In a letter dated February 16, 2018 to Seema Verma, Administrator for the Centers for Medicare and Medicaid Services (CMS), Representative Tim Walberg expresses his concern for feedback he has received from constituents about the HCBS settings rule that restricts personal choice and exacerbates already limited housing options for people with disabilities:
“…The Settings Rule…imposes certain unworkable standards on many HCBS settings. In particular, the ‘heightened scrutiny’ standard applied to homes and communities designed for individuals with disabilities, such as campus settings, farmstead communities, apartment buildings designed for individuals with disabilities, day programs, and other ‘intentional communities,’ presumes that these settings are not suitable for individuals receiving Medicaid HCBS.
“The St. Louis Center, a residential community in Chelsea, Michigan, is one of these ‘intentional communities,’ where nearly 50 of my constituents live and thrive as a result of the personalized care they receive from the Center’s kind and loving staff. Having visited the St. Louis Center many times over the past decade, I can testify to the exceptional services provided to the residents, the warm, caring environment of the campus, and the underlying support system fostered by the staff which encourages each individual to grow and reach his or her full potential.
“Community integration is a laudable goal and one I fully support. Unfortunately, settings like the St. Louis Center will not be able to meet CMS’s heightened scrutiny test. I have heard these concerns firsthand from the residents who believe the final rule will force them to move out of their homes. As Michigan already faces a lack of housing and vocational options for individuals with developmental disabilities, these individuals and their families are incredibly worried they will lose their community and the place they choose to call home.
“The St. Louis Center, a residential community in Chelsea, Michigan, is one of these ‘intentional communities,’ where nearly 50 of my constituents live and thrive as a result of the personalized care they receive from the Center’s kind and loving staff. Having visited the St. Louis Center many times over the past decade, I can testify to the exceptional services provided to the residents, the warm, caring environment of the campus, and the underlying support system fostered by the staff which encourages each individual to grow and reach his or her full potential.
“Community integration is a laudable goal and one I fully support. Unfortunately, settings like the St. Louis Center will not be able to meet CMS’s heightened scrutiny test. I have heard these concerns firsthand from the residents who believe the final rule will force them to move out of their homes. As Michigan already faces a lack of housing and vocational options for individuals with developmental disabilities, these individuals and their families are incredibly worried they will lose their community and the place they choose to call home.
“Each individual living with disabilities has their own needs and faces unique, personal challenges. As a result intentional communities may not be the best option for everyone with a intellectual disability, as nobody should be forced to reside in any setting that is not his or her choice. Unfortunately, as the Settings Rule and related policies are currently being implemented, too many of the the most vulnerable constituents in my district face the threat of losing the safe and healthy community they have chosen to live in.
“To ensure the HCBS final rule expands the quality options available to individuals with developmental disabilities, rather than restricts those options, I respectfully request that you consider amending the Settings Rule to clarify that individual choice is paramount in determining whether a setting meets the requirements; and eliminate the presumption in subparagraph 441.301(c)(5)(v) that settings designed for individuals with disabilities do not meet the requirements.
“On behalf of my constituents in Michigan who would are impacted by the Settings Rule, I thank you for your consideration of these concerns. As a member of the House & Energy Commerce Committee, please know that I stand ready to work with you to ensure the HCBS final rule promotes greater choice for individuals with disabilities so that they can reside in the settings that best meets their distinct needs.”
See also,
"U.S. Representatives raise concerns about restrictions on group settings for people with disabilities", 11/27/17
HCBS Advocacy Website
"Guidance on Settings that have the Effect of Isolating Individuals Receiving HCBS from the Broader Community" from CMS, 3/17/2014
"Legal Vulnerabilities of CMS’s Regulation of Home- and Community-Based Settings”
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