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

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 below.

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.

  • 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.

The state’s overall approach to transitioning all HCBS settings to full compliance with the Community Rule has not changed since the initial STP submissions to CMS in 2015. Therefore, substantive changes in the current version of the STP are limited to the inclusion of additional detail, 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).
  • 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.
  • 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.

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

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Program Instructions

These Program Instructions (PIs) are issued by the Office of Elder Affairs and provide required procedures, protocols, and instructions to ASAPs in their operation of the Frail Elder Waiver and do not apply to participants in any other HCBS waiver.

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Prior Materials Submitted to CMS as part of Initial Statewide Transition Plan

In response to new rules issued by the Centers for Medicare and Medicaid Services (CMS) related to home and community based settings for Medicaid-funded HCBS waivers, the Commonwealth of Massachusetts submitted the materials found below. These materials include our initial Statewide HCBS Transition Plan, agency-specific Transition Plans related to waiver-operating agencies, a summary of the comments received through the public input process and the state’s responses to these comments. Massachusetts submitted these materials to CMS in a letter dated March 2, 2015.

In addition you will find further information about the HCBS Community Rule through the links below.

Click on the links below to find additional information about the HCBS Community Rule and Massachusetts’ response to these rules.

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Addendum to the Statewide Transition Plan for Non-residential Services Compliance with the Home- and Community-Based Services (HCBS) Community Rule

Click on the links below to find the Massachusetts’ HCBS Transition Plan Addendum for non-residential services as well as agency-specific information for DDS, MRC and EOEA. Massachusetts submitted the addendum to CMS in a letter dated September 3, 2015.

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