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Date: 9/23/22 

HCBS stakeholder webinar 

Job 34887-2 

2:00 to 3:30ET 

Communication Access Realtime Translation (CART) captioning is 

provided to facilitate communication accessibility. CART captioning 

and this realtime file may not be a totally verbatim record of the 

proceedings.

>>CART Provider: Standing by. 

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correct?

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interpretation right now.

 >> Marcia: I wanted to start the spotlight since you're 

starting in like moments. I'm going to go ahead and I think I will be 

able to I'm going to launch the poll because I want to make sure you 

can see it. Possibly. Just to make sure it all works out properly. 

I'm going to lawn that now. Do you guys see that on your end.

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camera on right before it's my turn to be spotlighted, correct.

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 >> Got it. And I'm after Kirsten. Got it.

 >> This is Shawn when you run the poll maybe make sure they 

know to scroll down to get all the questions.

 >> Marcia: Who is going to introduce the poll.

 >> I'm happy to introduce it in the context of the welcome 

if you would like. Or Marcia if you would like to, that would be also 

fine I could just turn it over to you.

 >> Marcia: I am the behind the scenes person.

 >> 

>>CART Provider: Standing by.

 >> Kate Brady: Welcome folks, it's my pleasure to begin the 

voices of people with disabilities and older adults, strengthening 

advocacy in the HCBS settings rule webinar. My name is Kate Brady, I 
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work as a projects manager for HCBS stakeholder engagement in the 

national center on advancing person centered practices and systems. 

 Which is administered by the Human Services research institute. 

You will see on your screen today a welcome poll and we would love to 

have your engagement with that poll. It asks how you identify and you 

can check all options that apply. There's options include a person with 

a disability, a family member of a person with a disability, a person 

who provides direct support to people with disabilities or professional 

and disability services. An advocate and other. 

 If your answer is other, please feel free to put that information 

in the chat. If you'll scroll down in that poll you'll see that question 

number 2 is my employer is A and that's also a multiple choice question 

where you can check all that apply. And the options are community rehab

provider advocacy organizations, state Medicaid agencies, state DD 

agency, skilled nursing facility or group home. 

 Federal agency, University, person with a disability, or family 

member of a person with a disability, and other. The third question

is I am familiar with the home and community-based services settings 

rule. Yes or no. Fourth question, I have given written or public 

comment on an HCBS state-wide transition plan before. Yes or no. That 

is the extent of the poll. I would like to offer a quick visual 

description. 

 I am a middle-aged white woman with round brown glasses and short 

brown hair. I am wearing a dark blue scarf and white T-shirt with a 

blurry HSRI background behind me. I think we can, we'll leave that poll 
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up for a moment or two so folks can respond. 

 So this webinar is the first in the administration and community 

living webinar series on the role of stakeholders in ensuring high 

quality in home and community-based services. In this session we 

invite you to hear the vision, the administration has for advancing 

engagement. The stakeholders and there by the experiences of people 

receiving support. 

 We will look at the rationale for engagement, the pathways 

available for input and some model approaches for giving and receiving 

stakeholder feedback. 

 A quick overview of the agenda today. As you see we've started 

with the welcome and participant poll. Then you'll hear from the 

principle deputy administrator and as the acting secretary of aging 

Alison Barkoff. Then the commission of ACL's administration on 

disabilities. Then I will provide you an overview of HCBS rule settings 

stakeholder engagement. Then hear from senior policy advisor Nancy 

tell letter to speak 

about model approaches to stakeholder engagement. Hopefully we'll 

have time for a brief Q&A and a closing poll. Some logistics you will 

see you are muted. You can use the chat feature and the Q&A feature 

to submit questions here. We are providing both CART transcription and 

ASL interpretation. So hopefully you're seeing those pinned on your 

screen. The webinar is live captioned in English. If you need to pull 

up those 

captions you just want to click the CC button on your screen and that 
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will pull up those captions and as you've seen we are including polls 

and would love your engagement. It helps us to know who is here and 

what your needs are. So we would love to have your engagement there. 

All right. 

 It is now my pleasure to introduce Alison Barkoff. Alison was 

sworn in as principle deputy ad mirror on January 21 and currently 

serving as the administrator and secretary for aging. She provides 

executive leadership and cooperation for ACL programs nationwide and 

serves as an advisor to HHS secretary Bocera on things that impact people 

with disabilities and older adults. Alison is a lifelong advocate for 

community living 

both professionally and personally. She is the sibling of an adult 

brother with developmental disabilities and worked alongside her 

brother and parents from an early age to advocate for disability rights 

in her home state and later across the country. She graduated from 

emery University School of Law, became a civil rights attorney and has 

worked since then at the forefront of national efforts to expand home 

and community-based services that make community living possible. 

 Alison appeared before Congress and the U.S. commission on civil 

rights and has been a part of countless coalitions of people with 

disabilities and older adults and advocates prior to joining ACL. 

 She served as special council for the homestead enforcement in 

the civil rights division of the department of jigs. Held leadership 

reasons witness the centers for Medicare and Medicaid and directed 

advocacy efforts at both the center for public representation and the 
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Basal center for mental health law. Please join me in welcoming a true 

champion for people with disabilities and older adults, Alison Barkoff.

 >> Alison Barkoff: Thank you so much, Kate, and welcome 

everyone and truly thank you for taking the time to join today's webinar. 

Let me start with a really quick visual description. I'm a middle-aged 

white woman with curly brown hair wearing a gray blouse and a Blazer 

and I have a blue background with an ACL logo behind me. 

 Just so no one is confused, we have Q&A but our chat is disabled 

so just wanted to make sure people knew that. For those of you who 

aren't familiar with the administration for community living or ACL, 

we're an agency in the U.S. department of Health and Human Services and 

our mission is to ensure that all people have the opportunity to live 

and participate in their communities regardless of age, type of 

disability, or level of support needs. 

 And I am so thrilled today that we are doing this webinar on the 

Medicaid home and community-based services settings rule or HCBS 

settings rule because it is really critical to our mission. I am 

thrilled that over 1,000 people signed up for today's webinar from 

across ACL's disability and aging networks, advocacy organizations, and 

most importantly people with disabilities, older adults, and their 

families are joining us today. 

 Today's webinar is about how to elevate your voices as states are 

implementing the HCBS settings rule and as Kate mentioned this is just 

the first in a series of webinars that ACL will be hosting. For those 

of you who aren't familiar, the goal of the HCBS settings rule is to 
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ensure that everyone receiving home and community-based services has 

the full benefits of community living. Its truly a transformational 

opportunity to asymmetrical sure that your state service system 

 Support you to have the life you want and to be a full and valued 

member of your community. At the same time at it's core it's really 

about some very basic human rights, rights that other people take for 

granted. The ability to choose when you go to sleep, what you eat, who 

you live with and what activities you want. And so many of you over 

the last 8 years have been giving input and working in your own states 

on implementation of the settings rule. 

 We've made a lot of progress together but there have been have 

been delays of course due to COVID and COVID has made this rule more 

important than ever. Home and community-based service resist so 

critical. COVID showed us that the risk of institutional settings is 

so high with more people dying and infected from COVID in nursing homes 

than any other type of setting. COVID has had such a significant impact 

on our community service system and we are seeing 

people have lost access to services and seeing our direct care workforce 

put under further strain through this crisis. COVID-19 has created an 

unprecedented opportunity for us to advocate, to expand home and 

community-based services and as we are starting to move past the worst 

of the pandemic, it's up to all of us to make sure that all home and 

community-based services including new services that are being stood 

up because of new investments 

by Congress meet the requirements of the rule. And this time is really 
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urgent as you will hear in more detail today. The deadline for states 

to implement the rule is March of 2023. But that's not the end. Even 

once the rule is in place, we have work to do together to make sure that 

there is ongoing monitoring and that systems continue to comply with 

the rule. 

 By working together, we can achieve that goal of community living 

for all. So I just want to touch on why we're doing the webinar today 

and what our goals are. As I said, this is really about how to elevate 

your voices. People who receive services and support and their 

families know best about what's working and what isn't working in your 

own state. 

 And your input is critical to this rule being implemented 

successfully. It's not just good to have your input, the rule actually 

requires your states to get input and to respond to stakeholder input. 

And through my many decades of working both personally and 

professionally, I know the value of advocacy and how important it is 

that we make sure people who are most impacted by policies 

are at the table and have the tools and supports they need to make a 

difference. I did this work before I joined ACL and when the rule first 

came out working with national advocates to make sure people knew about 

the rule and had tools to give input. And I am so pleased that in joining 

ACL, my colleagues here share that same priority in making sure we are 

supporting stakeholder input. 

 And we are very uniquely positioned to help support this as you'll 

be hearing from speakers today by leveraging ACL's disability and aging 
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networks. Who are trusted voices in communities across the country. 

 And we've really put our money where our mouth is. As Kate said, 

we have provided funding to the national center on advancing person 

centered practices and systems or NCAP's to really begin reengaging our 

networks and other national advocacy organizations to help support 

people with disabilities and older adults across the country. 

 We have brought on national advocacy groups as part of this work 

including the national disability rights network, the association of 

the University centers on disabilities, the national association of 

councils on developmental disabilities, the autistic self advocacy 

network, the self advocacy resource and technical assistance center, 

the national association of state-wide independent living councils and 

the association of programs for rural independent living. 

 Each of them bring a unique perspective and will really, really 

help us support all of you in engaging. I'll just say that our goals 

over the next year include building on and amplifying and doing what 

we can to support the voices of people with disabilities and older adults 

around the settings rule to make sure we're working together to look 

past March 2023 about ensuring that there is ongoing monitoring of the 

rule and big picture we're looking to really increase the awareness 

of people who are receiving home and community-based services on what 

their rights are and to create the knowledge and the advocacy tools for 

engaging in state based policy much broader than the settings rule, 

really everything about home and community-based services. As you'll 

hear from Jill in a few minutes, we really are looking long range to 
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support you. With that, I will thank you again for being here, for all 

the work you've already done, and for what you'll be doing together 

with us over the next year and beyond. And I'll kick it over to Kate 

to briefly introduce Jill who will provide a few words.

 >> Kate Brady: Thank you so much, Alison for your 

leadership. So it's my pleasure to introduce to you all Jill Jacobs 

the Commissioner of the ACL's administration on disabilities. Jill 

brings to ACL more than two decades of professional experience managing 

disability services organizations analyzing policy and working towards 

improved health and disability programs and surfaces. 

 At local, state and federal levels. In addition she has worked 

with disability justice groups, disaster relief organizations and 

advocates to organize healthcare, human rights, and disaster relief 

initiatives in support of the most marginalized communities. Jill also 

brings to the role extensive lived experience both as a person with a 

disability and as the mother of two disabled adults. Jill joins ACL 

from her position 

as the executive director of the independent center of northern 

Virginia, a center for independent living. In that role she drafted 

and successfully advocated for the passage of two state laws to 

explicitly uphold the civil rights of people with disabilities, 

developed innovative approaches to providing services and supports to 

people with disabilities during the COVID-19 pandemic, and overhauled 

a number of processes and systems to both increase revenue 

and improve overall operations. And with that, in the interests of 
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time, and our ability to hear from Jill I'll pass it to you, Jill.

 >> Jill Jacobs: .

 >> Unmute, remember to unmute. I hope you are all well 

today, hello everyone. I want to first of all figure out where my 

comments went. They seem to have disappeared so give me a moment. I 

apologize. So I want to thank everyone for being here today. I'm very 

grateful for the opportunity to speak to you all. 

 Let me describe myself. I am a white woman middle-aged I have 

sort of reddish brown hair wearing a black sweater with cherry's and 

I am in my office with a bookshelf and artwork behind me. I am very 

happy to be here. I'm grateful that all of you showed up today and want 

to hear what we have to say. 

 As Alison said, the HCBS settings rule is extremely important. 

It is set standards around rights that many people with disabilities 

don't experience and for many, have never experienced. These include 

such things as having a lock on your door where you live, being able 

to access food when you are hungry, having a choice of the foods that 

you eat. Determining when you want to have visitors and who can visit 

you and how long they can stay. 

 How you might want to decorate your space. These seem so basic, 

they seem like really basic things. Most of us might not even think 

about them because they are so basic. But for many people with 

disabilities in our country who use home and community-based services, 

their everyday lives don't include these basic rights. So I ask that 

you get involved in the home and community-based settings rule process. 
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It's imperative, it's important, and we need you. 

 A key tenet of the disability community is nothing about us 

without us. When it comes to the settings rule, including the real 

stakeholders, the most important stakeholders, people with 

disabilities in the processes of requirement. But at ACL we believe, 

no, we know, that engaging with the people who need and are asking for 

services, in other words with people with disabilities is the best way 

to develop policy and the only way to turn that policy into 

good, solid, real programs that that are meaningful, inclusive, 

equitable and that truly achieve community integration and inclusion. 

 I want to share with you some specifics about how we are 

approaching public engagement in terms of the HCBS settings rule and 

I also want to explain our overall concept and our overall concept is 

kind of a long game. 

 So long game. We want to make sure that HCBS is what we, people 

with disabilities need. We want for disabled people, us, to feel 

ownership of HCBS. Because HCBS is the key to having real lives. To 

that end, we hope to educate, inform, and create a large community of 

people with disabilities who understand what HCBS is and what it is 

really supposed to be about. 

 Home, community, living, living our best lives, right. So what 

would living our best lives look like? What kinds of tools, supports, 

services are needed to get our best lives? What are the mechanisms, 

systems in place to deliver those supports and services? So something 

about ACL you all might not know, we are a federal agency dedicated to 
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advocacy, to the concept of change, and to the truth that change comes 

from people. 

 So we want to inform, engage, and give people tools that they need 

to the part of the process. We would like to see a cadre of knowledge 

filled advocates engage fully in making change happen. And we hope to 

see numbers of participants of change makers grow and grow and grow. 

So I'm pretty sure most of you here when I talk about growing, growing, 

growing our cadre of change makers, I envision it bigger, bigger bigger 

and I'm pretty sure 

most of you here are a lot younger than me back in the 70s there was 

a sha poo commercial when I was a little kid and is it started out with 

one person talking about how awesome the shampoo was and she wanted 

everybody to know. What did she do she told two friends and told those 

two friends to tell two friends and those two friends were supposed to 

tell two friends and pretty soon the TV screen was populated with little 

tiny pictures of all these people 

who knew about the super awesome shampoo, right. That's what we want 

to do. We want everyone to know about advocacy, about advocating for 

the HCBS settings rule, and to play the long game of changing HCBS and 

making sure we own HCBS. Now, I know that shampoo commercial and the 

idea of two people, two people, two people might seem kind of naïve and 

maybe to policy folks maybe a little silly or grassroots

folks out there doing advocacy a long time, activism a long time may 

be a little rudimentary. Okay, but I know that this collaborating, 

building, growing, educating each other, coalition building, these are 
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the basics of change making. And if we do it, we have the keys in our 

hand to change systems. We need to participate and that's what we're 

asking you to do. 

 We see advocacy around the HCBS settings rule as a starting point. 

And through it we hope to catalyze individual level engagement. Around 

the settings rule, we want you all to make public comments and we want 

you to tell two friends, tell two friends, tell two friends to make 

public comments. We want you to be talking about this everywhere all 

the time on socials. 

 But more broadly, for any state or federal program that provides 

programs or services for people with disabilities and older adults, we 

want you all engaged. So again, we see this, the settings rule work 

as a starting point and we're not just talking about it. We are funding 

it at ACL. That's what this webinar and subsequent webinars and 

activities is all about. Our hope is that ACL's networks all of you 

are our networks, and people with disabilities with whom you engage 

every single day 

can be our boots on the ground. You know these settings and you know 

the people in these settings who are using HCBS services. Because you 

are the people. You are the collaborators, you are the coalition 

builders, you are the change makers. It is early days right now to talk 

about the results of our ACL's public engagement but I'll tell you that 

the energy and interest we've seen particularly in states engaged in 

something called heightened scrutiny which you will learn about 

has been immense, huge, and we're learning really important things from 
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folks on the ground about their experiences related to settings rule 

implementation. I'll say again, I can't underscore enough how 

important we think it is to ensure that people receiving services are 

at the table, not only at the table but the key people speaking at that 

table being heard at that table and being involved in what happens. 

 At ACL I promise you we are in it for the long haul. We want to 

amplify your voices and we genuinely think that states, provides, 

individuals with disabilities, their families can be most successful 

when collaborating. So let's get started. I will turn it over to Kate. 

Let's hear from our team. Thanks.

 >> Kate Brady: Thanks so much, Jill. All right folks 

we're going to take just a few minutes and do an overview of the what 

and who of HCBS. So what are home and community-based services? Those 

are supports, employment, transportation, home healthcare, such as 

medications, housekeeping, in home therapy like PT, OT. Activities of 

daily living, bathing, dressing, going to the bathroom, cooking, 

finances and assistive technology and home modifications. 

 In 2018 more than 4.7 million people received Medicaid funded home 

examine community-based services and each state has it's own system and 

decides which populations they will offer HCBS waivers to. 

 Some of the core requirements of the CMS HCBS final settings rule 

are that every state must ensure that services meet the minimum 

standards for integration, access to community life, choice, autonomy, 

and other very important consumer protections. Such as the requirement 

of person centered planning. 
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 By March of 2023 as Alison mentioned, states must have received 

final state-wide transition plan approval. All states and settings 

should be fully compliant with the following regulatory settings, 

including privacy, dignity, respect, freedom from coercion and 

restraint and control of personal resources. 

 In terms of provider owned and controlled residential settings,

the requirements are a lease or other legally enforceable agreement 

providing similar protections, privacy in your home including lockable 

doors, freedom to furnish or decorate, access to food at any time, access 

to visitors at any time. Physical accessibility and a person centered 

service plan. 

 That documents any modifications to the regulatory criteria. 

States do have the option to submit corrective action plans. These 

flexibility allow for CMS to authorize caps to continue federal 

reimbursement of HCBS services beyond the end of the transition period 

if they need additional time to ensure full provider compliance. 

 So areas where CAPS will be allowed are areas of broader access 

to the community, opportunities for employment, option for private 

unit, and/or choice of a roommate and choice of non-disability specific 

settings. And states have to be able to show that their policies and 

procedures reflect the settings criteria. That they have made and they 

have made efforts to implement the criteria to the fullest extent 

possible. 

 So the reason we are here today is to talk about what are your 

engagements for opportunities for engagement and those include the 
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state-wide transition plans. If you're looking to see whether your 

state's transition plan has already been approved or is available for 

comment, you can access that link which we'll also get for you in the 

chat. States also have things like the heightened scrutiny package. 

This heightened scrutiny package 

identifies sites states anticipate may not comply with the rule. And 

currently CMS is identifying states to do site visits, to evaluate these 

items further, and there are opportunities for advocates to be involved 

in those heightened scrutiny site visits through stakeholder calls. 

 In the future, we anticipate corrective action plans although in 

the required to be available for public comment, we encourage advocates 

to be in communication with their state Medicaid agency and to express 

concerns and responses to corrective action plans. 

 And last but not least at all, as we build your engagement with 

HCBS settings, we anticipate that advocates will have insight about 

waiver amendments and renewals, new service provision, and we encourage 

you to stay engaged and also provide comment in those settings. What 

do we mean when we say stakeholders? Well, it's a broad group and you 

heard from Jill about the importance of your involvement. 

 And that includes individual people with disabilities, their 

families and neighbors, also advocacy groups including parent groups, 

sibling groups, self advocate groups, state-wide independent living 

councils and centers for independent living and the many protection from 

harm resources that state protection and advocacy organizations 

ombudsmen and adult protective services. 
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 So some when we think about engagement we don't just mean public 

comment and you're going to hear some great examples from states around 

the country in just a moment but a myriad of opportunities exist to 

engage in providing feedback regarding your experiences and the 

experiences of others in their home and community-based services. 

 You can show up and give in person comment. You can submit 

written comments, you can do that through your DD council or another 

organization that you're affiliated with. You can coordinate 

templates for others to use and submit comments and provide guidance 

so people know the framework for submitting a robust comment. 

 You can consult with partners and submit joint comments and of 

course you can call your legislators and your elected officials. 

 So we have created an opportunity to hear from you about the ways 

that you have been engaged in the HCBS settings rule. And we would love 

to see your comments in the jam board on the screen here. This feature 

will allow you to create little post it notes and write information for 

us about what you have been doing in regards to engagement. 

 We'll take that and turn it into a graphic and disseminate it after 

your response. So we would love to have you use that link and 

participate in that way. And in the interest of time, I am going to 

turn it over to Nancy Thaler, senior policy advisor for the 

administration on community living. Nancy will be guiding us through 

the conversation regarding state approaches to stakeholder engagement. 

Nancy comes to ACL having previously been the state director 

of Pennsylvania for 20 years. The CEO of NASD. The director of quality 
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at CMS where she also led the development of the HCBS waiver application, 

and Nancy also is a parent and spent eight years as a DSP including four 

years as a live in-house parent. So it's my pleasure to turn it over 

to you, Nancy.

 >> Nancy Thaler: Thank you, Kate, very much. I want to 

note for people the PowerPoint everybody has been asking for is in the 

chat box now. There is a link and you might want to look at it because 

all of the states that are going to present have parts in the PowerPoint 

and you might find that very useful. So while you are trying to download 

the PowerPoint out of chat, just let me say my job is pretty 

straightforward. I am going to introduce the four states of the 

speakers 

and I'm going to do the introductions rather briefly and they can say 

more about themselves. Speaking of introductions I should say to you 

that I'm an older white woman who has got very, very short blonde hair, 

a dark maroon shirt with a scarf and I have the standard background very 

plain blue background that has the ACL logo on it. 

 So going back to how we'll go about this, I'm going to introduce 

the four states very, very briefly who the speakers are, and then they 

will do their presentations and I will kind of try to do a little summary 

or point to points of interest before we move on to the next state. 

 So that said, we're going to start with Vermont, and our presenter 

is Kirsten Murphy who is the executive director of the DD council and 

Kirsten I'm going to hand it over to you. It's a real honor to be here. 

As Nancy said I'm Kirsten Murphy for visual I am an older white woman 
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I have salt and pepper hair but mostly salt at this point. I am wearing 

a black and white textured jacket and I have large eyeglasses on. 

There's a blurred background behind me. 

 So I assume I just ask to have the slides advance. So we could 

go to the next slide. I think all of us started with this thought of 

the foundational value of nothing about us without us. Everyone has 

said that so far. But what was behind that is of course this practical 

reality that I don't know what I don't know. Right. That self 

advocates and families who are living themselves or have a loved one 

living in a home and community-based settings 

are the ones that can bring the stories to us so that we can understand 

where the gaps are, where compliance is needed, what's going well, what 

isn't. Just a quick example. As a council member I run the DD council 

here I have a wonderful council member and he told a story about well, 

he's quite a foodie, right, he loves to eat, he's a wonderful cook. And 

he was placed in a home and community-based setting 

and his, the family with whom he was placed was vegetarian and they 

wouldn't buy him in I meat. This would no longer be consistent with 

the expectations of a home and community-based setting where this 

individual has a right to the food of his own choice. So those are the 

kinds of fine grained details that we so need from our colleagues who 

are people with disabilities and their families. 

 We can go to the next slide. So for the developmental 

disabilities council in Vermont we think of our role as having a three 

C's we're a conduit for information, we're a convener of stakeholder 
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meetings and various other gatherings, and we are a composer of public 

comment. We often try to get out in front in all of these activities. 

 So it keeps the pace at our office kind of high. Because we want 

to be rapid in responding to the latest events of the day and in that 

sense control the conversation a little bit. Out of the gate as we begin 

to pull in all of our families and self advocates and give them the tools 

they need to speak to the state. 

 So next slide. I like to start my dialogue with state partners 

often by reminding them that for DD councils anyway this is in your 

assurances. Your state has promised that you as a DD council will be 

a part of quality assurance activities. So section M of your assurances 

the council will participate in the planning, design or redesign and 

monitoring of state quality assurance systems 

that affect individuals with developmental disabilities every five 

years your agency signs that and you sign that and that is an agreement. 

And so if we're not being invited in, we invite ourselves and we say, 

well, this is our role, this is what Congress expects of us. 

 Next slide, please. So how do we do some of the nitty-gritty here 

because this is really work. We work hard in my office. And one of 

the places where that starts is becoming subject matter experts. We 

read everything related to the home and community-based settings rule. 

Not just the state transition plan. In order to be really on top of 

this, we needed to know what our state Medicaid waiver said. 

 What all the CMS guidance has been, especially letters to state 

Medicaid directors. What are state quality strategy is because that's 
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where much of the compliance resides. We made sure that we read all 

of these documents and became experts on them. As we watched this, 

we've been watching this unfold since 2014 and even before that. 

 We use every opportunity for public comment but that doesn't 

always mean formal public comment. We do submit formal public comments 

but we also try at most advisory group meetings and Vermont has a lot 

of advisory group meetings, we try really hard to find an opportunity 

to reiterate our message in the context of those meetings because often 

some of the trends and CMS rules come up in those meetings 

and we will be the first to raise our hand and reiterate the importance 

of the settings rule, the fact that the deadline is coming up on, in 

March of 2023, and we share, we also share our comments widely when they 

are written. We make sure that they are not a conversation just between 

us and, say, the state quality director who is written our transition 

plan. It's a conversation we want a lot of people to see as being had. 

 So we make sure that we share that widely. Next slide I think. 

We build partnerships with all of the disability communities, and that 

would not only be the formal DD network but we have really pulled an 

independent living a lot in this conversation about home and 

community-based settings. 

 Because that touches so much on their community as well. We often 

start a conversation with other allies by bringing draft talking points 

to them. We don't know that's going to, we see that is just a beginning 

of a conversation. We often work with them together as we pull in 

broader meetings with self advocates and family members and begin to 
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hone the message based on what they have to tell us. 

 They are the ones with the good stories. We have made a real 

effort to take a lead in explaining the settings rule in plain language 

because it is not, it's almost comes as a surprise to some of our 

self-advocates that the rules are changing so profoundly for them. 

 And I know has a reputation for very fine services and that happens 

in many cases but for many people the idea that you can have the right 

that you do have the right to have a visitor at any time of day and a 

provider owned setting is life changing. It's life changing and it is 

really important for people to come to understand those new norms. In 

a language that makes sense to them. 

 People often sit back and kind of say oh, well the state, gosh 

the state hasn't really invited us to the table. We don't work that 

way because that invitation might not be coming. Our state workers not 

out of meanness but because our state workers are overworked. Instead 

we organize town meetings and have done this around the home and 

community-based settings rule and then we invite the state to come and 

listen. 

 And when we do that we prepare very carefully for those 

opportunities. We look for stores in advance and make sure those 

individuals are there and make comfortable sharing the stories they 

have. We coach speakers in advance. We help people with plain 

language. And then we follow-up after the meeting with a written 

summary and key points that we hand back to the state so we make sure 

there's a record 
24

of the important points people share. Next slide. 

 So I like to talk about the home and community-based settings rule 

as a story and when I'm explaining it to people I start all the way back 

with Olmstead, and I tell a story about how we went from Olmstead to 

reaching out to people to find out what home and community-based living 

really meant and then CMS began to promulgate these rules in 2014, and 

then low and behold there's a straight line through to today where we 

are finally coming up with a deadline 

and the transition plan have to be a reality now in our states. So 

similarly, and in that story I want to really recommend something to 

you all while I have you. ASAN the autistic self advocacy network still 

holds a foundational paper which is titled self advocates describe the 

meaning of community living and if you want to see where some of the 

rules in the home and community-based settings rule kind of came from 

where the particulars came from, this is a wonderful short read. It's 

an example of bringing together self advocates who shared truly what 

it meant to them to live in the community. And what it meant wasn't 

about a particular building, it was about the quality of the life that 

they had. 

 And I find it a really inspiring way to begin to show people what 

is so aspirational about this home and community-based settings rule. 

Similarly, we've a long story in Vermont. In 2014 when the rules first 

came out, Vermont was not, still not in compliance with the person 

centered planning component of the rule. Because we actually do not 

have conflict free case management. And our state said nonsense that 
25

rule doesn't apply to us. 

 And we begged to differ politely and continued, like I said, to 

bring that up in every single meeting that we had an opportunity to bring 

it up to. We put it in every piece of public comment. Eventually the 

state said well maybe it does apply to us but we're going to ask for 

an exception and maybe we can get a different model, maybe we can have 

more choice and not have to have conflicting interest case management. 

We said I don't think so. 

 But we kept bringing it up. We kept bringing it up and eventually 

CMS said to the state no, no, you're under a plan of correction now you 

do have to comply with this rule. 

 All along the way we began to reach out to our colleagues in 

Washington, even to ACL's policy people and eventually we're allowed 

to put some of our thoughts directly in front of CMS because people were 

telling us example after example where conflicts of interest had 

operated not in their interest but had caused them to be disadvantaged 

in negotiating with the provider or their agency or their home provider. 

 We took that lesson and are doing the same thing again with the 

settings rule. We are bringing it up at every meeting, we are holding 

those town meetings. Vermont was selected for an early visit by CMS. 

We were very pleased because we had already established a relationship 

a little bit with ACL and with Nancy here and with CMS to be invited 

to bring stakeholders into conversation directly with CMS. 

 That's very powerful. I never thought in my career I would get 

to really be able to directly speak to our Medicaid liaison but we did. 
26

And people in our audience were prepared to share the stories that really 

needed to be heard. And that's how we're continuing to operate, those 

relationships that we built have really paid off. I think in the 

interest of time I'm going to stop.

 >> Nancy: Finish your last slide.

 >> I don't think they are important I want to stop right 

there thank you very much.

 >> Nancy Thaler: Really, really great. Your PowerPoint 

slides are almost a workbook or guidebook for community engagement. 

And I think that conduit for information and convene our stakeholders 

and propose public comments is a really great way to describe a role 

and maybe one of the favorite things if you're not invited to invite 

yourself. Really great. We're going to go through all four states and 

then we'll have a Q&A section. 

 So I'm going to introduce Pennsylvania next. My friend Lisa 

Tesler who is the executive director of the DD council and Sally Gould 

tailor whom I have not had the pleasure to meet but congratulations on 

your appointment to the temple U Lisa and Sally the floor is yours.

 >> Lisa Tesler: Thank you, Nancy. So good afternoon 

everyone. My name is Lisa Tesler and I'm the executive director of the 

Pennsylvania developmental disabilities council, and a visual 

description, I am a middle-aged white woman with shoulder length brown 

hair. Today I am wearing a V neck yellow sweater, a necklace with green 

and blue colors and I wear glasses. I have a green background with the 

Pennsylvania developmental disabilities 
27

logo behind me.

 >> Sally Gould Taylor: Good afternoon everyone my name is 

Sally Gould ta Taylor I am the executive record temple University. As 

a visual descriptor I am a white woman in my 40s with a round face, dark 

black hair pulled back wearing a white colored shirt with a blurred 

background. I will hand it over to you Lisa to start for Pennsylvania.

 >> Lisa Tesler: I'm excited to be here today and talk about 

how Sally and I and our organizations partner to engage with individuals 

and families. So the first thing I want to talk about is the information 

sharing and advisory committee. This is a committee that's led by the 

office of developmental programs. 

 The office of developmental programs provides services for people 

with intellectual, developmental disabilities in Pennsylvania. It is 

guided by the principles of everyday lives which is a philosophy and 

a set of values that were developed by people with disabilities and their 

families. 

 That kind of sets the standard of quality that the system follows 

and was a collaborative effort and agreed upon that kind of sets the 

standard for what quality means for everyone who is engaged with the 

system. 

 It's defined by the people and families. And this group focuses 

on the quality and they developed a set of recommendations that talks 

about how to improve quality of life and outcomes for people. And some 

of those recommendations align with the home and community-based final 

rule. Things like increasing self determination, choice and control. 
28

 Increasing community participation and employment. And 

increasing opportunities for different types of housing and community 

options. So that group comes together every other month. It's a broad 

stakeholder group. It includes all of the representatives from the DD 

network. So the developmental disabilities council, the institute on 

disabilities at temple, and disability rights Pennsylvania are all 

members of the group. 

 It has representation from self advocates and families. There 

are at present 14 different individuals with disabilities and families 

represented on the group. And that group then participants in all of 

the discussions around what are the policies and practices that the 

office of developmental programs puts in place, looks at data and 

measures an outcome and makes recommendations for improvements and 

strategies to 

the systems to measure how they are doing. And they produce an annual 

report every year that is public so that everyone who is engaged in the 

system knows what's going on and knows what progress is being made. 

 I don't know, Sally if you want to add anything about how that 

group works and functions?

 >> Sally Gould Taylor: I would just add that this group 

works in collaboration with and in response to kind of the decisions 

and guidelines that are being made in a response to the development of 

the state plan, the transition plan, putting out plans for heightened 

scrutiny, and all of that type of stuff. So it really is a dialogue 

happening back and forth.
29

 >> Lisa Tesler: Next slide. So one of the other important 

things that the council and temple has done together over the past five 

or six years is after the final rule was passed in 2014, the council 

recognized that there was an important opportunity here to create real 

transformational change for people with disabilities and their 

families. 

 If the final rule represented an opportunity for people and 

families to really have fully inclusive lives in the community in ways 

that we're currently not available. The way service delivery and the 

models that were offered in Pennsylvania were not giving access to the 

broad community to the same extent as people without disabilities. 

 Folks were not having the same experiences. The same 

opportunities for employment for work for freedom and choice and 

control, autonomy, to make choices in their own lives. So the council 

issued a competitive grant as part of the five year plan from 2017 

through 2021. And they wanted to make sure that individuals and 

families who are served by the system had the opportunity to engage in 

advocacy 

to the education and information they needed and to engage in the 

monitoring of how the implementation of the rule would be implemented 

in Pennsylvania. In the hopes that their lives would be better if the 

rule could be implemented in a way that led to really significant 

changes. 

 In how services would be delivered. Please temple won the award 

and so I'll turn it over to Sally to talk about what was some of the 
30

work they did while in that five year period.

 >> Sally Tesler: Absolutely. The institute was awarded 

this grant and we partnered with several stayed with the organizations 

including disability rights Pennsylvania, the Pennsylvania health law 

projects and self advocates united as one called SAU1 to carry out the 

grant. The four large tenets of the grant were sharing about the HCBS 

settings rule with Pennsylvania's information sharing advisory 

committee as well as gathering feedback on the rule. 

 Implementation from the ISAC members and other community members. 

Forming an HCBS advisory committee consisting of key community members 

including people with disabilities who receive HCBS waiver funded 

services and supports. And members of this advisory committee and 

others then went onto form a state-wide advocacy coalition which we call 

the coalition for inclusive community which we'll talk little bit about 

on the next slide. Also part of this work 

was assisting self advocates and families to develop and submit comments 

to the department of Human Services around access to quality HCBS and 

community living HCBS services and community living. As well as 

providing people using HCBS with a platform where they could share their 

personal stories about the importance of quality services in their 

lives. 

 And the highlighted link on the screen which you can look at 

another time will take you to some individual stories of Pennsylvanian's 

who are sharing how HCBS quality services impact their daily lives. 

 And those Pennsylvanian's were supported across Pennsylvania but 
31

also a federal level. So as I said one of the things that came out of 

that project was the development, the recognition people in 

Pennsylvania wanted to both think about, respond to and address the 

transition plan around the HCBS settings rule but also they saw it as 

a larger picture. 

 They wanted to create a coalition for inclusive community. Out 

of this work came a community, a group of community members across the 

state including all three of the DD network partners as well as many 

advocacy leaders from the self advocates organizations state-wide 

family advocacy groups, centers for independent living and the ARC of 

PA. They came together to talk about not only the implementation of 

the new settings rule and how Pennsylvania was responding 

but also to talk about other issues around community choice and quality. 

And for Pennsylvania over the last few years one of those large issues 

has been supporting the closure of some state centers, state 

institutions. 

 Move to the next slide.

 >> Sally Gould Taylor: Some of the work that council and 

temple partnered together to do is we create model comments for other 

organizations, individuals and families. So when there are 

opportunities for public comment on waiver changes, waiver amendments, 

the transition plan was just our comments were due yesterday. The 

community comes together 

usually the three sisters network DD network sisters come together or 

the coalition comes together. We get feedback and we create model 
32

comments that we can then distribute through our networks so that 

individuals and families have templates and information that they can 

use so that they can feel confident in submitting comments 

for themselves. Additionally, we convene small groups of families and 

self-advocates to talk about what the waiver changes or the HCBS rule 

means. Explain what the changes could mean one way or the other. And 

ask for their input and then support them to consider how they would 

respond and to provide input and comment to leadership. 

 And similar to what Kirsten said we do sometimes in the past 

preCOVID had invited administration and the office of developmental 

programs to some of those meetings to hear directly from individuals 

and families. And then Sally do you want to talk about the plain 

language resources.

 >> Sally Gould Taylor: Sure, again, as Kirsten talked 

about and we all know a lot of language within the HCBS final rule is 

complicated. It's difficult but it gets to the heart of people getting 

to choose the life that they want. And so this means spending time 

translating the rule, translating some of the language into plain 

language or easy read access. 

 Making sure that the resources are accessible by screen reader. 

Making sure that the resources are getting to all of the individuals 

in the accessible modes that they need. And then the last piece that 

we do around this additional support is social media engagement. 

Providing examples, Instagram, Facebook, and Twitter posts people can 

then share. People can make their own by providing their own pictures 
33

or example of how they are living their everyday lives. 

 But making sure we are pushing out this information in some of 

the new media or nontraditional ways as well. And I think that's it 

for us from Pennsylvania.

 >> Nancy Thaler: Thank you so much and your contact 

information, thank you. There is a thing here across the two states 

about being a conduit information I think you two used the word convening 

and some new ideas about translating this very complicated rule to plain 

language. What a great resource for people and using social media. 

 So again, a template for a wide range of ways to engage and 

influence state practice. Thanks so much. 

 Alabama is next. And there will be three speakers. James Tucker 

who are the director of the disability advocacy program at the 

University of Alabama. Louise woods who is a founding member of 

people's first Alabama. And Vicki Turnage who does a lot of things but 

one of the things is she is could director for self advocates becoming 

empowered. So I'll let you three do a fuller introduction 

and people can hear your voices then. Thank you so much.

 >> James Tucker: Thank you to everyone for being here, 

thank you to everyone who is facilitated this session and to all the 

stakeholders and advocates. Just a quick introduction my name is James 

Tucker, I am a lawyer, I am the director of the protection and advocacy 

agency in the state of Alabama. Also known as P and A as many of you 

know is one of the three DD network partners in the state as in many 

states along with 
34

the USAID and the DD council. I will do a quick visual description. 

I'm going to do a thumbnail summary but in order to respect the time 

of everyone, what we really want to do is to facilitate a discussion 

today with my good friends and advocacy partners, Vicki and Elouise, 

it's great to see both of you. 

 Elouise, if you can unmute then all three of us can talk in just 

a minute. So I want to say a word about what the P & A has done in 

Alabama. This work is challenging. This advocacy is challenging in 

the state of Alabama. Alabama is a state with not many resources 

dedicated to public services. 

 So several years ago the P & A decided that as a strategic matter, 

we wanted to monitor the 1,000 HCBS settings in the state vigorously. 

We haven't gotten to all 1,000 but we've gotten to a lot of them. Our 

state invited two sets of comments. One in the fall of 21, so last year, 

and one this spring. Again, I just want to give you a thumbnail. In 

the fall we were told that our comments could only relate to each 

individual setting, not to the system. 

 So our P & A prepared a comment that eventually ran more than 700 

pages long, and we commented on each of the more than 1,000 settings 

in the state. In the spring we were invited to comment again and we 

made something like a 50 page comment that was much more targeted and 

thematic and we're excited to be able to do so. 

 During both of those comment periods, we worked with a number of 

stakeholders from across the state, the P & A facilitated listening 

sessions with Elouise and Vicki, but also with many others. For 
35

example, members of the DD council, the USAID, ombuds advocates and 

others. Some reference has already been made in Vermont and Alabama 

we vigorously advocated to ACL and CMS that an on-site visit occur in 

the state of Alabama. 

 And such a visit did occur here in August. We worked with 

individuals to be able to provide comments in a wide range of formats 

but I want to describe one additional consideration that we made just 

because I have not heard it described so far. When we described to 

members of the public that individuals could make comment, we had some 

members who said they were afraid to comment. 

 They feared that if their comment was known, that they could 

experience retaliation or harm. In that situation, we offered to each 

such person that the P & A would adopt the comment as our own with their 

approval and make that comment. 

 To one more way in which we facilitated a wide range of comments. 

We would be happy to make any of those resources available but with that, 

Vicki, I'm going to mute and back off and ask you, Vicki, if you could 

facilitate a discussion with Elouise. The thank you both for being here 

and participating today.

 >> Vicki Hicks Turnage: Thank you, James. Elouise could 

you unmute yourself. Can one of the other presenters unmute Elouise, 

please.

 >> Alison: Marcia can you unmute Elouise.

 >> I can't she has to unmute herself.

 >> Elouise if you look on the bottom left of your screen 
36

there is a picture of a microphone with a red line through it. If you 

click on that, that should unmute yourself.

 >> Vicki: Give her a second to do that. As Nancy indicated 

at the very bottom of your screen there is a microphone. Tap on it it 

looks like Elouise, ask if you could ask your niece to help you unmute 

yourself.

 >> Hitting the space bar will also do it, one long space bar.

 >> That's a great suggestion.

 >> Vicki: We understand.

 >> Elouise if you press the space bar the long button on your 

keyboard on the bottom middle, press that button.

 >> Vicki Hicks Turnage: Let me introduce myself while I'm 

doing that. I'm an older white woman with Auburn hair with blonde 

highlights and I'm wearing dark rimmed glasses and I'm wearing a 

headphone. I have a red women's polo shirt with University of Alabama 

script A. 

 And my background is blurred. As I said my name is Vicki Hicks 

Turnage, and I actually run support coordination agency in the state 

of Alabama but I'm also the codirector of the SARTAC national self 

various center. 

 I have worked with safely advocates becoming empowered as an ally 

for many years as well as people first of Alabama. So when we get 

Elouise back on I'm going to talk with Elouise about her view of the 

HCBS rules. Elouise currently does receive services from the, one of 

the Alabama waivers and she was also involved in the writing of the 
37

position paper with ASAN and self advocates becoming empowered. 

 That we have referenced today. Of the meaning of community for 

self advocates. Elouise, could you tell folks about why it's important 

for self advocates to be involved in learning about the HCBS rules and 

how you have talked with folks over the years about living at the 

community and things that are important to them and to you.

 >> Elouise Woods: Can you all hear me now.

 >> Loud and clear.

 >> Elouise Woods: You hear me loud and clear. Hi.

 >> Yes.

 >> Elouise Woods: What you said now I forgot what you said 

now.

 >> Vicki Hicks Turnage: Tell us about community and what 

it means and how you've worked with folks to talk to folks who make the 

rules in the state about the community and the rules.

 >> Elouise Woods: Living in a community I thought it was 

very important to people who got a disability. I've been able to talk 

to people, tell people about rights. I would like to people to know 

what rights means. I tell them living in a community, get your right 

like going shopping, going to the movies, going to the store and just 

going to the park, just going to things line anybody else want to do. 

 And a lot of folks don't really understand because they don't 

know, they don't understand what we're talking about. But I think it's 

very important to people who talk to people to tell people about if you 

don't understand firsthand, repeat your words and make sure you're real 
38

clear for them to understand because when you talk to people they might 

not understand a lot of things to you. 

 But you might have to tell them again. But like I said, I knew 

somebody in a home, I had my own place, that's my choice where I want 

to be. Do I want to live in my own place or do I need a roommate. And 

my choice is I want a roommate, I wanted to learn how to pay my bills. 

I want to learn how to go shopping. I want to learn to travel some 

things, go out of town sometimes. And just 

my money, put my money in anything I need I could go and get it. But 

a lot of people just don't know that. They don't understand the rights. 

They don't understand what's going on in the community and going to 

people and asking people. They just don't know. I want to be part of 

people first and people first is to teach people how to speak up to make 

your dream come true. 

 My dream came true because long time ago I told them I wanted to 

be in my own place. I did get my own place. I had me a job, I had my 

own money what I want to do with it but when you go into people like 

group homes and institutions, sit down and talk to people, they really 

don't know what that means. And you're going to read it like I said 

earlier you're going to really work with people. 

 Please understand them and they might don't ask you and ask them 

do they really know what you mean, what you are talking about. 

 >> Vicki Hicks Turnage: Elouise, are you saying that for, 

in order for people to learn about the HCBS rules, states have to help 

them by going out and talking with them, having some focus groups, self 
39

advocacy groups, talking with them. And talking and understanding what 

these HCBS rules really are? Because I think you basically, everybody, 

all the self advocates that worked on this keeping the promise said these 

are just basically 

our human rights, they are no different than anybody else. That you 

know, we have the right to live where we want, have people come visit 

us, eat what we want, cook what we want without the system telling us 

what we have to do is that kind of what you're saying?

 >> Elouise Woods: Yes, uh-huh.

 >> Vicki Hicks Turnage: What did you want to share about 

what people first of Alabama has done in the past about helping people 

speak out and tell people what they want?

 >> Elouise Woods: Like I said, we had some, and what we do 

we talk about different stuff like some people want to know let me take 

that back. When we had a board meeting we made a list of some stuff. 

A lot of folks want to know transportation, jobs, home, money, and how 

you could have friends. 

 A lot of people don't have no friends. I don't know because they 

are scared to have friends. Or they are scared to go to the person. 

Or they don't really know. I met a lot of friends and a lot of friends 

told me we want to have some friends to go out sometime, go to dinner 

sometime, to go to the movies sometime. Or just go to the park and to 

walk around and have fun like anybody else want to have fun. 

 They really don't understand. Some people might get upset 

because they don't really understand and I said when you really, really 
40

really going to talk to people, please to make your words clear and then 

ask them for you to talk to them. Do you realize, do you understand 

what I'm talking about. They might not said that, they might give you 

some kind of exercise let you know they don't really understand. And 

I think they are just scared.

 >> Vicki Hicks Turnage: To summarize I think in terms of 

what seems to have been or is being effective in Alabama is the need 

to connect with self advocates and the people who are receiving 

services. With their families we would like to send messages to our 

state I'm blocking I'm sorry. Our department of developmental 

disability services is the need to listen the approachable, connect with 

self advocates. 

 Not to wait for, you know, to move us forward to make sure our, 

the information that's provided is in plain language and easily 

understood.

 >> Nancy Thaler: Thank you, Vicki and thank you Elouise and 

James. Really appreciate it and I think you make the point that peer 

to peer, people oh to people is really important to explain the rule 

and interpret it. Want so we're a little squeezed on time so I'm going 

to go quickly to Georgia. And Dr. Alyssa Lee who is the public research 

and development research director which is the council on disabilities. 

Doctor Lee would you like to proceed.

 >> Alyssa Lee: Thank you for having me. Excited to be 

here. My name is Alyssa Lee I'm the public policy research and 

development director for the Georgia council on developmental 
41

disabilities. I am a young white female with short brown hair. I have 

brown framed glasses and I'm wearing a Navy dress with multicolored 

flowers and my background is blurred. 

 I think there's always advantages and disadvantages to going 

last. One of the advantages is getting to listen to all of my fabulous 

coworkers around the country and all of the wonderful working they are 

doing. One of the disadvantages is probably many of my talking points 

have already been covered which is wonderful sounds like we're doing 

similar work across states. 

 I'm going to be brief, cover a couple of additional points that 

I didn't quite hear and maybe turn it back over to you Nancy and see 

if there are last words before we end. I would say that one of the 

pieces, I don't think I heard, I definitely heard a lot of work around 

convening partner organizations and making sure that, you know, our 

communication is a disability network. 

 We're using one voice and elevating that voice. At all meetings 

in all ways making sure that community members including folks with 

disabilities and their families are getting the information in a timely 

manner whether that be through social media or town halls, forums, 

certainly in plain language. 

 I think one of the things that we've also utilized at the Georgia 

council is the technology platform that allows us to assist people in 

creating email templates so they can send public comment very, very 

efficiently and easily. We think of Mad Libs where you can plug and 

chug some of your information into a template that's already been 
42

created. The other thing we are able to do with that platform is 

actually text our advocacy network so we can really have real time 

information the way most of us are receiving that now. Maybe we're not 

checking your emails frequently so we can send those texts so folks know 

as soon as it's made public that there's a public comment opportunity. 

And then I think last before I kind of wrap up one of the things that 

we also have worked on here in Georgia is sort of applying, I would say 

applying pressure to our state agencies to ensure that they really are 

putting forward opportunities for robust stakeholder engagement and not 

just for stakeholder engagement from provider agencies. So of course 

that's important perspective to receive but we really want to make sure 

that users of services, people with developmental disabilities and 

their families are also having opportunity to one, receive information 

from state agencies in a way they can understand 

but then also provide public comment and I'll provide two examples of 

the way that we apply pressure here in Georgia to make sure those things 

are happening. The first would be ensuring that there's a full 30 day 

public comment period. There is one instance in which the public 

comment period was open without proper notice so we actually advocated 

toward our state agency to make sure they extended public comment period 

so we could make sure advocates had ample time to understand the 

information and comment. And then the other opportunity was that there 

were some really great webinars being hosted by our state agency but 

they were provider focused and so we advocated to our state agency to 

ensure they incorporated an additional webinar that was focused on user 
43

perspective and so that was focused specifically on Georgian's with 

developmental disabilities and their families who are users 

of the service so the state can kind of keep in their minds there is 

this full picture here of the information they are disseminating and 

it's not just a provider heavy perspective they sometimes take. Please 

and so we just wanted to make sure that not only are we hosting meetings 

but that we're kinds of applying the pressure that the agency's don't 

just rely on our organizations but they are also keeping that in mind 

themselves. 

 That was it for me. Simple and quick. And I'm going to send it 

back over to Nancy.

 >> Nancy Thaler: Thank you so much. And everybody didn't 

say everything you were going to say. You had lots to add. I am going 

to wrap up and hand it back to Kate who is going to handle and manage 

the question and answer.

 >> Kate Brady: Thank you Nancy and thanks to Vermont, 

Pennsylvania, Alabama and Georgia. So on your screen here are some 

resources. You can access those after the fact because we will email 

this PowerPoint in PDF form to all registrants. Some of you have 

already downloaded it from the chat. We don't have time to do a verbal 

Q&A. 

 But we will make sure to capture any unanswered questions and 

include that content either in a follow-up document or in upcoming 

webinars as this is the first in the series. 

 So at this time, I would like to ask that we put up the final poll 
44

and that way we can hear from folks about looks like maybe that's the 

welcome poll that we've got right now. So we're going to want, there 

it is thank you for attending. So we would love to know what you thought 

of this webinar. It would help us immensely. We're asking was the 

webinar helpful in refreshing your recollection or to learn about HCBS 

settings rule. 

 Are you more likely to engage in advocacy organizing or other 

stakeholder activities, yes or no. Are you more likely to submit 

comments on the HCBS settings state transition plan after watching this 

webinar. So I see comments are coming in there. Responses. Thank you 

so much. 

 We would give that just another moment. And then we can close 

that and go to the final poll. It will just be one more I believe. And 

friendly remind to continue to populate that jam board that a wonderful 

Alixe Bonari after the email. You will find resources in the chat we 

will be sure to distribute. I think we can move to that final poll. 

 Marcia.

 >> This was the only poll I had on here this was the last one.

 >> Kate Brady: We are all set folks. Thank you so much for 

being with us today. Thank you to ACL for your leadership and I hope 

everyone has a lovely afternoon. 

Communication Access Realtime Translation (CART) captioning is 

provided to facilitate communication accessibility. CART captioning 

and this realtime file may not be a totally verbatim record of the 

proceedings.
45