HCBS Settings Rule Transition Planning

Relevant Documents

New Provider Requirements

All new home and community-based settings must be in compliance with the Settings Rule when they start providing services.

1. Training
   1. DSPD Providers
      
      1. New Settings Training – Slideshow
      2. New Settings Training – Recorded
      3. Quiz
   2. NCW Providers
      
      1. New Settings Training
      2. Quiz
   3. AW Providers
      
      1. New Settings Training
      2. Quiz
2. Attestation Form
   
   1. Non-Residential Attestation Form
   2. Residential Attestation Form
3. Self-Assessment
   
   1. Non-Residential
      
      1. Non-Residential Provider Self-Assessment
      2. Non-Residential Setting Specific Self-Assessment
   2. Residential
      
      1. Residential Provider Self-Assessment
      2. Residential Setting Specific Self-Assessment

Training

HCBS Settings Rule training on the revised NCW and AW PCCP addendum.

1. NCW and AW
   
   1. PCCP Training
2. Flyers and Brochures
   
   1. General Stakeholder Information:
      
      1. Settings Rule for Home and Community Based Services for Individuals, Families, and Caregivers (brochure)
      2. Settings Rule for Home and Community Based Services for Providers (brochure)
      3. HCBS Stakeholder Update May 2019 (flyer)
      4. Heightened Scrutiny
      5. Stakeholder Update July 2020
      6. Isolating and Institutional Factors
      7. Restrictions and Modifications (flyer)
      8. Restrictions and Modifications Examples
      9. Settings Rule Progress During COVID-19
      10. Opportunity for Employment
      11. Stakeholder Update Settings Compliance Timelines 2022
      12. Using Virtual Integration Activities to Work Towards Settings Compliance
      13. Virtual Integration Activities Community Resources
      14. HCBS Settings Rule Clarification: Desired Level of Integration
      15. Community Inclusion and Integration Flyer
      16. Community Inclusion and Integration Examples
   2. Residential Stakeholder Information:
      
      1. General
         
         1. Locks and the HCBS Settings Rule (flyer)
         2. Provider Owned and or Controlled Settings
         3. The Separation of Housing from the Provider of HCBS
      2. NCW Specific
         
         1. Policy and the Use of Cameras in the New Choice Waiver Residential HCBS Settings (flyer)
         2. NCW Licensing and Settings
      3. DSPD Waiver Specific
         
         1. DSPD Licensing and Settings

State Transition Plan (STP) and Related Documents

1. Final Approved Transition Plan and Related Documents
   
   1. Utah Statewide Transition Plan
   2. Appendix
   3. Corrective Action Plan (CAP)
2. Submitted Transition Plan and Public Comments
   
   1. Utah Statewide HCBS Transition Plan – Submitted to CMS 3/17/2015
   2. Summary of Public Comments – First Draft
   3. Summary of Public Comments – Second Draft
3. Draft Transition Plans
   
   1. Draft Transition Plan – February 2019
   2. Draft Transition Plan – October 22, 2014
   3. Draft Transition Plan – February 2, 2015
4. Draft Corrective Action Plans  (CAPs)
   
   1. Draft Corrective Action Plans (CAPs)

Systemic Assessment

1. Settings Crosswalk/Systemic Assessment
   
   1. List of Admin Rules/Policies Reviewed by the Department for Compliance)
2. Documents to Accompany Systemic Assessment
   
   1. Currently Approved Acquired Brain Injury Waiver Implementation Plan
   2. Currently Approved Aging Waiver Implementation Plan
   3. Currently Approved Community Supports Waiver Implementation Plan
   4. Currently Approved Medicaid Autism Waiver Implementation Plan
   5. Currently Approved Medically Complex Children’s Waiver Implementation Plan
   6. Currently Approved New Choices Waiver Implementation Plan
   7. Currently Approved Physical Disabilities Waiver Implementation Plan
   8. Currently Approved Technology Dependent Waiver Implementation Plan
   9. DSPD Contract Requirements

Stakeholder Meetings

1. Workgroup Meetings
   
   1. Documents for Workgroup Meeting on April 3, 2018 (Non-residential Integration)
   2. Documents for Workgroup Meeting on April 10, 2018 (Modifications and Restrictions)
   3. Documents for Workgroup Meeting on on April 17, 2018 (Residential Integration)
   4. Documents for Workgroup Meeting on May 1, 2018 (Heightened Scrutiny)
2. Focus Group Meetings
   
   1. Documents for Focus Group Meeting on June 5, 2018 (Adult Day Care Settings)
   2. Documents for Focus Group Meeting on June 19, 2018 (NCW, Residential Settings)
   3. Documents for Focus Group Meeting on June 26, 2018 (DSPD, Day Program Settings)
      
   4. Documents for Focus Group Meeting on July 3, 2018 (Employment, Non Residential settings)
   5. Documents for Focus Group Meeting on July 10, 2018 (DSPD, Residential Settings)
   6. Documents for Focus Group Meeting on August 28, 2018 (Person Centered Care Plan)
   7. Documents for Focus Group Meeting on September 11, 2018 (Modifications and Restrictions)
3. Other Stakeholder Meetings
   
   1. Documents for Open Meeting on August 20, 2018 (Center-Based Employment)

Settings Reports

1. HCBS Settings Self-Assessment Report
2. Initial Provider Compliance report

External Resources

1. Final Rule from CMS
2. Summary of Key Provisions in the Final Rule
3. An Advocate’s Guide to Consumer Rights in Medicaid HCBS
4. CMS HCB Settings Guidance

On March 17, 2014, new federal Medicaid rules for Home and Community Based Services (HCBS) went into effect. The rules impact many parts of HCBS. One of the most important topics is the places where HCBS can be provided.

Because HCBS programs are offered as alternatives to nursing and intermediate care facility services, the new rules make sure that HCBS are provided in settings that are not institutional in nature. To follow this rule, states must make sure that HCBS settings are part of a larger community, people are able to have choices about their service settings, and that people are assured their rights to privacy, dignity and respect.

States must evaluate their HCBS programs to determine the level of compliance with the new rules. 

How to Provide Comments

Once distributed, Utah will accept public comments and recommendations about the draft for a minimum 30-day period. In addition to submitting comments via the form below, public comments will be accepted through the following methods:

• Via fax: 801-536-0153
• Via Email: HCBSSettings@utah.gov

Via mail:

Utah Department of Health and Human Services
Division of Integrated Healthcare
Attn: HCBS Settings Rule Public Comments
PO BOX 143112
Salt Lake City, UT 84114-3112

What’s Happening Now?

Heightened Scrutiny

Here is a flowchart to explain the pathway to compliance and what leads a setting to go through the heightened scrutiny process.

• HCBS Settings Compliance Flow Chart

The following tools are and will be used in the heightened scrutiny process:

1. Heightened Scrutiny Provider Response Template
2. Heightened Scrutiny Packet Template 

The following settings have gone through the public comment process and have been submitted to CMS for review. 

Public Comment Period October 24, 2022 to November 28, 2022

1. Beehive Homes of Washington County Site 52
2. Cache Employment and Training Center Site 374

The following settings were previously identified as presumptively institutional, but subsequently demonstrated compliance with the settings criteria by July 1, 2021

1. Ability and Choice Services, Inc. Site 341
2. Ability and Choice Services, Inc. Site 342
3. CHRYSALIS UTAH, INC. Site 395
4. CHRYSALIS UTAH, INC. Site 399
5. CHRYSALIS UTAH, INC. Site 402 
6. CHRYSALIS UTAH, INC. Site 816
7. DANVILLE SERVICES OF UTAH, LLC Site 1394
8. DANVILLE SERVICES OF UTAH, LLC Site 1402 
9. DANVILLE SERVICES OF UTAH, LLC Site 1405
10.  Friends 4 Life Found Site 2336
11.  PHEASANT HOLLOW VALLEY MNTL Site 139
12.  STEPS, inc. Site 1679
13.  Stride Services Site 1818
14. Truewood By Merrill Site 70

Public Comment Period March 5, 2021 to April 6, 2021

1. New Settings
   
   1. Enable Utah Evidentiary Package
2. Settings located in, on the grounds of, or immediately adjacent to a public institution
   
   1. Mission at Community Evidentiary Package
   2. St. Joseph Senior Apartments Evidentiary Package
3. Public Comment
   
   1.  Public Comment Response for public comments received from March 5, 2021 to April 6, 2021

Validation Visits

Validation visits are conducted for settings that had previously been identified as having segregating or institutional characteristics once they have completed their remediation or transformation plans and they have submitted their evidence for compliance for review.  Due to the COVID-19 pandemic, the majority of these reviews have been conducted remotely.  Setting tours, observation of daily observations, HCBS Waiver recipient interviews, staff interviews, leadership interviews, and document/record reviews took place as part of the validation process.  The following tools were utilized in the validation process:

1. Pre-Validation Visit Communication
2. HCBS Settings Staff HS Validation Interview Tool
3. HCBS Settings Leadership HS Validation Interview Tool
4. HCBS Settings Individual Served HS Validation Interview Tool
5. Validation Visit Review Provider Summary Report

Previous Compliance Activities

Corrective Action Plans (CAPs)

Applications were accepted through December 30, 2022.    

Read through the both the Utah HCBS Settings Rule CAP below and the HCBS Settings Rule CAP Application instructions thoroughly prior to committing to completing the application.  The application does not have an option to save and return, it must be completed all at one time.  

• • Utah HCBS Settings Rule CAP (Pending CMS Approval)
  • HCBS Settings Rule CAP Application Instructions
  • APPLY HERE

Provider Self-Assessments

During the week of April 25th, 2016 providers were mailed letters outlining all of the settings that they will need to complete a self-assessment for. The State identified Residential and Non-Residential sites that were known. Providers will be expected to complete the appropriate survey for any setting they manage and to provide information about locations that they no longer have.

1. Copy of the Letter Mailed to all Waiver Providers with Settings Identified for Review
2. Provider Self-Assessment Survey – Residential (PDF)
3. Provider Self-Assessment Survey – Residential (Excel)
4. Provider Self-Assessment Survey – Non-Residential (PDF)
5. Provider Self-Assessment Survey – Non-Residential (Excel)
6. Self-Assessment Instructions
7. Settings Transition Presentation Slides (From Stakeholder Meetings)
8. Sample Self Assessment

Provider Remediation Plans

During the months of January and February of 2018, providers were emailed their self-assessment results and all the settings they will need to complete a remediation plan for. Remediation plan templates were generated for each setting specifying which self-assessment indicators required additional information or a corrective action plan to demonstrate compliance.

1. SE Provider Letter HCBS Settings Self-Assessment Report
2. Document 1 (Instructions) State Self-Assessment Report and Remediation Plan Non Residential
3. Document 1 (Instructions) State Self-Assessment Report and Remediation Plan Residential
4. Settings Transition and Remediation Plan Presentation 2.12.18.pptx

In-Depth Addition Review Site Visits

An in-depth additional review site visit was or will be conducted for settings that the State was unable to categorize based only on the self-assessment and validation review process. The majority of these reviews occurred during the months of August to October of 2019. This will continue to be an ongoing process if additional settings are identified as requiring further review. Setting tours, observation of daily operations, HCBS Waiver recipient interviews, staff interviews, leadership interviews, and document/record reviews took place as part of the additional review process. The following tools were utilized in the review process:

1. Non-residential Additional Review Assessment Tool
2. Residential Additional Review Assessment Tool
3. Non-residential Additional Review for Individuals Receiving Services Interview Tool
4. Residential Additional Review for Individuals Receiving Services Interview Tool
5. Additional Review Leadership Interview Tool
6. Additional Review Staff Interview Tool

For settings that had identified areas of non-compliance, a remediation plan is required. The following remediation plan template is not required; providers can choose to use their own format as long as the plan includes the minimum requirements.

• Provider Remediation Plan Template

Completion of the remediation plan is mandatory and must be completed and returned to the State within 30 days of notification. For technical assistance or further information email: HCBSSettings@utah.gov