The Settings Rule: As it relates to Adult Day Training (ADT): The Arc of Florida’s Advocacy Committee will be focused on the top priorities identified by self-advocates, families, and professionals. One of the priorities is Adult Day Training (ADT). The Agency for Persons with Disabilities (APD) is working to bring iBudget Waiver funded Adult Day Training (ADT) and Supported Employment services into compliance with the federal Home and Community-Based (HCBS) Settings Rule. In 2014 CMS issued a rule referred to as the “Settings Rule.” The purpose of the rule is to ensure individuals on the Waiver have rights, choices, options, and opportunities while living at home and participating in their community. Florida is required to follow the rules and regulations in order to receive the funds to operate waiver services and has until March 2023 to come into compliance with the regulations. Kudos to the legislature for recognizing in the closing days of session the importance of ADTs in their budget by adding $20 million for this important service to those who utilize it. It was a big investment which protects the programs and choices for persons on the iBudget Waiver.
How APD interprets specific language in the Settings Rule impacts how Florida will move into compliance with it. The CMS Bulletin states “Waiver funding is not available for the provision of vocational services delivered in facility based or sheltered work settings, where individuals are supervised for the primary purpose of producing goods or performing services.” What the term “primary purpose” means has not been discussed as we address the “Settings Rule” and it is this omission that limits choice which may be to the detriment to those served by the iBudget Waiver. This is likely to be one of the most important issues for disability rights in Florida in the next year. It is critical that policymakers make an informed decision by listening to those who will be affected by this decision.
Currently there exists ADT (Life Skills Development 3) and Supported Employment through Vocational Rehabilitation. The Agency for Person with Disabilities (APD) intends to add Pre-Vocational Training (Life Skills Development 4) to include pre-vocational and work experience on a time-limited basis which will help individuals transition into Vocational Rehabilitation. Individuals will learn non-job specific skills. The following questions and comments came up during a recent discussion.
1. Who specifically is developing the proposal for Life Skills Development 4? Will any providers or recipients be included in that development process in a meaningful way beyond simple feedback? Additionally, will the proper cost analysis be conducted and shared for financial impact on providers of proposed changes to Handbook or Rule changes?
2. CMS doesn’t require separating ADT and pre-vocational. What if the time limit put in rule for Life Skills Development 4 isn’t enough time?
3. Some families don’t want iBudget Waiver individuals to work because they are afraid they will lose benefits.
4. These are some programs where they are losing money, but are continuing with them not with a “primary purpose” of producing good or performing services but because it gives those individuals self-worth.
5. Settings rule is about two things: community access and self-direction. We have to be careful when we operationalize it that we don’t remove choice.
6. What is the timeframe going to be based on? What is the empirical evidence that supports it?
7. Need to make decisions in terms of the person, not in terms of the business end. What happens if the time limit selected is not enough? Make sure we’re not putting unnecessary demands on people we are trying to serve.
8. Look to “primary purpose” of rule. The program encompasses a lot of things, only one part of it is salaried work.
9. Older individuals on the iBudget Waiver want to move to retirement. Some are tired of being trained.
10. What if there aren’t jobs are in certain communities, even if ready to be employed after the time limited period? Also, some areas are high crime and individuals don’t feel safe working in community.
11. Many don’t want to be in the community because they feel isolated, even though they are integrated. Many able-bodied people choose not to work. Why are we forcing iBudget Waiver individuals to make the choice to work? Many want to be with friends at ADTs.
12. Is there a difference between work experience stipend and work under ADT? Can work experience activities with stipend be done at ADT?
13. How can we support medically complex individuals? How integrate into the community?
14. For some individuals, ADT is their community. It is not one size fits all; it is about choice.
15. What is being done to support employers so they want to hire individuals who are on the Waiver?
The issue is how Florida will come into compliance with the Settings Rule: Should Florida be more restrictive than the federal rules require or should Florida allow as much choice and flexibility as permissible for people with disabilities? What should it look like? Will you have an opportunity to weigh in? How will ADTs be impacted by the decisions made when Florida amends its rule to come into compliance? It is imperative that people on the iBudget Waiver, guardians, families and others impacted by these decisions weigh in on how the rule should be interpreted because this issue will directly impact those people on the iBudget Waiver. If we don’t let those most impacted by the Settings Rule make the decisions to come into compliance with the rule where Florida has flexibility, we are doing a disservice to those same individuals we want to empower. Those who are most impacted need to be listened to before decisions are made about their lives. Over the coming months, The Arc of Florida Advocacy Committee will be looking at these questions and weigh in when opportunities come up for public comment when changes are proposed to the existing rule.
