meet the new regulations, they will receive guidance on the corrective action needed and assistance throughout the process.
The plan also includes procedures for relocating individuals from settings that are not made compliant with the new regulations, but Cloud said he does not anticipate anyone being displaced.
"We help them during the transition to make sure that doesn't happen," Cloud said.
The Statewide Transition Plan is available for review at the Division of Medical Services, 2nd floor Donaghey Plaza South, 700 Main St.; by mail at P.O. Box 1437, S-295, Little Rock, Ark., 72203-1437; by telephoning (501) 320-6429; or at www.medicaid.state.ar.us/InternetSolution/general/comment/comment.aspx.
Comments may be provided during the 30-day comment period, which ends at midnight April 20, during the public hearing, in writing to the Division of Medical Services at the address above or by email to becky.murphy@dhs.arkansas.gov.
State Desk on 04/04/2015