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Questions and Answers:

How Medicaid Changes are Affecting our Programs and Clients

 

What is the CMS HCBS Final Rule?

The Centers for Medicare and Medicaid Services (CMS) published the Home and Community Based Services (HCBS) final rule in the Federal Register on January 16, 2014, setting forth new requirements for Medicaid waivers.  The intent of the rule is to maximize opportunities for people with disabilities to have access to the benefits of community living, including receiving services in the most integrated setting.  The rule emphasizes personal autonomy, community integration, and choice for people who choose HCB settings instead of an institutional setting.

 

How will the Final Rule affect Wendell Foster?

People who receive case management from Wendell Foster will not be able to live in one of the 8 SCL homes on 6th and Center Streets with Wendell Foster as their residential provider.  This affects 23 people currently living in the homes.  Wendell Foster is a leader in person centered thinking and will continue providing high quality case management services.  We expect most of the 23 people will choose Wendell Foster to provide their case management as they find other residential providers, which will allow us to monitor services and make changes if the person isn’t satisfied.  This rule will not affect Wendell Foster’s 63 bed intermediate care facility, outpatient therapies, Western Kentucky Assistive Technology Center (WKATC), or the Kelly Autism Program (KAP).  We don’t anticipate any significant changes to the way we provide MP waiver services. 

 

Why is this happening? 

This rule is not unexpected, though we did not know until recently how Kentucky would interpret the rule.  The final rule is intended to help states meet their obligations under the Americans with Disabilities Act (ADA) and the Supreme Court’s Olmstead decision in 1999.  It is consistent with activity by the Department of Justice in implementing Olmstead and with provisions of the Affordable Care Act intended to create more community-based service options.  The final rule reflects a decades-long trend toward integration and community living in policy and social attitudes and is affecting providers across the country.  Many other states have already started eliminating settings that isolate or segregate.  There are many service options available now that weren’t available when people started receiving services from Wendell Foster.

 

How quickly will these changes take place?

States must comply with the federal rule in its entirety by 2019.  Kentucky is requiring compliance with certain provisions, including conflict free case management, starting this year.  People who use case management from Wendell Foster will need to find a new residential provider within about a year and half.  

 

How is Wendell Foster responding?

Our primary focus right now is supporting the 23 people currently living in SCL homes on Wendell Foster’s property during this transition.  Case managers are working closely with each person and their family and friends to identify their individual needs and wants and find available housing and services that match as closely as possible.  No layoffs are expected for the 40 employees currently working in the program.  Affected employees will have the option to transition into other programs at Wendell Foster.  At this point, future use of the homes has not been determined.  Wendell Foster is exploring new ways to support people with disabilities and their families in the community.

 

Where will the 23 people go?

This will depend on what the person and their family wants and is limited by the options that are available.  Some people may choose another agency in Owensboro to provide services in a home located in the community.  Some people may move out of town to be closer to family.  Others may choose to live with another person or family that provides the supports they need, or to apply to live in Wendell Foster’s ICF if space is available.  Still others may choose to find a home or apartment on their own or with roommates and exercise more control over the staff they hire.

 

Isn’t this taking away people’s choices?

Yes.  It is taking away the option for these 23 people to remain in their homes and receive both residential and case management services from Wendell Foster.  Some of the people affected have been involved with Wendell Foster for most of their lives and have become like family to fellow residents and staff.  Others chose to come to Wendell Foster from other settings and value the quality of supports and opportunities provided to them.  This change is disruptive and upsetting to everyone involved.  The final rule removes any setting that isolates or segregates as an acceptable “choice” for funding under HCBS waivers.  A setting can isolate because of its physical location, but also because of the way it is operated.  HCBS funding is for home and community based services, and congregate or institutional-like settings no longer meet this definition.  We will honor people’s choices through this difficult transition by listening to their preferences, giving them all available opportunities, and supporting them to have as much control as possible among all available options.

 

Aren’t you worried about sending people out into the community on their own?

Yes, our relationships with people we care about deeply are changing and we want the best for them.  While the current SCL homes are adjacent to the ICF, they are operated independently and residents of these homes receive no services from the ICF.  No one will move to a setting in which they do not have the supports they need.  People will not live alone unless it is their choice.  Case managers will play a key role in monitoring the quality of services and supports a person receives.  We are concerned about the availability and cost of resources to support people’s lives in the community.

 

Do you think this rule can be reversed?

Wendell Foster agrees with the intent of the Final Rule, which is for people with disabilities receiving HCBS to experience full access to the community and have greater control of their lives.  We don’t anticipate this rule being changed or exceptions being allowed which would allow people to continue living in Wendell Foster’s SCL homes as they are operated now.  We are working closely with other agencies, our state associations, and state officials to explore all potential options for the 23 people currently living in the homes.  Wendell Foster has provided public comment on the federal rule and state interpretation at every available opportunity.  We will continue to advocate for policies and practices that will improve the lives of people with disabilities:

  • We support community efforts that increase the accessibility of sidewalks and parks, housing, public transportation, and buildings, as well as awareness activities that promote inclusion and acceptance.
  • We support policies and funding, particularly Medicaid, that ensure people with disabilities have access to the full range of services and supports they need to pursue the lives they want while remaining safe and healthy.
  • We support policies and funding that promote integration in education, employment, and other facets of community life, while ensuring the necessary supports are available.

Medicaid Waivers -

Allow states to offer a community based alternative to services provided in an institutional setting, such as a nursing home or intermediate care facility for individuals with intellectual and developmental disabilities (ICF/IID).  In Kentucky, this includes the Supports for Community Living (SCL) and Michelle P (MP) waivers, among others.

 

Provisions Affecting Wendell Foster:

Settings - The settings where a person receives waiver-funded services need to promote integration and autonomy and cannot have institutional qualities.  CMS presumes that settings adjacent to an institution and clustered together have the qualities of an institution.

Conflict-Free Case Management -

Prohibits a person who receives case management from an agency (such as Wendell Foster) from receiving any other waiver-funded service (such as residential or day program) from the same agency.

Person centered planningThe basis for all services and supports should be an individualized person centered planning process.

 

 

Link to

Final Rule in Federal Register

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Link to

Kentucky’s 1915 (c) Waiver Statewide Transition Plan

815 Triplett Street
P.O. Box 1668
Owensboro, Kentucky 42303
PHONE | 270-683-4517
TOLL FREE | 877-932-2678
[email protected]