OCDD Home and Community-Based Services Setting Transition Plan

The Centers for Medicare and Medicaid Services (CMS) has issued regulations that define the settings in which it is permissible for states to pay for Medicaid home and community-based services (HCBS). The purpose of these regulations is to ensure that individuals receive Medicaid HCBS in settings that are integrated in and support full access to the greater community. The Office for Citizens with Developmental Disabilities (OCDD) has developed a transition plan to evaluate HCBS settings within the Children's Choice Waiver, Residential Options Waiver, Supports Waiver, and the New Opportunities Waiver to assure that the requirements of the rule are being met and to allow the public an opportunity to provide input on the transition plan. Comments or questions may be sent to ocdd-hcbs@la.gov

Annoucement: The Louisiana Statewide Transition Plan Receives CMS Initial Approval March 3, 2017

In March of 2014, the Centers for Medicare and Medicaid Services (CMS) established the Home and Community-Based Services (HCBS) Settings Rule about home and community-based services provided through several Medicaid authorities.  The Rule enhances the quality of HCBS, provides additional protections to HCBS program participants, and ensures that individuals receiving services through HCBS programs have full access to the benefits of community living.

CMS expects all states to review current HCBS programs and to develop a transition plan detailing site assessment processes, assessment of policies/regulations/rules, correction strategies, and timelines for compliance with the HCBS Settings Rule.  The Louisiana Department of Health (LDH) program offices, i.e. Office of Aging and Adult Services (OAAS), Office of Behavioral Health (OBH), and Office for Citizens with Developmental Disabilities (OCDD) created a comprehensive Statewide Transition Plan (STP) and this initial STP was submitted to CMS for review and approval in March, 2015.  In October, 2015, CMS responded to Louisiana’s STP with a request for more detailed information on the site assessments, systemic assessment of rules/regulations/policies, monitoring of settings, relocation of participants, and Heightened Scrutiny process.  Through guidance from CMS, Louisiana submitted a revised version of the STP addressing these issues on December 18, 2015.

In June, 2016, CMS requested supplemental information (site-specific assessment process/results; site-specific remediation activities; relocation of participants; Heightened Scrutiny; ongoing monitoring and compliance) be included in the STP in order to earn Initial Approval.  In addition, on August 12, 2016 CMS provided feedback to Louisiana on the systemic assessment crosswalk of rules/regulations/policies and requested further information/clarifications. Louisiana incorporated the requested information /corrections into the STP and submitted this revised version to CMS October 26, 2016.

Louisiana received notification of STP Initial Approval via email from CMS with the attached Approval letter on March 3, 2017.  In order to receive Final Approval of the STP, Louisiana must complete remaining steps and submit an updated STP.  These steps include: completion of comprehensive site-specific assessments with implementation of strategies for validating results; identifying remediation strategies and timelines for resolution of site-specific settings issues; establishing a detailed process for sites requiring CMS Heightened Scrutiny; developing a process for communicating with participants who need to be relocated; and establishing ongoing monitoring of settings to ensure continuing compliance.  CMS will also be providing Louisiana with technical issues that must be resolved prior to Final Approval of the STP.

Once these revisions are complete and prior to submission to CMS, Louisiana will issue the updated STP for a minimum 30-day public comment period.

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