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Community Settings Rule Update

Community Settings Rule Update. Rebecca Oliver, Policy Analyst Advanced Office of Health Services. Community Settings Rule Update. Where we are now

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Community Settings Rule Update

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  1. Community Settings Rule Update Rebecca Oliver, Policy Analyst Advanced Office of Health Services

  2. Community Settings RuleUpdate Where we are now • The updated Maryland State Transition Plan (STP) was submitted to the Centers for Medicaid and Medicare Services (CMS) for preliminary approval on August 31, 2016. • The Office of Health Services has received all survey responses and is in the process of reviewing and providing feedback to the providers. • The facility-based and residential-based CSQ is currently being administered for all participants. • OHS is in the process of updating the State regulations.

  3. Community Settings Rule Update The State Transition Plan Updates • Updated all waiver programs provider/participant information. • Technical changes to clarify the State plan. • Updated the community settings questionnaire (CSQ) for residential and facility-based programs. • Updated the remediation strategies. • Updated the State timeline for completion.

  4. Community Settings Rule Update Heightened Scrutiny • Sites will be reviewed under heightened scrutiny that are located within a: • Nursing Facility, • Institution for Mental Disease, • Intermediate Care Facility for Individuals with Intellectual Disabilities, • Hospital, • Other locations that have qualities of an institutional setting, or • Site near a quarter (¼) mile of another site owned by the same provider.

  5. Community Settings Rule Update • Heightened Scrutiny Continued • If Maryland believes that the setting is home and community based, it will submit evidence of its findings to CMS with the help of the provider. • CMS reviews the evidence submitted by the state and makes a determination as to whether the evidence is sufficient to overcome the presumption that the setting has the qualities of an institution. • Evidence submitted to CMS should focus on the qualities of the setting and the role it plays in ensuring that individuals who are receiving home and community based services have access to and are part of a greater community.

  6. Community Settings Rule Update Contact Information Please feel free to contact the OHS team at dhmh.hcbssetting@maryland.gov or 410-767-1820 for further information.

  7. Community Settings Rule Update Any Questions?

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