IN FSSA DDRS Non-Residential Self-Assessment

BACKGROUND:

In March 2014, the Centers for Medicare and Medicaid Services (CMS) implemented a final rule related to Home and Community Based Settings. This final rule requires that states assess all residential and non-residential settings which receive funding or payment through an approved home and community-based services (HCBS) waiver. The purpose of the final rule is to ensure that individuals receiving services are provided personal choice and control over the services in which they participate. The goal is to provide individuals the opportunity to control personal resources and achieve integration into their local community in the manner, and to the degree, which the individual chooses. This includes opportunities to seek employment, work in competitive and integrated settings, engage in community life, control personal resources and receive services in the community to the same degree as people who do not receive HCBS.

CMS is requiring states to develop a Transition Plan that describes the process for bringing all HCBS settings into compliance with the rule no later than March 17, 2019. As part of the Transition Plan, Division of Disability and Rehabilitative Services (DDRS) must assess each HCBS setting in order to determine compliance. DDRS has chosen a self-assessment for non-residential service providers. This self-assessment will assist in identifying potential areas of non-compliance and allow the provider to develop a transition plan outlining how they plan to achieve full compliance by 2018.

It is important to note that the desire of this self-assessment is not to close or terminate day services but instead, to work with members, providers, and other stakeholders to transition these waiver services to meet compliance with the CMS final rule and the vision of ensuring members are fully integrated into the community, afforded choice, and have their health and safety needs met.

Many individuals participate in non-residential services through waivers operated by DDRS. In order to continue receiving waiver funding, these sites must be considered “home and community-based” as defined in federal regulations under 42 CFR 440.180. This means the setting is integrated in and supports full access of individuals receiving Medicaid HCBS to the greater community - including opportunities to seek employment and work in competitive integrated settings, engage in community life, control personal resources, and receive services in the community, to the same degree of access as individuals not receiving Medicaid HCBS (ensuring people in the HCBS programs have the same opportunities as anyone else).


DEFINITIONS:

For the purposes of the self-assessment:

• ‘Services’ refers to the array of services a member may receive, including adult day services, case management, prevocational services, respite, and individual/group community-based habilitation. Note: this list is not all-inclusive of services available under the waiver
• ‘Setting’ refers to the general location of where the member may receive services, such as in the home, in the community, or in a facility
• ‘Site’ refers to the physical location/specific address where the service is delivered

INSTRUCTIONS:

You Are a Day Service Provider

You have been identified as a current provider of BDDS waiver-funded HCBS day program services under the Division of Disability and Rehabilitation Services (DDRS). Indiana is currently assessing these day services (Facility Based Habilitation, Community Based Habilitation, Adult Day Services, Prevocational Services) as required by the HCBS final rule and as established in Indiana’s Statewide Transition Plan.

You Are Required to Respond
 
DUE DATE:

Your responses to this self-assessment are due by October 13, 2016.

This self-assessment is one component of the HCBS compliance determination process. DDRS will review your responses and provide feedback to you identifying any areas in need of a transition plan by December 30, 2016.

COMPLIANCE:
This survey self-assessment will assist DDRS with determining site specific compliance with the HCBS final rule.

NON-COMPLIANCE:

For areas identified as non-compliant, DDRS will work with your agency to develop a plan to support the effective transition of the site to become HCBS compliant by July of 2018. This timeframe is to provide necessary time and planning for the providers to demonstrate compliance, and ensure minimal interruption in service delivery to individuals being supported by an HCBS waiver service.

All Agency Day Service Site(s) Must Be Included

Each site must be self-assessed by 10/13/2016. Sites that are not reported by this date, that are not confirmed compliant by DDRS, and that do not have accompanying documentation will be deemed non-compliant and will be subject to immediately meeting HCBS final rule compliance. Therefore, it is absolutely critical for providers to respond to the survey realistically, and accurately. Site information will be verified, and in some cases an on-site visit will be scheduled to confirm the self-assessment responses.

For assistance related to the Day Service Self-Assessment, please email questions to inbdds@pcgus.com.

EXAMPLES:

Each provider could be part of multiple settings and could have multiple sites related to each setting. In order to gather the necessary information from you in this self-assessment, we ask that you complete this self-assessment for each set of company policies/procedures that establish the rules of conduct within your organization's settings and sites. For example, Provider Smith has determined they have 2 settings and 5 sites. Sites 1-4 operate under Provider Smith company-policy-A, but site 5 operates under Provider Smith Company-Policy-B. Provider Smith will complete this self-assessment two times; once responding to the questions given policy A and once responding to the questions given policy B.

For example: Provider Smith provides Community Based Habilitation, Facility Based Day, and Pre-Vocational services under the waiver. There are two physical buildings and three hubs. The physical buildings provide Facility Based Day services in one building and Pre-Vocational services in another building that is it a sheltered work shop. The hubs are where the individuals utilizing Community Based Habilitation meet prior to going into the community. While Provider Smith may have overarching policies in place, each site that services are delivered in must be assessed for compliance. For this example, Provider Smith has 5 sites total. The facilities that provide Facility Based Day and Pre-Vocational services as well as the three addresses of the hubs. Regardless of the services provided at the site, the site itself must be assessed for compliance with the final rule.

Provider Smith has separate policies in place that address Facility Based Day services and Pre-Vocational services so they will complete one survey for those settings and list the two sites that are governed by those policies. Their Community Based Habilitation operates under a different set of policies, so a separate survey must be completed with the three sites listed.
 

Survey 1

Provider Smith	Facility Based Day site	Pre-Vocational site
	123 S. Vine St	123 S. Vine St

 

Survey 2

Provider Smith	Community Based Hub site 1	Community Based Hub site 2	Community Based Hub site 3
	123 1st St	456 2nd St	789 3rd St

 
Another example would be Provider Jones provides Facility Based Day services in three different physical locations as well as Community Based Habilitation operating out of the same locations. All operate under the same polices. Provider Jones would complete one survey, listing out each site.
 
 

Provider Jones	Facility Based Day/ Community Based habilitation site 1	Facility Based Day/ Community Based habilitation site 2	Facility Based Day/ Community Based habilitation site 3
	123 B Street	456 C Street	789 D Street

  
NEXT STEPS:

This self-assessment will identify sites that would benefit from an in-person evaluation to allow DDRS to provide additional guidance/feedback as to how the provider can achieve full compliance with the HCBS final rule. At the time of the on-site assessment, providers must be prepared to provide evidence to the assessor to support the information provided in the self-assessment. Providers must be able to provide evidence at the time of an onsite assessment to support the responses on this self-assessment. Evidence includes, but is not limited to:

1. Provider policies/procedures:

• Service descriptions – and how services are planned for each individual (ISP/PCP)
• Participant Rights Policies
• Any policies/procedures that address choice
• Any Policies/procedures that address community integration and community access
• Any policies/procedures that address restrictions, risk plans, etc.

2. Participant handbook

3. Staff training curriculum specific to rights, consumer choice, ISP implementation, and Person Centered Planning

4. Training schedule