VII Appendices Appendix A: Louisiana Master Work Plan (Includes all Programs)-Updated 9/6/16 Current Louisiana Work Plan Master – Public & Stakeholder Engagement Action Step OAAS Both Waivers OBH CSoC OCDD Children’s Choice Waiver OCDD NOW OCDD Supports Waiver OCDD ROW Change Note Reference Convene Interagency group to manage planning process Began 9/22/14 and continuing through 3/2019 9/22/14 and continuing 9/22/14 and continuing 9/22/14 and continuing 9/22/14 and continuing 9/22/14 and continuing 2015 Q4 OCDD Update II.A 2015 Q4 OAAS Update I.A
2015 Q4 OBH Update III.A - 2016 Q2 OAAS Update I. A 2016 Q2 OCDD Update II.A 2016 Q2 OBH Update III.A Identify all potential stakeholders including consumers, providers, family-members, state associations; advocacy organizations, and Began 10/1/14 Completed 10/15/14. All stakeholders identified on 10/31/14. All stakeholders identified on 10/6/14 to 11/15/14 All stakeholders identified on 10/6/14 to 11/15/14 All stakeholders identified on 10/6/14 to 11/15/14 All stakeholders identified on 10/6/14 to 11/15/14 Create portal on State Medicaid website. Provide transition information and plan. List end of comment period. OAAS website: OBH website: OCDD website: Website created and transition plan posted on 10/29/14. Comments due 3/13/15. Website created on 9/30/14. Issued white paper and transition plan. Public notice appeared in major Website created on 10/6/14 with transition postings. Comments due 12/17/14. Website created on 10/6/14 with transition postings. Comments due 12/17/14. SW Plan was posted on 11/21/14 and comments are accepted until through 2/28/15 Website created on 2/11/15 with transition postings. Comments due 4/10/15
newspapers on 10/10/14. Comments due 11/10/14. Appeared in major newspapers on 10/19/14. Support ongoing stakeholder communications. Held public forum (including OAAS stakeholders) on 11/19/14 and continuing as needed through 3/2019. Stakeholders are informed of STP’s progress through provider association meetings, OAAS quarterly provider meetings, and support coordination executive meetings Held public forum on 11/17/14. Presented information about the new HCB setting at the following: 1) 9/29/14 Statewide Coordinating Council; 2) 10/22/14 CSoC Governance Board meeting; 3) 10/23/14 Affinity call with CSoC Wraparound Facilitators, & 4) 11/3/14 Louisiana Behavioral Health Advisory Held public forum on 11/17/14 in Baton Rouge. Using the LA System’s to continue discussion. Update website as needed. Held listening session on 10/28/14. Additionally, 2 public forums were held on 2/11/15 in Shreveport and 2/20/15 in Houma. Held public forum on 11/17/14. Using the LA System’s to continue discussion. Update website as needed. Held listening session on 10/28/14 Additionally, 2 public forums were held on 2/11/15 in Shreveport and 2/20/15 in Houma. All notices will Held public forum on 11/17/14 in Baton Rouge. Using the LA System’s to continue discussion. Update website as needed. Held listening session on 10/28/14. Additionally, 2 public forums were held on 2/11/15 in Shreveport and 2/20/15 in Houma. Held public forum on 11/17/14 in Baton Rouge. Using the LA System’s to continue discussion. Update website as needed. Held listening session on 10/28/14. Additionally, 2 public forums were held on 2/11/15 in Shreveport and 2/20/15 in Houma. 2015 Q4 OCDD Update II. A 2016 Q2 OAAS Update IA 2016 Q2 OCDD Update II.A
Committee. Updating website as needed. All notices will appear in newspapers with details on how to access non-electronic format via the LGE offices appear in newspapers with details on how to access format via the LGE offices All notices will appear in newspapers with details on how to access non-electronic format via the LGE offices All notices will appear in newspapers with details on how to access format via the LGE offices Reach-out to providers and provider associations to increase understanding of rule and maintain open lines of communication. ADHC providers were sent letters describing the new rule on 3/13/15 Meeting with ADHC providers held 4/30/15 to review the rule, STP, and assessment process. Provider outreach continued through April 2016 for the self-assessment process and will continue through February 2017 to complete validation and remediation Distribute letters to providers describing the transition, criteria for HCB setting, deadlines for compliance and availability of TA. Begin 4/1/15 and ends 5/1/15. Completed 4/1/15 Held 5 provider meetings with OCDD providers, stakeholders and Support Coordinators on 10/20/14 in Lafayette, 11/6/14 in Houma, 1/13/15 in Baton Rouge and 1/14/15 in Alexandria and 2/12/15 in Covington. Providers were notified of the meetings through the Held 5 provider meetings with OCDD providers, stakeholders and Support Coordinators on 10/20/14 in Lafayette, 11/6/14 in Houma, 1/13/15 in Baton Rouge and 1/14/15 in Alexandria and 2/12/15 in Covington. Providers were notified of the meetings through the Local Governing Held 5 provider meetings with OCDD providers, stakeholders and Support Coordinators on 10/20/14 in Lafayette, 11/6/14 in Houma, 1/13/15 in Baton Rouge and 1/14/15 in Alexandria and 2/12/15 in Covington. Providers were notified of the meetings through the Held 5 provider meetings with OCDD providers, stakeholders and Support Coordinators on 10/20/14 in Lafayette, 11/6/14 in Houma, 1/13/15 in Baton Rouge and 1/14/15 in Alexandria and 2/12/15 in Covington. Providers were notified of the meetings through the electronic
work. Local Governing Entities. Sent e-mail blasts to all providers and associations of upcoming remaining public forums on 2/3/15. Otherwise notices listed on the website. Entities. Sent e-mail blasts to all providers and associations of upcoming remaining public forums on 2/3/15. Otherwise notices were listed on the website. Local Governing Entities. Sent e-mail blasts to all providers and associations of upcoming remaining public forums on 2/3/15. Otherwise notices were listed on the website. Local Governing Entities. Sent e-mail blasts to all providers and associations of upcoming remaining public forums on 2/3/15. Otherwise notices were listed on the website. Collect all public comments. Synthesize comments and develop responses to comments. See Appendix B for Comments received by OAAS See Appendix C for Comments received by OBH See Appendix D for Comments received by OCDD Began 11/13/14 and completed 3/13/15. Comments and responses are included in the Statewide transition plan. Second round of public notice: 9/14/16-10/14/16. Responses to Completed 11/12/14 and included in the Statewide Transition Plan. Second round of public notice: Began 11/15/14 and completed on 3/13/15. Comments and responses are included in the Statewide Transition Plan. Second round of public notice: Completed on 3/13/15. Comments and responses are included in the Statewide Transition Plan. Second round of public notice: 9/14/16-10/14/16. Responses to Completed on 3/13/15. Comments and responses are included in the Statewide Transition Plan. Second round of public notice: Comments are due 4/10/15. Comments and responses will be forwarded to CMS once they are finalized. Second round of public notice: 2016 Q2 OCDD Update II.A
comments and incorporation into STP will be completed by 10/30/16. Note: No comments were received during 9/14/16-10/14/16 comment period. Responses to comments and incorporation into STP will be completed by 10/30/16. Note: No comments were received during 9/14/16-10/14/16 comment period. Responses to comments and incorporation into STP will be completed by 10/30/16. Note: No comments were received during comment period. comments and incorporation into STP will be completed by 10/30/16. Note: No comments were received during 9/14/16-10/14/16 comment period. Responses to comments and incorporation into STP will be completed by 10/30/16. Note: No comments were received during comment period. Responses to comments and incorporation into STP will be completed by 10/30/16. Note: No comments were received during comment period. Continued Community Outreach Continue to meet with participants, family members, providers, support coordinators, stakeholders, and providers to provide updates on the progress of STP activities. Contact methods include provider quarterly meetings, support coordinator executive meetings, conferences, correspondence, website, newspaper announcements and Continue to meet with participants, family members, providers, support coordinators, stakeholders, and providers to provide updates on the progress of STP activities. Contact methods include provider quarterly meetings, Continue to meet with participants, family members, providers, support coordinators, stakeholders, and providers to provide updates on the progress of STP activities. Contact methods include provider quarterly meetings, support coordinator executive meetings, conferences, correspondence, website, Continue to meet with participants, family members, providers, support coordinators, stakeholders, and providers to provide updates on the progress of STP activities. Contact methods include provider quarterly meetings, support Continue to meet with participants, family members, providers, support coordinators, stakeholders, and providers to provide updates on the progress of STP activities. Contact methods include provider quarterly meetings, support coordinator executive meetings,
general meetings support coordinator executive meetings, conferences, correspondence, website, newspaper announcements and general meetings (See Appendix D for additional detail and activities held with stakeholders) newspaper announcements and general meetings (See Appendix D for additional detail and activities held with stakeholders) coordinator executive meetings, conferences, correspondence, website, newspaper announcements and general meetings (See Appendix D for additional detail and activities held with stakeholders) conferences, correspondence, website, newspaper announcements and general meetings (See Appendix D for additional detail and activities held with stakeholders) Current Louisiana Work Plan Master – Systemic Assessment & Remediation Action Step OAAS Both Waivers OBH CSoC OCDD Children’s Choice Waiver OCDD NOW OCDD Supports Waiver OCDD ROW Change Note Reference Review licensure, certification, policy and procedures, and provider qualifications 10/17/14 – 11/30/14 Crosswalk created 11/16/15 – 12/11/15 Crosswalk revised 10/17/14- 11/30/14 Determined changes to review documents not needed. 10/17/14 – 11/30/14 Crosswalk created 11/16/15 – 12/11/15 10/17/14 – 11/30/14 Crosswalk created 11/16/15 – 12/11/15 10/17/14 – 11/30/14 Crosswalk created 11/16/15 – 12/11/15 10/17/14 – 11/30/14 Crosswalk created 11/16/15 – 12/11/15 - 2015 Q4 OCDD Update II.A - 2015 Q4 OAAS Update I.A
7/22/16 and 9/1/16 incorporating guidance from CMS (See Appendix B for systemic review) Crosswalk revised 12/11/15 (See appendix C for systemic review) Crosswalk revised 7/22/16 and 9/1/16 incorporating guidance from CMS (See Appendix D for systemic review) Crosswalk revised 7/22/16 and 9/1/16 incorporating guidance from CMS (See Appendix D for systemic review) Crosswalk revised 7/22/16 and 9/1/16 incorporating guidance from CMS (See Appendix D for systemic review) Crosswalk revised 7/22/16 and 9/1/16 incorporating guidance from CMS (See Appendix D for systemic review) . - 2015 Q4 OBH Update III.A - 2016 Q2 OAAS Update I. A Prepare list of services subject to new rule. Classified as: 1) clearly meets HCBS setting rule; 2) with modifications, will meet new settings rule; 3) meets CMS close scrutiny review; 4) unclear if new setting rule will be met; and 5) services meet the definition of an institution. Completed 10/17/14. Only waiver service impacted is ADHC Completed 10/17/14 Crosswalk revised 12/2015 Completed 10/6/14 12/2015 Completed 10/6/14 12/2015 Completed 10/6/14 12/2015 Completed 10/6/14 12/2015 Complete remediation identified through systemic assessment process Completed by 12/30/17 Completed by 12/30/17 Completed by 12/30/17 Completed by 12/30/17 Completed by 12/30/17 Completed by 12/30/17 Current Louisiana Work Plan Master – Site Specific Assessment and Validation Action Step OAAS Both Waivers OBH CSoC OCDD Children’s Choice Waiver OCDD NOW OCDD Supports Waiver OCDD ROW Change Note Reference
Draft a self-assessment tool that familiarizes providers with the new settings rule and allows an opportunity to measure compliance with the new requirements. The assessment tool will identify areas for the new rule for which the provider is non-compliant and will allow providers to target compliance efforts. The tool will include questions that accurately assess provider compliance; and methods to quantify provider assessment results. Develop a draft self-assessment tool that assesses non-residential settings – 3/13/15 Develop a draft self-assessment tool that assesses settings and settings 3/25/15 – 3/31/15 Completed 3/31/15 Assessment tool revised 12/22/15 Develop a draft self-assessment tool that assesses settings – 3/13/15 Completed 2/1/15 Develop a draft self-assessment tool that assesses non-residential settings – 3/13/15 Completed 2/1/15 Develop a draft self-assessment tool that assesses residential settings and settings 3/25/15 – 3/31/15 Completed 2/1/15 Develop a draft self-assessment tool that assesses settings – 3/13/15 Completed 2/1/15 . 2015 Q4 OBH Update III.A Post on the website. Completed 3/16/15 Completed 4/1/15 Revised assessment posted 1/12/16 3/18/15 Completed 3/18/15 3/18/15 Completed 3/18/15 3/18/15 Completed 3/18/15 3/18/15 Completed 3/18/15 2015 Q4 OBH Update III.A Circulate self-assessments to stakeholder groups 3/16/15 – 4/15/15 Completed 4/1/15 – 5/1/15 Completed 5/1/15 Revised assessment circulated 1/12/16 3/18/15-5/2015 3/18/15-5/2015 3/18/15-5/2015 3/18/15-5/2015 -2015 Q2 OCDD Update II. A Modify self-assessment tool and 4/15/15 Assessment 4/19/15 4/19/15 -4/30/15 4/19/15 -4/30/15 4/19/15 -2015 Q2 residential residential residential residential
Completed 1/11/16 OCDD Update II.A 2015 Q4 OBH Update III.A 2016 Q2 OCDD Update II.A Post participant survey on the website and circulate to all stakeholders ADHC specific: 8/6/15-9/9/15 All waiver participants: 1/12/16-2/11/16 Completed 1/12/2016 4/20/16-5/20/16 4/20/16-5/20/16 4/20/16-5/20/16 4/20/16-5/20/16 --2015 Q3 OAAS Update I. A -2015 Q2 OCDD Update II. A 2015 Q4 OBH Update III.A 2016 Q2 OCDD Update II.A Modify participant survey based on comments N/A - no comments received for both 2/2016 4/20/16-5/20/16 4/20/16-5/20/16 4/20/16-5/20/16 4/20/16-5/20/16 -2015 Q2 OCDD
Transition of individuals will be tracked to ensure successful placement and continuity of service. Current Louisiana Work Plan Master –Ongoing Monitoring & Quality Assurance Action Step OAAS Both Waivers OBH CSoC OCDD Children’s Choice Waiver OCDD NOW OCDD Supports Waiver OCDD ROW Change Note Reference Continuous scrutiny will be provided to licensing, certification, policy and procedures, to ensure all document are compliant with the HCB Settings Rule. Completed 9/1/16 Scrutiny of new rules and regulations will continue to ensure compliance Completed 10/31/14 Scrutiny of new rules and regulations will continue to ensure compliance 12/15 – ongoing 12/15 – ongoing 12/15 – ongoing 12/15 – ongoing -2015 Q4 OCDD Update II.A -2016 Q2 OAAS Update I.A Specific quality assurance and improvement strategies are developed to ensure providers are evaluated against the HCB Setting Rule prior to enrollment. Completed 1/23/15 Completed 10/31/15 Begin 7/1/16 Begin 7/1/16 Begin 7/1/16 Begin 7/1/16 Practical performance measures are created to ensure providers continue to meet the HCB Settings Rule. Completed 1/23/15 Measure drafted and will be included in Completed 12/1/15 Measures have been included in the CSoC 1915(c) waiver Begin 1/1/16 Begin 1/1/16 Begin 1/1/16 Begin 1/1/16 2016 Q2 OCDD Update II.A
individual from among setting options including specific settings and an option for a private unit in a residential setting. The setting options are identified and documented in the person-centered service plan and are based on the individual's needs, and preferences. Code: Applicants/Participants of HCB Waiver Services (OAAS-RF-10-005, EFF. 9-2-14), p.1. Current rules and participant rights ensure participants are afforded choice in provider and service settings. 3 Ensures an individual's rights of privacy, dignity and respect, and freedom from coercion and restraint. Louisiana Administrative Code: Partially Compliant Current rule language (§4237, 4239) ensures participant rights of dignity, respect, and privacy while at the ADHC. Additionally, the right to privacy will be added to the participant rights and responsibilities document which already lists both dignity and respect. Rules and the participant rights and responsibilities document will be amended to prohibit all forms of restraint use and coercion. The title of the restraint training topic (§5049.C.19) will be amended The following rules will be amended: §4239.C.6 (Statement of Rights) - strike language and replace with “the right to be free from coercion and restraints” §4261.B.8 (Orientation & Training) – Clarify training module title to “Ensuring participants remain restraint free” §5049.C.19 The OAAS participant rights and responsibilities document will be amended Change 1st bullet to “Ensure rights of dignity, privacy, and respect” Change 8th bullet to “To be free from restraints” 12/1/17
to clarify the intent of the training – that participants remain free from restraints. 4 Optimizes, but does not regiment, individual initiative, autonomy, and independence in making life choices, including but not limited to, daily activities, physical environment, and with whom to interact. Louisiana Administrative Code: LAC 48:I:4239 Rights and Responsibilities of HCBSW EFF. 9-2-14), p.1. Partially Compliant The setting’s support for participants’ autonomy and independence in making choices is referenced throughout §4239 (C.1, D.2, D.3, D.9, and F). Additionally, per §4239.A, participants are both informed of their rights and must acknowledge receipt of these rights as part of the care planning process. Recently, language was modified in the ADHC provider manual to better support the participants’ ability to exercise choice/preference in their dining options. Language will be added to the participants’ rights and responsibilities document to ensure that participants’ autonomy and independence are supported and not infringed upon. ADHC provider manual revised language by 12/30/16. The OAAS participant rights and responsibilities document will be amended to reflect this requirement. by 12/30/16
48 4201 ADHC Licensing and Certification General Provisions Introduction 48 4233 ADHC Licensing and Certification Administration and Organization Participant Case Records 48 4237 ADHC Licensing and Certification Administration and Organization Confidentiality and Security of Records 48 4239 ADHC Licensing and Certification Participant Rights Statement of Rights 48 4241 ADHC Licensing and Certification ADHC Center Services Mandatory Daily Program Components 48 4253 ADHC Licensing and Certification Participant Care Nutrition Services 48 4255 ADHC Licensing and Certification Participant Care Social Work Services 48 4261 ADHC Licensing and Certification Human Resources Orientation and Training 48 4265 ADHC Licensing and Certification Center Responsibilities General Provisions 48 4273 ADHC Licensing and Certification Direct Service Management Admissions 48 4277 ADHC Licensing and Certification Direct Service Management Interdisciplinary Team Responsibilities 48 4279 ADHC Licensing and Certification Direct Service Management Interdisciplinary Team Composition 48 4281 ADHC Licensing and Certification Direct Service Management Individualized Service Plan 48 4283 ADHC Licensing and Certification Direct Service Management Individualized Service Plan Review 48 5029 HCBS Licensing Standards Administration and Organization Policy and Procedures
waiver. Individuals have the freedom to furnish and decorate their sleeping or living units within the lease or other agreement. N/A According to 42 CFR §441.301(c)(4)(vi), this requirement is not applicable as CSoC is a setting. Compliant; however, OBH will modify applicable rules and the CSoC Member Handbook to indicate the member must reside with their family in order to be eligible to enroll in the CSoC waiver. Individuals have the freedom and support to control their own schedules and activities, and have access to food at any time. N/A According to 42 CFR §441.301(c)(4)(vi), this requirement is not applicable as CSoC is a setting. Compliant; however, OBH will modify applicable rules and the CSoC Member Handbook to indicate the member must reside with their family in order to be eligible to enroll in the CSoC waiver. Individuals are able to have visitors of their choosing at any time. N/A According to 42 CFR §441.301(c)(4)(vi), this requirement is not applicable as CSoC is a setting. Compliant; however, OBH will modify applicable rules and the CSoC Member Handbook to indicate the member must reside with their family in order to be eligible to enroll in the CSoC waiver. The setting is physically accessible to the individual. LAC 48:I, Chapter 56, Subchapter I Compliant. This requirement is supported by regulation. C.3 OBH Provider Survey residential residential residential
D.3—Systemic Review and Assessment Residential Systemic Review Specific Requirement Regulation Other Outcome of Review By Waiver Remediation Required by Waiver Timeline 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 DD Law RS28:451.1 thru RS28:452.2 Partially compliant – does not address control of personal resources None- this law is not specific to HCBS waivers N/A LAC Title 48, Part I, Chapter 50, HCBS Providers Licensing Standards Click on Title 48, Public Health – General Click on Title 48:I, Public Health – General (Book 1 of 2) Go to page 10 of TOC §5079 PCA Module – Partially compliant, addresses development of relationships with and inclusion in meaningful, integrated experiences §5089 C. 3 – SFC Module – partially compliant – support individuals in home environment in community - similar to those enjoyed by most individuals living in community in all stages of life §5093 – SIL Module – Partially compliant in that it requires access to community services, client choice, proximity to client’s family and friends, access to transportation, proximity to health care services and place of employment when selecting setting §5107 –MIHC. This section is silent on access to greater community; however, it Language overall is weak on describing setting requirements. Will put requirement language in each HCBS waiver versus licensing Will include statement in this Licensing Rule that client has right to control personal resources in Client Assets section. December 2017
is specifically required to be a private residence §5059, Client Funds and Assets- Partially compliant. Does not specifically state that person has right to control personal resources, but does state that provider cannot require that they manage the client’s funds Title 50, Part XXI, Subpart 11, Chapters 137 and 139 (NOW) Click on “Title 50” Go to page 24 of TOC. §13701 – This section applies to all services in NOW. Partially compliant. Language states that mission is to supplement the family and/or community supports that are available to maintain the individual in the community §13901 – IFS – partially compliant §13905 – CID – compliant §13907 – SIL - partially compliant §13909 – SFC – silent §13929 – One time transitional expenses partially compliant §13931 – ACC – compliant §13935/13937 – Housing Stabilization – Rule is silent on controlling personal resources. Need to add to residential settings (SIL, SFC, Housing Stabilization and One time transitional expenses) Insert overall language to support these setting requirements in each waiver rule or overall HCBS rule December 2017
supports the integration of recipients within their community. Section 38.1, page 3 – CLS –Partially compliant - Setting is living with family or independently in their own residence. Goal is to maintain involvement in the community as outlined in the POC. Transportation to the community is included in this service. Section 38.1, Page 6, Host Home – Partially compliant – Setting is integrated in community because it is a private family residence. Community activities in POC are encouraged and supported in this services Section 38.1, Page 7 – Companion Care– Services are delivered in the recipient’s home and in the community as indicated in the POC. Section 38.1, Page 9 – Shared Living – Partial compliance/silent – place of service can be in person’s residence in the community or can be owned by the provider in the community. Does not address integration into the community, although the setting may exist in the requirements in each waiver manual Add control of personal resources to CLS, Companion Care, Host Home, and Shared Living as these are residential settings.
community. Supports Waiver Rule Title 50, Part XXI, Subpart 5, Chapter 53 Click on “Title 50”, Go to page 22 of TOC. §5301 – Introduction -compliant – create options and provide meaningful opportunities through vocational and community inclusion. Provide services and supports that promote community inclusion and independence. §5707 – Respite – partially compliant – provided in participant’s home which is a private residence or in a respite care facility. Rule silent on integration and access to community regarding facility. §5709 – Habilitation – compliant – Is provided in the home or community. §5717 & §5719 – Housing Stabilization services – compliant - Allow participant to maintain their own housing in the community. Insert overall language to support these setting requirements in each waiver rule or overall HCBS rule December 2017 Supports Waiver Manual Section 43.0 – Overview –Compliant - Mission is to create options and provide meaningful opportunities through vocational and community inclusion. Provides supports necessary for Insert overall language to support these setting/service requirements in each waiver manual December 2017
other settings as normal children attend (after school programs, summer camps, and other places designated in the POC). Services cannot be delivered in school setting. Includes participation in community including transportation to community activities. Section 14.1, page 10 Housing Stabilization Services –Partially compliant - Services must be provided in home or community setting. Silent on community integration. resources is not applicable to children, and should not be hindered for the family for these services. The setting is selected by the individual from among setting options including specific settings and an option for a private unit in a residential setting. The setting options are identified and documented in the person-centered service plan and are DD Law RS28:451.1 – RS28:452.2 Partially compliant, silent on settings being identified and documented in service plan None- this law is not specific to HCBS waivers N/A LAC Title 48, Part I, Chapter 50, HCBS Providers Licensing Standards - Partially Compliant §5094 A. – Supervised Independent Living Module – Partially compliant – living situation is freely selected by client. No mention of documenting setting options in service plan except agreement for shared living. §5094 10b. Each client shall have the right to choose whether or not to share a bedroom and a bed with another client. §5094 D. 2 – No clients shall be placed Insert overall language to support these setting requirements in each waiver rule or overall HCBS rule. Require all settings December 2017
based on the individual's needs, preferences, and, for settings, resources available for room and board. Click on Title 48, Public Health – General Click on Title 48:I, Public Health – General (Book 1 of 2) together in a living situation against their choice. The consent of each client shall be documented in the client’s record (for shared living). §5094 G. Selecting the location must be based on client choice and consider client cost, risks, proximity to family, friends, work, health care, community §5089 – Substitute Family Care – silent §5071- Adult Day Care – silent §5079 – Personal Care Attendant – partially compliant –identifies services to be provided in community and promoting individualized community supports targeted towards inclusion into meaningful integrated experiences. §5107 – Monitored In Home Caregiving – compliant – requires setting to be a private residence occupied by the client and cannot be any type of licensed facility. Selection of the setting occurs when the service is requested, Adult Companion Care which is in the NOW rule offered to be documented in service plan. Title 50, Part XXI, Subpart 11, Chapters 137 and 139 (NOW) §13701 Introduction – Partially compliant / mostly silent. Plan of Care for services is developed using a person Program office policy or manual will be revised to December 2017
Click on “Title 50”, Page 24 of TOC. centered process. All services must be delivered in accordance with the approved plan of care (POC). No mention of listing setting options or including in the POC §13901 – Individualized and Family Support – silent – addressed in the person centered plan process §13905 Community Integration Development – Silent – addressed in the person centered plan process §13907 – Supported Living – Silent §13909 – Substitute Family Care – Silent §13911 – Day Habilitation – Silent §13913 – Supported Employment – Silent §13917 – Employment Related Training – Silent §13925 – Professional Services - Silent §13927 – Skilled Nursing – Silent §13929 – Transitional Expenses – Silent §13931 – Adult Companion Care – partially compliant – setting is the require documentation of choice of specific setting for these services. The person centered process documentation is currently under review and these requirements will be incorporated into the most appropriate document.
individual’s home, is identified in the Plan of Care, service is based on individual needs but does not require all options to be documented in the POC. §13935 – Housing Stabilization Transition Services – Partially Compliant – does not require all options to be documented in POC §13937 – Housing Stabilization Service – Partially Compliant – does not require all options to be documented in POC NOW Manual Manual is silent Program office policy or manual will be revised to require documentation of choice of specific setting for these services. The person centered process documentation is currently under December 2017 disability
review and these requirements will be incorporated into the most appropriate document ROW Rule Title 50, Part XXI, Subpart 13, Chapters 161 Click on “Title 50” Go to page 25 of TOC. Silent Same as NOW remediation Same as NOW remediation ROW Manual: Silent Same as NOW remediation Same as NOW remediation Children’s Choice Rule Title 50, Part XXI, Subpart 9, Chapters 111 Click on “Title 50” Go to page 23 Silent Same as NOW remediation Same as NOW remediation
of TOC. Children’s choice Manual Silent Same as NOW remediation Same as NOW remediation Supports Waiver Rule Title 50, Part XXI, Subpart 5, Chapter 53 Click on “Title 50” Go to page 22 of TOC. Silent Same as NOW remediation Same as NOW remediation Supports Waiver Manual Silent Same as NOW remediation Same as NOW remediation Guidelines for Support Planning Silent Same as NOW remediation Same as NOW remediation
Ensures an individual's rights of privacy, dignity and respect, and freedom from coercion and restraint. DD Law RS28:451.1 – RS28:452.2 Partially compliant. Does not address dignity, freedom from coercion or restraint None- this law is not specific to HCBS waivers N/A LAC Title 48, Part I, Chapter 50, HCBS Providers Licensing Standards Click on Title 48, Public Health – General Click on Title 48:I, Public Health – General (Book 1 of 2) §5049 – Client Rights – Compliant – privacy, dignity, respect, freedom from restraint §5021D – Revocation of license – compliant – cannot intimidate, threaten, coerce Will update client’s rights language to include freedom from coercion December 2017 Title 50, Part XXI, Subpart 11, Chapters 137 and 139 (NOW) Click on “Title 50” Go to page 24 of NOW rule is silent Clients rights will be documented in licensing rule and in program manual December 2017
Optimizes, but does not regiment, individual initiative, autonomy, and independence in making life choices, including but not limited to, daily activities, physical environment, and with whom to interact. DD Law RS28:451.1 – RS28:452.2 Partially compliant in 452.2. Weak in autonomy and daily activities language. None- this law is not specific to HCBS waivers N/A LAC Title 48, Part I, Chapter 50, HCBS Providers Licensing Standards – Partially Compliant Click on Title 48, Public Health – General Click on Title 48:I, Public Health – General (Book 1 of 2) §5049 – Client Rights – partially compliant – 10 – ability to refuse services or activities which optimizes independence and choice. Is silent in other areas Update in program rule. December 2017 Title 50, Part XXI, Subpart 11, Chapters 137 and 139 (NOW) §13701 – broad statement of principle of self-determination, but does not specifically address autonomy and independence in choice. Partially Update program rule and manual in introduction to require all services December 2017
Click on “Title 50” Go to page 24 of TOC. compliant but not specific to the entirety of this requirement. to meet this requirement. NOW Manual Click on overview – Broad statements on principles of self-determination and services designed to promote independence and community inclusion. Partially compliant but not specific to the entirety of this requirement. Update program rule and manual in introduction to require all services to fully meet this requirement. December 2017 ROW Rule Title 50, Part XXI, Subpart 13, Chapters 161 Click on “Title 50” Go to page 25 of TOC Partially compliant §16101 - to promote independence through strengthening the individual’s capacity for self-care, self-sufficiency and community integration §16103 - to utilize the principles of and to supplement the family and/or community supports that are available to maintain the individual in the community. Partially compliant but not specific to the entirety of this requirement. Update program rule and manual in introduction to require all services to fully meet this requirement. December 2017 ROW Manual: Section 38.0 – Overview – Broad Update program rule December
Section 32.4, page 1, Freedom of choice of program, Section 32.4, page 2, Choice of SC and Providers Section 32.4, page 2, Voluntary Participation – Recipients have right to refuse services and be informed of alternative services. Guidelines for Support Planning Compliant Page 19, 1.1 A. 5. a. plan is unique and focused on things important to participant Page 33 -2.4.A.2 – Support Coordination choice Page 83, 4.4.1, B – FOC of provider No action required NA ROW Rule Title 50, Part XXI, Subpart 13, Chapters 161 Click on “Title 50” §16103 C Program Description – Partially compliant – Identifies freedom of choice for support coordination but not for provider. POC developed utilizing person-centered process. Update rule to include FOC for service provider December 2017
Section 43.2 – Page 2 - Support coordinators and service providers shall allow recipients/authorized representatives to participate in all person-centered planning meetings and any other meeting concerning their services and supports. The unit or dwelling is a specific physical place that can be owned, rented, or occupied under a legally enforceable agreement by the individual receiving services, and the individual has, at a minimum, the same responsibilities and protections from eviction that tenants have under the landlord/tenant law of the State, county, city, or other DD Law RS28:451.1 – RS28:452.2 Silent Will not be updated. Law not specific to HCBS services NA LAC Title 48, Part I, Chapter 50, HCBS Providers Licensing Standards – Click on Title 48, Public Health – General Click on Title 48:I, Public Health – General (Book 1 of 2) Note: Most residences are personal residences chosen by the participant or his/her family and are separate from the actual HCBS services provided. However, in the case of provider owned or controlled residences, the following is applicable. §5094 – Supported Independent Living - Silent - No requirement for a lease agreement for the participant. §5089 – Substitute Family Care – Silent - No requirement for a lease agreement for participant. Lease requirements will be addressed at the program level, not the licensing level NA
designated entity. For settings in which landlord tenant laws do not apply, the State must ensure that a lease, residency agreement or other form of written agreement will be in place for each HCBS participant, and that the document provides protections that address eviction processes and appeals comparable to those provided under the jurisdiction's landlord tenant law. Note: In both situations, the provider is required to give 30 days written notice and appeal rights as documented in §5037 Involuntary Transfers and Discharges. §5101 – Monitored In-home caregiving – setting is a private, unlicensed residence, which presumes the residence to not be owner controlled or operated. Lease agreements would be between the individuals living in the residence and the owner of the residence, not the provider of services. Title 50, Part XXI, Subpart 11, Chapters 137 and 139 (NOW) Click on “Title 50” Go to page 24 of TOC. Note: Most residences are personal residences chosen by the participant or his/her family and are separate from the actual HCBS services provided. However, in the case of provider owned or controlled residences, the following is applicable. §13907 – Supported Living – Silent Update rule to require lease agreements for residential services. That includes SIL, SFC. Adult Companion Care will be revised to include language December 2017
§13909 – Substitute Family Care – Silent §13931 – Adult Companion Care – Services are provided in the participant’s home which is not owned or controlled by the provider. This is considered a private dwelling and not part of the service provided to the participant. §13935 and §13937 – Housing Stabilization services - Both require lease agreements that does not allow the provider to own or control, and that the setting is chosen by the participant separate from any ACC services received. NOW Manual Section 32.1 – Covered Services: Page 12 – Supported Independent Living - Partially compliant - Implies that a lease is required for provider owned/controlled property. Need more specific info on lease requirements in this section. Page 13 – Substitute Family Care – silent Pages 34-37 – Housing Stabilization services - compliant Update rule to require lease agreements for residential services. December 2017 ROW Rule Title 50, Part XXI, Subpart 13, Chapters 161 Partially compliant §16303, E.3 – Community Living Supports – compliant -Services may not Update rule to require lease agreements for December 2017
where the service is delivered is a private residence. Chapter 38.1, page 7 – Host Home - although setting is a private home, it is the home of the host family. Manual is silent on lease agreement for participant. Chapter 38.1, page 8 – Companion Care Services –compliant - silent on lease but lease is implied because setting is in a private home the participant owns or rents Chapter 38.1, Page 10, Shared Living - Partially compliant – services can be provided in home leased by participant but also allows provider to own or lease the property. Silent on lease requirements for the participant if provider leased or owned. Children’s Choice Rule Title 50, Part XXI, Subpart 9, Chapters 111 Ctrl/Click §11101 –Compliant - Setting is home of parents or guardians. Implies that setting is private and parents own, rent, or lease the property Ctrl/Click 11303 – Housing Stabilization No action required NA
are implied as the service helps participants meet the terms of the lease. Units have entrance doors lockable by the individual, with only appropriate staff having keys to doors. DD Law RS28:451.1 – RS28:452.2 Silent Will not be updated. Law not specific to HCBS services NA LAC Title 48, Part I, Chapter 50, HCBS Providers Licensing Standards – Click on Title 48, Public Health – General Click on Title 48:I, Public Health – General (Book 1 of 2) Silent Update SIL and SFC requirements for doors lockable by individual December 2017 Title 50, Part XXI, Subpart 11, Chapters 137 and 139 (NOW) Silent Update SIL and SFC requirements for doors lockable by individual December 2017
Subpart 9, Chapters 111 Click on “Title 50” Go to page 23 of TOC Children’s choice Manual Silent No residential settings NA Supports Waiver Rule Title 50, Part XXI, Subpart 5, Chapter 53 Click on “Title 50” Go to page 22 of TOC. Silent No residential settings NA Supports Waiver Manual Silent No residential settings NA
Individuals sharing units have a choice of roommates in that setting. DD Law RS28:451.1 – RS28:452.2 Silent Will not be updated. Law not specific to HCBS services NA LAC Title 48, Part I, Chapter 50, HCBS Providers Licensing Standards – Click on Title 48, Public Health – General Click on Title 48:I, Public Health – General (Book 1 of 2) §5094 D. 2 Supervised Independent Living - Compliant– Consent for sharing is documented in participant’s record §5089 Substitute Family Care – silent §5101 – Monitored In Home Caregiving - silent Selection of roommates will be addressed in program rule and manual NA Title 50, Part XXI, Subpart 11, Chapters 137 and 139 (NOW) Click on “Title 50” Go to page 24 of §13901 – B. Individual and family support – Services may be shared when agreed to by participants. §13907 – Supported living – service is not the living arrangement, but the supervision of the home. The living Update rule to require consent for roommates for SIL, SFC and ACC. December 2017
TOC. arrangement is defined in the licensing standard, not the NOW program rule. Silent on roommate §13909 – Substitute Family Care – Silent on roommate §13931 – Adult companion care – Silent on roommate NOW Manual Covered Services Section 32.1 Individual and Family Support – Page 3 – Individual must agree to share services Supported Independent Living – silent on roommates Substitute Family Care – silent on roommates Update Manual for consent on roommates for SIL and SFC Add ACC December 2017 ROW Rule Title 50, Part XXI, Subpart 13, Chapters 161 Click on “Title 50” Go to page 25 of TOC. Silent Shared Living and Host Home – silent Community living Supports – participants must agree to shared supports – partially compliant. Companion Care – Agreement between participant and companion, but no language that participant selects the companion – partially compliant. Update rule for consent for roommates on Shared Living, Community Living Supports, Host Home, and Companion Care December 2017
ROW Manual: Silent Update program rule/manual to comply with this requirement December 2017 Children’s Choice Rule Title 50, Part XXI, Subpart 9, Chapters 111 Click on “Title 50” Go to page 23 of TOC. Silent Update program rule/manual to comply with this requirement December 2017 Children’s choice Manual Silent Update program rule/manual to comply with this requirement December 2017 Supports Waiver Rule Title 50, Part XXI, Subpart 5, Chapter 53 Click on “Title 50” Silent Update program rule/manual to comply with this requirement December 2017
Title 50, Part XXI, Subpart 11, Chapters 137 and 139 (NOW) Click on “Title 50” Go to page 24 of TOC. Silent Update in client’s rights in licensing rule as well as client’s rights in program rules December 2017 NOW Manual Section 32.8, Page 8, - Partially compliant – Allows for deviation from typical schedule and services if recipient driven, person-centered, and prior authorized. Silent on access to food Update in client’s rights in licensing rule as well as client’s rights in program rules December 2017 ROW Rule Title 50, Part XXI, Subpart 13, Chapters 161 Click on “Title 50” Go to page 25 of TOC. Silent Update in client’s rights in licensing rule as well as client’s rights in program rules December 2017 ROW Manual: Silent Update in client’s December
rights in licensing rule as well as client’s rights in program rules 2017 Children’s Choice Rule Title 50, Part XXI, Subpart 9, Chapters 111 Click on “Title 50” Go to page 23 of TOC. silent Update in client’s rights in licensing rule as well as client’s rights in program rules December 2017 Children’s choice Manual Silent Update in client’s rights in licensing rule as well as client’s rights in program rules December 2017 Supports Waiver Rule Title 50, Part XXI, Subpart 5, Chapter 53 Click on “Title 50” Silent Update in client’s rights in licensing rule as well as client’s rights in program rules December 2017
Go to page 22 of TOC. Supports Waiver Manual Silent Update in client’s rights in licensing rule as well as client’s rights in program rules December 2017 Guidelines for Support Planning NOW Section 5.3, page 8, Partially compliant – any deviation in the participant’s schedule must be “consumer driven” or requested by the recipient or family. Silent on access to food Update in client’s rights in licensing rule as well as client’s rights in program rules December 2017 Individuals are able to have visitors of their choosing at any time. DD Law RS28:451.1 – RS28:452.2 Silent RS28:452.1 (8) – partially compliant. Can have visitors but does not indicate at any time Will not be updated. Law not specific to HCBS services NA LAC Title 48, Part I, Chapter 50, HCBS Providers Licensing Standards – Silent Update in client’s rights in licensing rule as well as client’s rights in program rules December 2017
Click on Title 48, Public Health – General Click on Title 48:I, Public Health – General (Book 1 of 2) Title 50, Part XXI, Subpart 11, Chapters 137 and 139 (NOW) Click on “Title 50” Go to page 24 of TOC. Silent Update in client’s rights in licensing rule as well as client’s rights in program rules December 2017 NOW Manual Silent Update in client’s rights in licensing rule as well as client’s rights in program rules December 2017 ROW Rule Title 50, Part XXI, Subpart 13, Chapters 161 Silent Update in client’s rights in licensing rule as well as client’s rights in program rules December 2017
Title 50, Part XXI, Subpart 5, Chapter 53 Click on “Title 50” Go to page 22 of TOC. rule as well as client’s rights in program rules Supports Waiver Manual Silent Update in client’s rights in licensing rule as well as client’s rights in program rules December 2017 The setting is physically accessible to the individual. DD Law RS28:451.1 – RS28:452.2 Refers to ADA None NA LAC Title 48, Part I, Chapter 50, HCBS Providers Licensing Standards – Click on Title 48, Partial compliance §5073 Adult Day Care – E.3 facility shall be accessible to and functional for participants, silent on setting for supported employment §5091 Substitute Family Care – H.5.h – accessible to all members of household §5094 – Supervised Independent Living Revise Licensing Rule, Program Rules and Program Manuals to require all settings in which HCBS services are provided to be physically accessible by the participants. December 2017
ROW Rule Title 50, Part XXI, Subpart 13, Chapters 161 Click on “Title 50” Go to page 25 of TOC. Silent Revise Licensing Rule, Program Rules and Program Manuals to require all settings in which HCBS services are provided to be physically accessible by the participants. December 2017 ROW Manual: Silent Revise Licensing Rule, Program Rules and Program Manuals to require all settings in which HCBS services are provided to be physically accessible by the participants. December 2017 Children’s Choice Rule Title 50, Part XXI, Subpart 9, Chapters 111 Click on “Title 50” Go to page 23 of Silent Revise Licensing Rule, Program Rules and Program Manuals to require all settings in which HCBS services are provided to be physically accessible December 2017
Title 50, Part XXI, Subpart 11, Chapters 137 and 139 (NOW) Click on “Title 50” Go to page 24 of TOC §13701 – This section applies to all services in NOW. Partially compliant. Language states that mission is to supplement the family and/or community supports that are available to maintain the individual in the community §13911 – Day Hab – Partially compliant - provided in community setting but silent on full access to greater community§13917 – ERT– silent on setting §13913 – SE Compliant – definition is employment or competitive work in an integrated work setting. Insert overall language to support these setting requirements in each waiver rule or overall HCBS rule Need to add language on controlling personal resources if paid employment 2017 NOW Manual Section 32.1 pg 14 - Day Habilitation – silent Section 32.1, pg 20 Related Training – Not compliant – Insert overall language to support these setting requirements in each waiver manual 2017
training occurs at provider facility Section 32.1 – pg 16 Supported Employment – Compliant Guidelines for Support Planning Setting is only described in the definition of services. Is partially compliant, compliant, or non-compliant in definitions. Update all definitions to ensure proper settings language is included 2017 ROW Rule Title 50, Part XXI, Subpart 13, Chapters 161 Click on “Title 50”, Go to page 25 of TOC §16307 Day Habilitation Services – silent §16323 Prevocational services – partial compliance – goals include regular community inclusion and development of work skills to improve employability. Actual setting is not described. §16335 – Supported Employment – compliant – competitive employment that occurs in an integrated work setting Insert overall language to support these setting requirements in each waiver rule or overall HCBS rule Need to add language on controlling personal resources if paid employment 2017
Supports Waiver Rule Title 50, Part XXI, Subpart 5, Chapter 53 Click on “Title 50”, Go to page 22 of TOC. Silent Same as NOW remediation Same as NOW Supports Waiver Manual Silent Same as NOW remediation Same as NOW Guidelines for Support Planning Silent Same as NOW remediation Same as NOW Ensures an individual's rights of privacy, dignity and respect, and freedom from coercion and restraint. See Residential Settings – Systemic assessment – No changes for Non-residential services
law. Units have entrance doors lockable by the individual, with only appropriate staff having keys to doors. See Residential Settings – Systemic assessment – No changes for Non-residential services Individuals sharing units have a choice of roommates in that setting. See Residential Settings – Systemic assessment – No changes for Non-residential services
capabilities, interests, preferences and needs Community Integration 3 2 1 Recommendations/Comments Acceptable evidence of support may include: Review a sample individual’s plans of care for agency Review applicable policy/procedures for the agency Review a sample of individual’s schedules Interview some of the individual’s supported by the agency If the agency completes satisfaction survey’s with the individual’s, they support could review a sample of those Evidence provided supports that individuals have choice and are able to access services in the community in the same way that persons not receiving Medicaid funded services have choice and are able to access the community: Individual is afforded opportunity to have knowledge of or access to information regarding age appropriate activities including competitive work, shopping, attending religious services, scheduling appointments, meeting with families/friends, etc. Individual is able to come and go in the same manner as person’s not receiving Medicaid funded services Individual regularly accesses the community and/or is engaged in activities/organizations of their choosing Individual and/or their representative is able to describe how he or she accesses the community, the type of assistance they need to access the community, and who will assist them in the community Individual has access to transportation Rights and Privacy/Individual Initiative, Autonomy, and Independence *** To rate this item you will need to look at appropriate description. If the assessment, you are looking at is for Residential you will look at the first description and if assessment is for vocational program look at non-residential description (second description). 3 2 1 Recommendations/Comments Acceptable evidence of support may include: Review a sample individual’s plans of care for agency Review applicable policy/procedures for the agency Review a sample of individual’s schedules Interview some of the individual’s supported by the agency If the agency completes satisfaction survey’s with the individual’s, they support could review a sample of Residential Settings: evidence supports that the individual has the same rights/protections and privacy as person’s not receiving Medicaid services: Individuals who do not own their home have a legally enforceable agreement Agreement offers same responsibilities/protections from eviction There is a lease, resident agreement or other written agreement in place
those Individuals know how to relocate or request new housing Individual’s health information is kept private Non-Residential: evidence supports that the individual has the same rights/protections as person’s not receiving Medicaid Services: Information is kept private Setting assures that staff interact/communicate with individuals respectively and in a way the person would like to be addressed Each individual’s support plan is person centered and reflective of their individual needs/preferences and is not the same as everyone else in the setting Setting offers a secure place to store belongings The setting supports individuals who need assistance with their personal appearance to `appear as they desire and if assistance is needed it is provided in private Setting is free from gates, Velcro strips, locked doors or other barriers that might prevent entering/exiting certain areas Free from restrictive measures Setting offers a variety of meaningful non-work activities that are responsive to individual goals, interests and needs of the Individual Individuals are able to choose with whom to do activities Options are available to have meals/snacks at the time and place of their choosing Recommendations/Comments Acceptable evidence of support may include: Review a sample individual’s plans of care for agency Review applicable policy/procedures for the agency Review a sample of individual’s schedules Interview some of the individual’s supported by the agency If the agency completes satisfaction survey’s with the individual’s, they support could review a sample of those Living Arrangements **This section is only addressed on the Residential Assessment; you can enter N/A for this item and move to the next if you are reviewing a Non-Residential Assessment. 3 2 1 Recommendations/Comments Acceptable evidence of support may include: Review a sample individual’s plans of care for agency Review applicable policy/procedures for the agency Review a sample of individual’s schedules Interview some of the individual’s Evidence provided supports that individuals have choice and access to privacy within their living setting: Individual is able to have privacy-lockable doors, close and lock bedroom/bathroom doors, private cell phone, computer, or other communication device, and has space around to ensure privacy Individuals have freedom to decorate home as they desire