Minnesota Ahead of Most States in Effort to Comply with HCBS Settings Rule

The federal government is giving states and providers an ultimatum to make progress on meeting the requirements of the home- and community-based services settings final rule that goes into effect in the spring. Minnesota is only one of 18 States that has already received final approval of the statewide transition plan. The Centers for Medicare and Medicaid Services (CMS) approved the Minnesota State Transition plan on Feb. 12, 2019.

The final rule was initially set to transition to full compliance in 2019. However, the deadline was extended to 2022 and then to 2023, the latter extension due to the pandemic. In addition to receiving final approval of the transition plans by March 17, states and providers must comply with all settings criteria not directly affected by public health emergency disruptions to continue receiving federal reimbursement for HCBS beyond the transition period. Among HCBS settings are adult day services and assisted living facilities.

CMS indicated that its recent warning was prompted by site visits revealing failures to follow person-centered service plans, gaps in worker training, insufficient integration of participants into the community, and unequal treatment of tenants in provider-owned or operated residential settings, according to the Inside Health Policy news outlet.

Action steps

Providers in Minnesota should review their attestation to the Minnesota Department of Human Services (DHS) on meeting the HCBS Settings Rule Standards to ensure continued compliance. The Minnesota State Transition Plan can be reviewed on the DHS website along with a provider toolkit and the evidentiary packets for any settings that underwent “heightened scrutiny.” CMS visited several sites in Minnesota last summer as part of the validation of heightened scrutiny processes.

What’s in the Transition Plan?

The work that occurred in Minnesota that resulted in the approval of the Minnesota HCBS State Transition Plan by CMS included the following:

• Assessment:
  • DHS administered a provider attestation to assess compliance for 100% of provider-owned or -controlled settings.
  • Providers self-reported either full compliance with HCBS requirements or not fully compliant with one or more HCBS requirements.
  • DHS required all settings to submit supporting documentation as evidence of compliance. Supporting documentation included provider policies and procedure manuals, staff training documentation, activity program calendars, resident handbooks, leases, or other setting-specific information.
  • DHS provided technical assistance, instructional guidance, resources, and one-to-one outreach to settings that reported not yet in full compliance with one or more HCBS requirements.
• Validation:
  • DHS conducted desk audits for 100% of the 5,991 provider-submitted supporting documentation to validate setting compliance.
• Remediation:
  • DHS provided “compliance plans” for all settings that were determined “not yet compliant,” re-reviewed supporting documentation, provided a significant amount of technical assistance (email and phone calls), and developed assurance statements. The top three areas of noncompliance are employment, community life, and independent choices
  • DHS developed provider tools and resources, improved licensing policy templates and forms, and developed provider expectation guidance to help providers transition to compliance.
  • DHS responded to nearly 7,000 requests for technical assistance via phone and through a dedicated email box.
  • DHS conducted monthly targeted outreach to providers.

Outcomes

Almost all settings (99%) are compliant with the HCBS settings requirements. DHS has established a priority to revalidate the 1% of settings that remain non-compliant through provider enrollment.

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