PAR 17-232
CMS Is Asking I/DD Providers to Comment on HCBS Settings Rule
Respond By November 27, 2017
The Centers for Medicare and Medicaid Services (CMS) have asked the National Association of State Directors of Developmental Disability Services (NASDDDS) for insights into where providers of intellectual and developmental disability services are at in terms of compliance with the HCBS Settings Rule. In order to answer this question, NASDDDS has set up an anonymous, very basic 3 question survey asking providers how they perceive their services are meeting the HCBS regulation. The survey will not track who is answering, and answers are due by COB on November 27, 2017. All providers are encouraged to respond.

Please take the two minute survey here.

At last week's NASDDDS Annual Conference, the CMS Representative discussed the Final Rule and took questions from the audience. Some in attendance interpreted her remarks to suggest states would be given more discretion in the determination of what constitutes isolation, while others felt current CMS discussions are unlikely to shift authority away from the current CMS definition. Upcoming CMS sub regulatory guidance is expected to add clarity.

Notes from the presentation include:
  • the definition of "settings that isolate" has become controversial
  • There is intense discussion going on within CMS as to what that really means
  • CMS is establishing a workgroup to "cut a middle path"
  • States have a voice in what is considered isolating
  • CMS is looking for a balance to understand what states are doing.
  • CMS is not looking to re-open the regulation but hopes to have sub-regulatory guidance ASAP (not before the end of the year)
  • The heightened scrutiny process has "taken on a life of its own."
  • 37 states, including Pennsylvania have either had their State Transition Plans given initial or final approval leaving only a small minority of states that "are not breaking any speed barriers" to complete their STPs.
Employment First Legislation Advances
Senate Labor & Industry Committee Unanimously Passed Senate Bill 21
With the support of PAR and other advocates across Pennsylvania, the Senate Labor & Industry Committee advanced  Senate Bill 21  today.

The legislation would provide for a policy known as “Employment First” in state law. The policy provides that competitive employment in integrated settings will be the preferred outcome for all working age adults and youth with disability, regardless of severity of disability.

To the extent practicable, the legislation would extend the policy to state, county, and local governments, including any entity providing publicly funded education, training, employment and related services, and long-term services and support for individuals with disability. Among other provisions, the legislation requires certain levels of training, goals and milestones, and tracking of the progress toward the goals. The legislation also establishes an oversight commission, endorsed by PAR, which will include a member who provides competitive integrated employment services from a statewide disability association.

The legislation is now awaiting consideration by the full Pennsylvania Senate before it will go to the House of Representatives for consideration.