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In January 2014, the Centers for Medicare & Medicaid Services (CMS) published regulations to better define the settings in which states can provide Medicaid Home and Community-Based Services (HCBS). The HCBS final rule became effective March 17, 2014. The HCBS settings final rule, along with additional guidance and fact sheets, is available on the CMS Home and Community-Based Services site.
The purpose of these regulations is to ensure that members receive Medicaid HCBS in settings that are integrated in and support full access to the greater community. This includes opportunities to seek employment and work in competitive and integrated settings, engage in community life, control personal resources and receive services in the community to the same degree as individuals who do not receive HCBS. CMS expects all states to review current HCBS programs and to develop a transition plan providing an assessment, strategies and timelines for compliance with the new rules.
The programs currently under review include 1915(c) HCBS Waivers and 1915(i) HCBS State Plan programs operated by the following divisions within the Family and Social Services Administration.
The Indiana Family and Social Services Administration (FSSA) has created a Statewide Transition Plan (STP) to assess compliance with the HCBS settings final rule and identify strategies and timelines for coming into compliance with the new rule as it relates to all FSSA HCBS programs. Indiana’s initial STP was submitted to CMS for review and approval in December 2014. In October 2015, CMS responded to Indiana’s STP with a request for supplemental information, noting the STP was not approved by CMS at that time. Through guidance from CMS, Indiana submitted a second version of the STP to CMS in April 2016 that incorporated Indiana’s systemic assessment of rules, codes, policies and licensure requirements. In September 2016, FSSA submitted a third version of the STP incorporating site-specific assessment results for Indiana’s HCBS programs. Per CMS guidance, Indiana submitted a fourth version of the STP with technical corrections in October 2016. CMS responded in November 2016 requesting additional revisions. A fifth version with technical corrections was submitted to CMS which received initial approval on November 8, 2016. The technical corrections versions did not require public comment, but are available for the public in the STP links below.
Additionally, CMS requested further revisions to the site-specific assessments within Indiana’s STP in order to receive final approval. Once revisions are complete, FSSA will give public notice and the sixth version of the STP will be posted for public comment prior to submission to CMS for final approval.
Any substantive changes to the statewide transition plan will be made available for public comment prior to submission to CMS.