Tuesday, August 4, 2009

HCBS waivers and CMS rules-opportunity for input

HCBS Waivers and CMS Rules- Information Bulletin #291 (8/09)

Comments must be submitted by August 21, 2009 by email
http://www.regulations.gov and follow instructions under more search
options' tab.

It is important for advocates and people with disabilities of all ages to make your views known regarding the proposed changes

The two CMS proposed changes are:

1. To change waivers so they can be "based on need, rather than diagnosis
or condition." CMS states that the proposed change will "strengthen
person-center principles."

FYI - there are currently about 350 waivers serving about 1 million
people. Each waiver must serve one of three specific target populations -
mentally retarded or developmentally disabled, or both; aged or disabled,
or both; or mentally ill. CMS writes that the "impediment to serving more
than one target group through an HCBS waiver relates to the division
between the target groups..., not the associated institutional settings
where those target groups would otherwise receive services but for the
provision of HCBS."

The proposed change is intended to increase flexibility to combine target
groups in one HCBS waiver, or to offer services based on individuals
needs, instead of what target group they may fall in.

2. To address residential settings and housing, CMS recognizes that "some
individuals who receive HCBS in a residential setting managed or
operated by a service provider have experienced a provider-centered and
institution-like living arrangement, instead of a person centered and
home-like environment with freedoms that should be characteristic of
any home and community-based setting."

CMS proposed that persons receiving HCBS services "must reside in the home
or community," meaning either "resides in a home or apartment that is NOT
owned, leased or controlled by a provider of any health-related treatment
or support services; OR resides in a home or apartment that is owned,
leased or controlled by a provider of one or more health-related treatment
and support services, and that meets standards for community living...."

Some suggestions for comments from Steve Gold (http://www.stevegoldada.com):

1. All HCBS waivers should be based on functional needs of individuals.
This will eliminate that A-MI-DA, A-MR/DD-DA, A-A/PD-DA mentally and
might, just might move us to an ADA perspective.

2. All HCBS should reduce administrative waste and overlap, which
combining waivers based on functional needs accomplishes.

3. Existing discrimination against people with the greatest needs, those
people with the most severe disabilities, must end. In combining
waivers, the proposed change must address the widespread discrimination
against the most disabled members of the community.

4. Housing services are critical to transitioning back to the community.
But persons in HCBS should reside in a home or apartment that is "NOT
owned, leased or controlled by a provider of any health-related
treatment or support services." Housing should be delinked from
services - if CMS truly believes what they write about residing "where
they can enjoy all the liberties of community living...[and] have
maximum choice, control and individual liberties...."

5. Cost neutrality should be based on a combination of aggregate
expenditures, combining the numbers of persons in a functional waiver
and comparing their costs to a combination of costs of people in the
relevant institutions.

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