Fillable Printable Transition Plan - New York State Department of Health
Fillable Printable Transition Plan - New York State Department of Health
Transition Plan - New York State Department of Health
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Overview
On January 16, 2014, the Center for Medicare and Medicaid Services (CMS) published the final rule
related to Home and Community Based Settings (HBCS) for Medicaid-funded long term services and
supports provided in non-institutional residential settings under the following authorities of the Social
Services Act: 1915(c), 1915(i) and 1915(k). This rule implements a number of changes to home and
community based waivers, finalizes regulatory changes to the 1915(i) state plan home and community
based services and imposes new requirements on what is considered an appropriate home/community
based residential setting for all the authorities in its scope. The crux of this final rule is to provide
person-centered requirements which identify the strengths, preferences and needs (clinical and
support), as well as the desired outcomes of the individual. The inclusion of defined HCBS residential
setting requirements is one part of this strategy.
The final rule took effect March 17, 2014. States are required to submit transition plans to CMS within
one year of the effective date indicating how they intend to comply with the new requirements within a
reasonable time period. If states amend or renew any waivers or state plan amendments in place prior
to the effective date, that action serves as a trigger for the state to submit a transition plan for all its
waivers under 1915(c), as well as any state plan amendments under 1915(i) or 1915(k) within 120 days
of the initial amendment/renewal submission.
The following is New York State’s statewide transition plan pursuant to this requirement.
Background
New York State operates 12 1915(c) waivers across the four major offices that oversee programs and
services to individuals who are aged and/or physically, behaviorally, mentally, developmentally or
intellectually disabled. These agencies/offices are the Department of Health (DOH), Office of Mental
Health (OMH), Office for People with Developmental Disabilities (OPWDD) and Office of Children and
Family Services (OCFS). In addition, the Office for Alcohol and Substance Abuse Services (OASAS) also
provides services to individuals in these waivers and participated in the development of the statewide
transition plan. We do not currently offer services through our state plan under a 1915(i) or 1915(k)
authority, although we have applied to CMS for approval of a 1915(k) Community First Choice Option
state plan amendment.
The following 1915(c) waivers are currently operating in New York State:
Long Term Home Health Care Program Waiver
Nursing Home Transition and Diversion Waiver
Traumatic Brain Injury Waiver
Care at Home Waivers (I, II, III, IV, and VI)
Bridges to Health (B2H) Waivers (B2H Serious Emotional Disturbances, B2H Developmental
Disabilities and B2H Medically Fragile)
OPWDD Home and Community Based Services
OMH/SED (Serious Emotional Disturbances) Children’s Waiver
In addition, the above agencies/offices offer significant home and community based LTSS through our
Medicaid state plan and, in the case of those operated by the DOH and the OPWDD, through 1115
demonstration waivers. We do not read the rule to apply to state plan services outside of 1915(i) and
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1915(k) authorities and understand that CMS does intend to apply the rule to 1115 demonstration
waivers upon renewal or amendment through negotiation of the terms and conditions of approval.
Most individuals receiving services through these waivers are living in their own homes or those of
family members, certain group homes or other adult care facilities where they enjoy the qualitative
benefits of receiving services in the community as opposed to in an institution. However, there are
individuals who live in congregate housing, adult care facilities and supportive housing where their
autonomy, independence and community integration may be less apparent, including children and
youth where their rights are delegated to their parents or guardians. New York has affirmed its
commitment to serving individuals with disabilities in the least restrictive environment under Governor
Andrew Cuomo’s leadership. In 2012, the Governor introduced legislation to establish the Justice
Center to ensure protection against abuse and neglect of individuals with special needs. The Justice
Center became operational in 2013. Also in 2012, he convened the Olmstead Development and
Implementation Cabinet, which met with over 160 stakeholder groups and reviewed over 100 position
papers before releasing its report in October 2013 laying out recommendations for New York
policymakers to continue efforts to ensure that individuals with disabilities are provided the services and
supports they need that reflect their choice and support their goals to live an independent and fully
integrated life in the community.
Consistent with these efforts, New York State convened an interagency workgroup in 2014 to address
how best to comply with the requirements of the new settings rule. The group met a number of times
to ensure that a cohesive statewide transition plan was developed to address the unique needs of
individuals across a wide variety of community-based settings. The interagency workgroup includes
representatives from the Executive Chamber, DOH, OMH, OPWDD, OCFS, and OASAS. Four meetings
were held between January and June to develop the transition plan that follows.
New York State’s Statewide Transition Plan for Community Based Settings
42 CFR §441.530 requires that all settings in which individuals receiving Medicaid-funded home and
community based services live must have the following characteristics and qualities:
(i) The setting is integrated in and supports full access of individuals receiving Medicaid HCBS to the
greater community, including opportunities to seek employment and work in competitive integrated
settings, 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.
(ii) The setting is selected by the individual from among setting options, including non-disability specific
settings and an option for a private unit in a residential setting. The setting options are identified and
documented in the person-centered service plan and are based on the individual's needs, preferences,
and, for residential settings, resources available for room and board.
(iii) Ensures an individual's rights of privacy, dignity and respect, and freedom from coercion and
restraint.
(iv) Optimizes but does not regiment individual initiative, autonomy, and independence in making life
choices, including but not limited to, daily activities, physical environment, and with whom to interact.
(v) Facilitates individual choice regarding services and supports, and who provides them.
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The rule imposes further requirements on settings that are provider owned or controlled, as is often the
case with supportive housing and certain independent residential alternatives (IRAs) where individuals
receiving services through OPWDD’s Home and Community Based Services Waiver may live. The
following qualities and/or conditions must be assured in these settings:
(A) The unit or dwelling is a specific physical place that can be owned, rented or occupied under a legally
enforceable agreement by the individual receiving services, and the individual has, at a minimum, the
same responsibilities and protections from eviction that tenants have under the landlord tenant law of
the State, county, city or other designated entity. For settings in which landlord tenant laws do not
apply, the State must ensure that a lease, residency agreement or other form of written agreement will
be in place for each participant and that the document provides protections that address eviction
processes and appeals comparable to those provided under the jurisdiction's landlord tenant law.
(B) Each individual has privacy in their sleeping or living unit:
(1) Units have entrance doors lockable by the individual, with only appropriate staff having keys to doors
as needed.
(2) Individuals sharing units have a choice of roommates in that setting.
(3) Individuals have the freedom to furnish and decorate their sleeping or living units within the lease or
other agreement.
(C) Individuals have the freedom and support to control their own schedules and activities, and have
access to food at any time.
(D) Individuals are able to have visitors of their choosing at any time.
(E) The setting is physically accessible to the individual.
Finally, the rule asserts that hospitals, nursing homes, institutional care facilities (ICF) for the
developmentally disabled and institutes for mental disease are not community-based settings and
further that settings on the grounds of public or private institutions and those in close proximity to
public institutions are presumed to be institutional rather than community-based. New York State
understands that it has the burden of providing evidence to the Secretary of Health and Human Services
(HHS) if it believes that such a setting should be considered community-based for the purpose of
allowing the provision of Medicaid-funded HCBS LTSS to individuals who reside there.
New York State proposes the following time table and deliverables to come into compliance with this
rule where settings do not yet exhibit these qualities and characteristics.
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Timeline
Transition Plan Activity
Deliverables
September 2014 – August 2015
a. Develop detailed census of
existing settings on an agency
by agency basis;
b. Evaluate settings based on
exploratory questions in CMS
toolkit; and
c. Develop mitigation strategies
for those settings not in
compliance.
Evaluation indicating scope of
any issues.
Menu of mitigation strategies.
September 2015 – August 2016
a. Begin transition plan
implementation in a phased
approach.
Progress Report
September 2016 – August 2017
Complete detailed transition
process for all settings that are
not provider owned or in, near
or adjacent to a public
institution.
Progress Report
September 2017 – August 2018
Develop plan for all settings
that would require the
Secretary to review under
heightened scrutiny including
Assisted Living Program
facilities, Adult Care Facilities,
Enriched housing, supportive
housing, etc.
Completed plan
September 2018 – August 2019
Implement final stage of
settings transition.
Implementation report
