Statewide Transition Plan

Background:

On January 16, 2014 the Centers for Medicaid and Medicare Services (CMS) issued new regulations for the provision of Medicaid Home and Community-Based Services (HCBS). The intent of the new regulations is to ensure that individuals receiving long-term care services and supports through HCBS programs have full access to benefits of community living and the opportunity to receive services in the most integrated setting appropriate.

Each state that operates a 1915(c) waiver or a Section 1915(i) state plan benefit that was in effect on or before March 17, 2014, is required to file a Statewide Transistion Plan outlining the state's strategies for bringing its HCBS delivery system into compliance with the federal regulations by March 16, 2019.

The following 1915(c) waivers are currently operating in Illinois:

 

1.    Adults with Developmental Disabilities

2.    Support for Children and Young Adults with Developmental Disabilities

3.    Residential for Children and Young Adults with Developmental Disabilities

4.    Medically Fragile/Technology Dependent Children

5.    Persons who are Elderly

6.    Persons with Brain Injury

7.    Persons with Disabilities

8.    Persons with HIV/AIDS

9.    Supportive Living Program

 

 

The current version of the State’s transition plan, submitted to CMS on February 29, 2016, is available at the below link:
 

 

 

HCBS Settings Surveys

In September and October 2014, the State distributed a self-administered survey to all of its HCBS waiver settings, as the first step of the State’s initial assessment of its settings’ compliance with the federal rule.  The State worked in collaboration with the University of Illinois at Springfield (UIS) Survey Research Office and created two provider self-assessment surveys – one for residential and one for non-residential settings.  
Those surveys, and the letters that accompanied them, are linked below:
 

 

 

Using the setting self-assessments above, and relying on a preliminary review of available licensing and other data available, the State preliminarily divided its settings into the following four categories:

·         Category 1: Settings that fully align with the federal requirements

·         Category 2: Settings that do not comply but may comply with modifications

·         Category 3: Settings that are at risk of being unable to meet the federal requirements

·         Category 4: Settings that are presumably not home and community-based (presumed to be institutional) but for which the State may provide justification/evidence through the federal heightened scrutiny process to show that the settings do not have the characteristics of an institution and do have the qualities of home and community-based settings

The results of the self-assessment surveys, broken down by the state agency that operates the waiver program the settings participate in, appear below:

 

 

 

DRS

IDoA

DDD

SLP

Total

Category 1/2

41

85

2379

113

2618

Category 3/4

5

7

40

33

85

Total

46

92

2419

146

2703

 

  

Survey Validation and On-Site Assessments

 

The survey results allowed a preliminary categorization, but as suggested by federal CMS and in public comments, the State is using other methods to reach a final assessment of its settings’ initial compliance with the federal HCBS rules. The State’s final assessment will be reached through the following steps:

·         For all settings, the State will consider public input. The State published a list of Category 3 and 4 sites in the Illinois Register on April 1st, 2016, and solicited public comment on the sites included and omitted from the list. The public notice is available below:

April 1, 2016 Solicitation of Public Comment on HCBS Settings

·         For all settings preliminary listed in Categories 3 and 4, the State’s assessment will be determined by an on-site visit conducted by the agency with normal oversight of the setting to be visited. For example, HFS will conduct the on-site visit for the Supportive Living Program, and DHS will conduct the on-site visit for a Community Integrated Living Arrangement. These visits will be based on the survey validation tool available below:

Survey Validation Assessment Tool

·         Settings preliminarily listed in Categories 1 and 2 will not be asked to host an on-site assessment unless they are randomly selected as part of the statistically valid sample of settings the State visits to validate its self-assessment survey results, as required by CMS.

o   Category 1 and 2 sites not randomly selected for an on-site visit will be assessed as either initially compliant or near compliant, and need only maintain or demonstrate compliance at the next regular monitoring visit.  

o   Category 1 and 2 sites selected for an on-site visit will host on-site assessment visits just as Category 3 and 4 sites will, and their initial compliance will be assessed by the results of those visits.

For all settings that receive an on-site assessment, the results of the assessment will undergo an HFS desk audit, with oversight from a multi-agency committee. This committee will review the results of a sample of the visit reports, and will review all reports for Category 3 and 4 settings, in light of its knowledge of each site and other State records.

In total, the State will conduct on-site assessments on 336 Category 1 and 2 sites and 85 Category 3 and 4 sites, for a total of 421 visits. The chart below shows the number of visits broken down by HCBS program operating agency.

 

Visits

DRS

IDoA

DDD

SLP

Total

Sample of Category 1/2

6

12

300

18

336

All Category 3/4

5

7

40

33

85

Total

11

19

340

51

421

 

 

Remediation and Compliance

Providers and Settings

 
All HCBS settings must achieve compliance with the new HCBS rule. Settings that will not receive an on-site visit as part of the initial assessment process will be initially assessed as compliant.  However, these sites can expect the Survey Validation Tool to be used in their next regularly scheduled State monitoring, licensing, or certification visit, and they are encouraged to consult this tool to self-evaluate and fix issues before the visit.
For settings that receive an on-site assessment visit, the State will review the results of the assessment, as well as any public comments and any information from the desk audit process, to reach an initial assessment of their compliance.  All of those sites will receive a communication stating their level of compliance and any required remediation actions.

 

State Remediation: Laws, Rules and Policies

 
In concert with the assessment and remediation process for providers, the State is also reviewing its own laws, rules, and procedures to ensure compliance with the federal rule. To that end, the State has identified four major areas of focus to ensure alignment between its policies and the HCBS rule: Laws and rules; provider contracts; HCBS waiver documents; and provider trainings, manuals, and guidebooks.
To undertake this process, the State has convened meetings among the legal and program staff of all state agencies that operate an HCBS waiver program. Any changes made to laws and rule will be posted for public comment and review before changes are officially made. Those public notices as well as a list of changes will be added to this website as they become available, and eventually incorporated into a new version of our Statewide Transition Plan.
 

Heightened Scrutiny 

 
As mentioned above, settings that fall within Category 4--that is, settings that the federal rule presumes to be institutional—must pass through the federal heightened scrutiny process in order to continue to participate in a Medicaid HCBS program. All of the settings that are presumed to be institutional will receive an on-site visit before December 31, 2016. During that visit, the State assessors will conduct the same review that they conduct on all 421 sites that receive an on-site visit, but the State will also seek out additional evidence to support those sites’ possible presentation to CMS for heightened scrutiny.  Assessors will use the below list as a guide for their visits to sites that are presumed to be institutional:
 
 
The State will use the results of the site visit, including any supplemental information collected by assessors, to determine whether presumed institutional sites are candidates to present to federal CMS for heightened scrutiny.  The State will communicate with affected sites as part of this determination process.
Based on its determinations, the State will work with sites to ensure that it has proper evidence to support the position that the sites have the qualities of an HCBS setting.  Before finally submitting its evidence to federal CMS, the State will, to the extent it can do so consistent with privacy protections, release for public comment the sites it proposes to submit for heightened scrutiny, along with documentation the State has collected regarding the sites. In its final submission to federal CMS, the State will also include any public comments and input from the agency, the general public, and HCBS participants and families.
CMS released a Home and Community based Settings Requirements Heightened Scrutiny FAQthat describes the heightened scrutiny process in greater detail.  
 
 

Ongoing Monitoring

 
 
In addition to the initial assessment activities described above, the State must also ensure its HCBS sites’ ongoing compliance with the federal HCBS rule.
To accomplish this ongoing monitoring, the State will incorporate into its regular assessment and monitoring visits the on-site assessment tool that is currently being used to evaluate the 421 sample and Category 3 and 4 sites. The agencies that already complete the regular assessments will add the on-site assessment tool to their current process. These data will be reviewed on a regular basis to ensure 100% continued compliance.
 
 

Transition Plan

 
The State of Illinois sought public comment on this version of the Statewide Transition Plan for a period of 30 days beginning on December 4, 2015 and ending on January 3, 2016.  The notice of public comment is available here. The State continues to welcome input on its plan. To submit more comments or questions about the revised Statewide Transition Plan, please email HFS.SWTransitionPlan@illinois.gov or mail comments to:
Illinois Department of Healthcare and Family Services
Attn:  Waiver Management
201 South Grand Avenue East, FL2
Springfield, IL 62763

Persons who are unable to access the Internet may request a hard copy of the revised Statewide Transition Plan by calling HFS at (217) 524-4148. 

Prior Versions of the State’s Transition Plan

Draft Illinois Statewide Transition Plan presented for public comment on December 4, 2015 through January 3, 2016:
The original Illinois Statewide Transition Plan submitted to federal CMS on March 16, 2015:
·         Original Statewide Transition Plan (pdf)
 
 

Additional Resources

 

 For more information regarding the new Federal HCBS setting requirements, please visit: 

 

Statewide Transition Plan

 

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