Thursday, October 23, 2014

Frequently Asked Questions on HCBS settings

These FAQs on the Home and Community Based Services (HCBS) settings rule are from ACCSES, a national organization representing disability service providers. They are helpful in understanding the HCBS rule:

September 2014

Frequently Asked Questions Regarding the Home and Community-Based Services (HCBS) Setting Requirement and the Full Array of HCBS Services  

1. Does the rule regarding home and community-based services settings continue to permit the full array of home and community-based services, as defined in the Medicaid HCBS statute and regulations and included in the individual’s person-centered plan? 

Yes. As we indicated in the section-by-section analysis accompanying the final rule “the final rule will continue to convey this flexibility for states.” [79 FR 2954 (January 16, 2014)] Consistent with the Americans with Disabilities Act and the Olmstead decision, the state must administer the full array of home and community-based services in the most integrated setting appropriate to the needs of qualified individuals with disabilities. In addition, the state, in providing these services, directly or through contract or other arrangement, may not provide different or separate services unless such action is necessary to provide qualified individuals with disabilities with services that are as effective as those provided to others. [28 CFR 35.130(b)(1)(iv) and 35.130(d)]

2. Does the full array of home and community-based services defined in the Medicaid HCBS statute and regulations include prevocational services?

Yes. Prevocational services are defined in the regulations [42 CFR 440.180] to mean habilitation services that prepare an individual for paid or unpaid employment and that are not job-task oriented but are instead aimed at a generalized result, for example, teaching an individual such concepts as compliance, attendance, task completion, problem solving and safety.

As specified in the regulations, prevocational services are distinguishable from noncovered vocational services by the following criteria [42 CFR 440.180]:
  • The services are provided to persons who are not expected to be able to join the general workforce; 
  • If the beneficiaries are compensated, they are compensated at less than 50 percent of the minimum wage; 
  • The services include activities which are not primarily directed at teaching specific job skills but at underlying habilitation goals (for example attention span, motor skills); and 
  • The services are reflected in a plan of care directed to habilitation rather than explicit employment objectives.
Prevocational services, as a form of habilitation services, are designed to assist individuals acquire, retain, and improve self-help, socialization and adaptive skills. [42 U.S.C. 1396n(c)(5)] 

Prevocational services are time limited and the time limitations are determined based on the individual’s needs, including the need to retain skills, as identified in his or her person-centered plan. [September 16, 2011 Information Bulletin at page 7]

 3. May prevocational services be provided in a variety of locations in the community, including fixed site facilities?

Yes. Consistent with an individual’s person-centered plan, prevocational services may be furnished in a variety of locations in the community, including fixed site facilities but prevocational services are not limited to fixed site facilities. [September 16, 2011 Information Bulletin at page 8]

4. Must prevocational services provided in fixed-site facilities satisfy the home and community-based setting requirement?

Yes. The final HCBS setting rule establishes affirmative outcome-based criteria rather than criteria based solely on a setting’s location, geography, or physical characteristics. [79 FR 3011 (January 16, 2014)] Thus, prevocational services and other home and community-based services that are provided in fixed-site facilities must meet the HCBS setting requirements set forth in the rule [79 FR 3013 January 16, 2014)], including the requirement that the setting is integrated in and supports full access of individuals receiving Medicaid HCBS to the greater community, including opportunities to seek employment and work in competitive integrated settings, engage in community life, control personal resources, and receive services in the community, to the same degree of access as individuals not receiving Medicaid HCBS [42 CFR 440.301(c)(4)(i)-(vi)].

5. What practices illustrate the qualities of a home and community-based setting in a fixed-site facility providing prevocational services?

Example of appropriate practices regarding the provision of prevocational services in fixed site facilities that illustrate the qualities of a home and community-based setting include:

  • The program is in a facility that resembles any other business of its size and scope; Individuals are working on production of goods and services for the greater business community, similar to other businesses; 
  • The program may serve populations other than HCBS participants with disabilities, including
    Veterans, individuals who are poor and under-privileged and need assistance; 
  • Participants are provided an overview of employment options, including discussions about and referrals to state vocational rehabilitation and other programs for competitive integrated
  • Community competitive integrated employment is discussed, encouraged, and promoted at every review, and the person is directly involved in making an informed choices, as well as during the delivery of prevocational services; and 
  • Prevocational services include opportunities to gain greater exposure to the greater community and to teach individuals how to access the greater community, including trial work experiences, and internships, and tours of local businesses.

6. If a program provided in a fixed-site facility satisfies the home and community-based services setting outcome-based criteria set out in 42 CFR 440.301(c)(4)(i)-(vi), does the program qualify for HCBS funding?

Yes. The program conforms to the HCBS setting characteristics and thus may receive HCBS funding.

Wednesday, October 22, 2014

Unintended Consequences of Closing Sheltered Workshops

Parents have their say on closing sheltered workshops for their adult children:

Michigan 2014 Medicaid Waiver Conference Update

The Michigan Department of Community Health & The Michigan Association of CMH Boards Present: 

ANNUAL HOME AND COMMUNITY BASED WAIVER CONFERENCE on November 18 & 19, 2014 at the Kellogg Hotel & Conference Center - 55 South Harrison Road, East Lansing 48823.

We have three easy ways to register: 1. Online here; 2. Fax (517) 374-1053 or 3. Mail at MACMHB 426 S. Walnut, Lansing, MI 48933

Topics Covered: Michigan Medicaid Waivers including the Children’s Waiver Program (CWP) and the Habilitation Supports Waiver (HSW). Also, training in ASD (Autism Spectrum Disorder) and implementation of the Medicaid/MIChild Autism Benefit.

The regular fee for this Conference is $140 but it is only $20 for individuals receiving waiver services and their family members.

Continuing Education Credits available for Licensed Social Workers.

Overnight Accommodations/Directions:   The Kellogg Hotel & Conference Center is located in East Lansing adjacent to Michigan State University.  Our special guestroom rate is $75+ fees and taxes per night based on availability.   For specific directions or to reserve a room, please call 517/432-4000 and mention that you are attending the C-Waiver Conference.

Conference Brochure & Registration Materials:  Conference details and registration will be available on our website, or if you have any questions, please call (517) 374-6848.

MACMHB Contact info:

Anne Wilson, Training & Meeting Planner
Michigan Association of Community Mental Health Boards
426 S. Walnut Street, Lansing, MI  48933
(517) 374-6848 phone
(517) 374-1053 fax

Tuesday, October 21, 2014

Bringing Home the Bacon

Is there such a thing as a multi-Billion dollar NONprofit? Yes, there is, and one of them is The ARC, the country's largest advocacy organization for people with developmental disabilities. 

An article in Fusion, a newsletter from the national ARC for September 29, 2014, covers a recent report from the National Center on Charitable Statistics of the Urban Institute. Based on a year's worth of data compiled from IRS 990 forms (the forms that most nonprofit organizations file annually with the IRS),  The ARC and its chapters throughout the United States have brought in $4.02 Billion in Gross Receipts, "…including $3.83 Billion in Total Revenue, $2.76 Billion in Program Service Revenue, $989 Million in Contributions & Grants (includes Government Grants) and $20 Million in Investment Income."

"Of the Total Contributions, Gifts and Grants, $145 Million is from individuals, foundations and corporations while $847 Million is from government…"

That's a lot of money! Of The ARC's total revenues of $3.83 Billion, $847 Million or 22% came from government, and  $145 Million or 3.8% from individual donations.

One can learn a lot about an organization from its IRS 990 forms, including its revenues, expenditures, and how much it pays its highest paid employees. Guidestar is a good place to start looking for information on nonprofit organizations. Registration is free. Here is Guidestar's Frequently Asked Questions about form 990.

Read the full article on The ARC's finances here.

Friday, October 17, 2014

The Revolving Door between Advocacy Organizations and Government

I found this in an email newsletter from ACCSES, a national disability provider organization. 

Careful! You might get dizzy. Ms. Barkoff has gone from staff attorney at the Bazelon Center for Mental Health Law, to the US Department of Justice, with forays into the Centers for Medicare and Medicaid Services and the Department of Labor, and back again to the Bazelon Center:

Alison Barkoff Returns to Bazelon as Advocacy Director

Ms. Barkoff was a staff attorney with the Bazelon Center [for Mental Health Law] from 2005 to 2010, before joining the U.S. Department of Justice (DOJ), where she served for four years as Special Counsel for Olmstead Enforcement in the Civil Rights Division. As Director of Advocacy, Ms. Barkoff will help lead the Bazelon Center's policy and litigation work, as well as work on organizational activities such as fundraising. While at the DOJ, Ms. Barkoff led the Civil Right Division's efforts to enforce the rights of individuals with disabilities to live, work, and receive services in the community. Under her leadership, the Division issued its first guidance based on the U.S. Supreme Court's landmark Olmstead disability-rights ruling and was actively involved in Olmstead litigation across the country, including several cases culminating in statewide system reform settlement agreements. She also worked with Centers for Medicare and Medicaid Services [CMS, the federal agency that regulates Medicare and Medicaid] on finalizing rules governing Medicaid-funded community-based services and with the Department of Labor on implementation of its new home care rule in Medicaid-funded disability service systems.

Wednesday, October 15, 2014

New Jersey: Autistic man brought "home" from PA; ends up in jail with no other options

This is from the VOR Weekly News Update for 10/10/14:

Tyler Loftus, 23, has been sitting in New Jersey’s Hunterdon County Jail since September 18. “Every day he calls and says, ‘Mom, come get me, I don’t want to stay here,'” his mother, Rita O’Grady, told me.

Diagnosed with autism and intellectual disability, Tyler has the cognitive capacity of a 5-year-old. He can’t understand why he’s not allowed to leave.

“I never consented to this placement,” O’Grady said. “I specifically withdrew consent, because I knew what would happen. But the Arc [the agency that operated the group home] moved him anyway.”

And there are facilities that specialize in the treatment of individuals with developmental delay and dangerous behaviors: the Woods School in Pennsylvania, for instance, where Tyler lived from the ages of 15 to 21. Closer to home there are state-run developmental centers, such as the one in Hunterdon, where Tyler has previously been admitted.

But these are no longer options. Governor Chris Christie’s Return Home New Jersey program has put a moratorium on all out-of-state placements and “Christie is closing [developmental centers],” O’Grady told me. “And he’s put a stop order on all new admissions. Ideally, Tyler would be at Hunterdon while a permanent placement is found, but they can’t take him.”

The problem, O’Grady explained, is that the community-based supports that Christie promised have not yet materialized...

Read the full article here : "No End in Sight for Autistic Man Jailed in New Jersey" by Amy Lutz, 10/3/14.

Here is an updated article about the case: "Christie plan to return disabled to N.J. leads one man to hospitals, jail" by Susan Livio, 10/10/14 at .

VOR is a national organization that advocates for the right of individuals with intellectual and developmental disabilities and their families to choose from a full array of high quality residential and other support options including own home, community-based, and large settings such as Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICFs/IDD). See also VOR Weekly News Updates and Olmstead Resources.