HCBS Settings Review Panel

Overview

On Jan. 16, 2014, CMS issued a new rule that governs home and community-based services (HCBS) for all states, referred to as the “HCBS rule.”

DHS developed standards to meet the federal rules as well as a transition plan to help waiver service providers across the state to comply. The standards focus on the quality of a person’s experiences. They maximize opportunities for people to have access to the benefits of community living and the opportunity to receive services in the most integrated setting appropriate to meet their needs.

The HCBS rule requirements apply to all new and existing Minnesota waiver programs. These programs and services must comply with all requirements of the rule by March 17, 2022.

Part of a successful transition across the state involves a closer assessment of settings that CMS “presumes are not HCBS” to determine whether the state believes these settings are in fact HCBS. Settings that are presumed not to be HCBS include:

• Those in a public or private institution that also provides inpatient treatment
• Those that are adjacent to or on the grounds of public institutions
• Settings that have the effect of isolating people who receive HCBS from the broader community.

The term “setting” refers to the physical location where a person receives services. The term “provider” refers to a person or organization that is enrolled in and authorized to provide the service. A single provider may deliver services in multiple settings; therefore, DHS assessed individual settings for compliance, rather than individual providers.

DHS is evaluating each setting presumed not to be HCBS to determine if there is evidence the setting can overcome this presumption. DHS is completing on-site assessments of each setting between April 2017 and March 2019. DHS is also using other evidence such as the provider attestation and desk audits. DHS is developing an evidentiary package for each setting that summarizes information about that setting. We will post each setting’s evidentiary package for a public comment period. DHS will evaluate all of the evidence collected and summarize the public comments. If DHS finds that the evidence supports the setting as having the characteristics of an HCBS setting, DHS will submit the setting’s evidentiary package to CMS for heightened scrutiny.

DHS plans to use an HCBS Settings Review Panel to review settings when:

• DHS does not believe the setting is HCBS
• Public comment raises concern that the setting has institutional or isolating qualities.

Roles and responsibilities

The HCBS Settings Review Panel is not a governing group, but advises DHS’s Aging and Adult Services and Disability Services divisions on settings that we have identified for review. DHS will rely on the HCBS Settings Review Panel to provide recommendations on the settings that require further review, as outlined above, quarterly through early 2020.

The panel member will:

• Attend all scheduled panel trainings, phone calls and meetings, either in-person or via remote options, or provide feedback in a timely manner
• Review evidentiary packages for identified settings before panel meetings
• Review public comments about evidentiary packages before panel meetings
• Review supplemental materials for the identified settings before panel meetings
• Develop recommendations for DHS during panel review meetings about support for, transition of or lack of support for identified settings.

Attendance: Participation in meetings is critical to meet the goals of the HCBS settings review panel. DHS will score prospective candidates on their ability to participate (in person or remotely).

Experience

Members will have personal or professional experience that has prepared them to assess compliance with the HCBS rule.

This may include experience with:

• Lead agencies that administer waiver programs for people on disability waivers, Elderly Waiver or Alternative Care
• HCBS waiver providers who serve people with disabilities and older adults
• Provider trade associations that serve people with disabilities and older adults
• Advocacy organizations that represent people with disabilities and older adults, including those who receive waiver services
• People who receive waiver services and their family members.

DHS seeks applicants with diverse perspectives and experiences, including:

• Representation from various geographic areas of the state
• Aging and disability perspectives.

Members

SRP members:

• Katherine Karakash, lead agency
• Suzanne McMullen Sancilio, HCBS waiver service provider
• Jill Schewe, provider trade association
• Gene Martinez, advocate
• Genevieve Gaboriault, advocate
• James Clapper, family member
• Amy Koehnen, family member
• Kim Pettman, person who receives services
• Joshua Berg, HCBS waiver service provider
• Maureen Melgaard-Schneider, lead agency
• Nancy Rosemore, provider trade association

Meetings

DHS will rely on the HCBS Settings Review Panel to provide recommendations on the settings that require further review, on the following schedule:

• Tuesday, April 30, 2019
• Tuesday, Aug. 6, 2019
• Tuesday, Oct. 29, 2019
• Tuesday, Jan. 14, 2020

Review meetings will last for six to eight hours each. The first review meeting will be preceded by a training on Tuesday, March 12, 2019. The last review meeting will be followed by a wrap-up meeting in February 2020.

Meetings will be held at 444 Lafayette Road N., St. Paul, MN in Room 5134. There will be an option to participate remotely, if needed.

Resources

• Minnesota’s Home and Community-Based Services Rule Statewide Transition Plan (December 2018) (PDF)
• Home and Community-Based Services Rule Overview video