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Statewide Transition Plan for Compliance with the Home and Community Based Services (HCBS) Community Rule

Learn about new requirements related to the Statewide Transition Plan.

Massachusetts submitted its Statewide Transition Plan (STP) to CMS in October of 2019, along with a summary of public comments received on the proposed plan. Use the links below to access these documents, and scroll down for more information about the development of the Statewide Transition Plan.

  • Statewide Transition Plan for Compliance with the CMS Home and Community Based Services Community Rule PDF | Word
  • Summary of Public Input PDF | Word

Background

The CMS final rule related to Home- and Community-Based Services (HCBS) for Medicaid-funded long-term services and supports provided in residential and non-residential home and community-based settings (the “Community Rule”) took effect March 17, 2014.

States were required to submit transition plans to CMS within one year of the effective date indicating how they would comply with the new requirements ensuring participants have access to and are integrated into the broader community. In December 2014, CMS issued guidance on how the Community Rule applies to non-residential services such as employment and day services.

Massachusetts first submitted its Statewide Transition Plan (STP) regarding residential HCBS services to CMS in a letter dated March 2, 2015, followed by an addendum that addressed non-residential services in a letter dated September 3, 2015. Prior to these submissions, the state gathered public comments on the STP and the addendum during two public comment periods, including three public forums. In total, 323 individuals or agencies submitted comments in writing, through e-mail, mail, and written testimony. Summaries of the comments received and the state’s response to these comments for all previously submitted materials are posted on this page.

In November 2015, the state received feedback from CMS addressing both the first STP submission and the addendum, and in response informally submitted a revised draft of the STP to CMS in February 2016. CMS provided additional, informal feedback in May 2016. The current version of the STP reflects updates responsive to all feedback and guidance received from CMS. Updates since the original 2015 submissions to CMS include several technical, structural, and formatting changes, including but not limited to the following.

  • The current version of the STP covers both residential and non-residential services for all three HCBS waiver-operating agencies in one comprehensive document. The comprehensive STP was compiled in response to CMS’s request that the state present a single combined document. Previously, residential and non-residential services were addressed in separate STP attachments corresponding to each HCBS waiver-operating agency: the Department of Developmental Services (DDS), the Massachusetts Rehabilitation Commission (MRC), and the Executive Office of Elder Affairs (EOEA).
  • A description of EOHHS’s role in the Statewide Transition Plan was added.
  • A chart that maps each Community Rule requirement to one or more state regulations, policies, or other sub-regulatory instrument was added to the STP as Table 1.
  • The results of the site-specific assessment process are combined into a single chart reflecting residential and non-residential settings in each waiver (Table 2).
  • Systemic and site-specific transition steps and associated timelines for both residential and non-residential settings across the three waiver-operating agencies are combined into a single chart (Table 3).
  • Links to related documents are provided in a chart (Table 4).
  • The Public Input section is updated to reflect the public comment period and public forum that occurred prior to submission of the revised STP to CMS.

In addition, changes were made to the STP to provide additional, updated information and/or clarifications in the following areas.

  • The systemic assessment section and the transition tasks/timeline chart (Table 3) were updated to reflect progress toward promulgation of revised regulations and issuance of new or revised policies, guidance, and other tools that will strengthen compliance by more clearly aligning state requirements with the Community Rule. Examples include
    • Revisions to 115 CMR 5, 7, and 8 (DDS);
    • Revisions to the licensure and certification tool for residential and non-residential settings (DDS);
    • Development of a participant handbook and policy document for the ABI and MFP waivers (DDS and MRC);
    • Development of guidance for providers regarding the requirements for locks and tenancy protections (DDS and MRC);
    • Revisions to the HCBS Provider Policy Manual (MRC); and
    • Revisions to the HCBS Program Guidelines (EOEA).
  • The site-specific assessment section was reorganized for clarity as follows.
    • Additional details were included to describe more clearly each agency’s site-specific assessment process;
    • Findings were updated; and
    • Details were included to describe more clearly the remedial actions or actions related to compliance undertaken by each waiver-operating agency.
  • The site-specific assessment section was updated to reflect DDS’s determination that all Community Based Day Services (CBDS) settings and group employment settings require some level of modification to fully comply with the Community Rule. Details are provided regarding the steps that DDS will undertake with each provider/setting to ensure that all settings achieve full compliance.
  • Additional details were added regarding the “heightened scrutiny” and “participant relocation” processes, as well as the state’s plan for continued monitoring of all HCBS settings for ongoing compliance with the Community Rule. This information appears in three new sections in the STP.

If you're looking for documents related to the Statewide Transition Plan, please go to the Statewide Transition Plan Previous Documents web page. 

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