The Home & Community Based Services (HCBS) provide opportunities for Medicaid beneficiaries to receive services in their own home or community rather than institutions or other isolated settings. These programs serve a variety of targeted populations groups, such as people with intellectual and developmental disabilities, physical disabilities, and or/mental illnesses.
HCBS has released a new set of rules that focus on Person-centered service plans. Medicaid will not cover HCBS without a person-centered service plan that addresses the beneficiary’s long-term care needs as an alternative to institutionalization. Clausen House has always put our clients’ needs first, so this transition does not change many of our programs. Below is a complete summary of what these new rules look like:
Person Centered Planning Requirements in HCBS Rule
The person-centered planning process:
- Is driven by the individual
- Includes people chosen by the individual
- Provides necessary information and support to the individual to ensure that the
individual directs the process to the maximum extent possible - Is timely and occurs at times/locations of convenience to the individual
- Reflects cultural considerations/uses plain language
- Includes strategies for solving disagreement
- Offers choices to the individual regarding services and supports the individual receives and from whom
- Provides method to request updates
- Conducted to reflect what is important to the individual to ensure delivery of services in a manner reflecting personal preferences and ensuring health and welfare
- Identifies the strengths, preferences, needs (clinical and support), and desired
outcomes of the individual - May include whether and what services are self-directed
- Includes individually identified goals and preferences related to relationships, community participation, employment, income and savings, healthcare and
wellness, education and others - Includes risk factors and plans to minimize them
- Is signed by all individuals and providers responsible for its implementation and a
copy of the plan must be provided to the individual and his/her representative
The written plan reflects:
- Setting is chosen by the individual and is integrated in, and supports full access to the greater community
- Opportunities to seek employment and work in competitive integrated settings
- Opportunity to 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
- Reflects individual’s strengths and preferences
- Reflects clinical and support needs
- Includes goals and desired outcomes
- Providers of services/supports, including unpaid supports provided voluntarily in
lieu of waiver or state plan HCBS - Risk factors and measures in place to minimize risk
- Individualized backup plans and strategies when needed
- Individuals important in supporting individual
- Individuals responsible for monitoring plan
- Plain language and understandable to the individual
- Who is responsible for monitoring the plan
- Informed consent of the individual in writing
- Signatures of all individuals and providers responsible
- Distributed to the individual and others involved in plan
- Includes purchase/control of self-directed services
- Exclude unnecessary or inappropriate services and supports
- Modification of the additional conditions as previously discussed in the home and
community-based setting requirements - Must be reviewed, and revised upon reassessment of functional need as
required every 12 months, when the individual’s circumstances or needs change significantly, and at the request of the individual.
For more information, the CMS Webinar Presentation is available here
