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Home and Community-Based Services Programs
Public Notice - Amendments to Home and Community Based Services (HCBS) Waiver and 1915(i) State Plan.
New Provider Rates Effective July 1, 2016
It is the Department of Developmental Services' intent to amend both the HCBS Waiver and the 1915(i) State Plan in order to obtain federal approval for changes to provider payment rates as a result of the passages of both the State budget for Fiscal Year 2016-17, and Assembly Bill (AB) X2-1 (Chapter 3, Statutes of 2016) which provide for several rate changes and/or increases for some service providers effective July 1, 2016. As required by the federal government, notice must be issued prior to the effective date of the rate changes.
The State budget for Fiscal Year 2016-17, and Assembly Bill (AB) X2-1 (Chapter 3, Statutes of 2016) provide for a number of rate changes and/or increases for some service providers. The rate increases, effective July 1, 2016, are only applicable for providers with rates set by the Department (including rates set in statute or regulation), or providers with rates set through negotiation between regional centers and the provider. The rate increases do not apply for providers with usual and customary rates or rates that are set by other entities. Provider rate changes include the following:
- Five percent (5%) rate increases for supported living, independent living, respite and transportation. The estimated annual aggregate expenditures for these increases in fiscal year 2016-17 is $64.6 million. A comprehensive list of specific Medicaid services affected by this increase can be found here.
- Survey based rate increases for the purpose of enhancing wages and benefits for staff who spend a minimum of 75 percent of their time providing direct services to consumers and for provider administrative expenses. The estimated annual aggregate expenditures for these increases in fiscal year 2016-17 is $312.1 million. A comprehensive list of the Medicaid services being affected by the proposed payment change as well as their perspective percent increase in rate can be found here.
- New rate for supported employment. The estimated annual aggregate expenditures for this increase in fiscal year 2016-17 is $10.9 million. New supported employment rates effective July, 1, 2016 can be found here.
- The budget for FY 2016-17 and accompanying trailer bill language, allow the Department to establish an Alternative Residential Model (ARM) rate schedule for community care facilities vendored to provide services to a maximum of four individuals. This schedule can be found here. The estimated annual aggregate expenditures for these rates in fiscal year 2016-17 is $46.0 million.
Additional, detailed information on the topics summarized above can be found in the letter issued by the Department on June 24. 2016.
If you would like to view this notice and corresponding attachments in person, please visit your local regional center or the department at the address below. Comments regarding the proposed amendments to the HCBS Waiver and state plan will be accepted through July 30, 2016 and can be sent via email to Ashley Draper at firstname.lastname@example.org or via hard copy to:
Department of Developmental Services
Community Services Division
1600 Ninth Street, Room 320 (M.S. 3-8)
Sacramento, CA 95814
ATTN: Ashley Draper
Medicaid, known as Medi-Cal in California, is a jointly-funded, federal-state health insurance program for certain low income and needy people that includes long-term care benefits. In 1981, President Reagan signed into law the Medicaid Home and Community-Based Services (HCBS) Waiver program, section 1915(c) of the Social Security Act. The legislation provided a vehicle for California to offer services not otherwise available through the Medi-Cal program to serve people (including individuals with developmental disabilities) in their own homes and communities. The HCBS Waiver program recognizes that many individuals at risk of being placed in medical facilities can be cared for in their homes and communities, preserving their independence and ties to family and friends at a cost no higher than that of institutional care.
The federal Centers for Medicare & Medicaid Services (CMS) approved California's five year renewal of the HCBS Waiver for Californians with Developmental Disabilities effective March 29, 2012. Consistent with the Department's goal to maximize federal funding, approval of the HCBS Waiver secures the availability of approximately $1 billion in federal funding for regional center services. This HCBS Waiver includes new services previously not eligible for federal funding such as vouchered community-based training services, participant-directed nursing, financial management services and behavior management technician services.
1915(i) State Plan Program
Established as part of the Deficit Reduction Act of 2005, section 1915(i) of the Social Security Act gives states the option to provide Home and Community Based Services (HCBS) without a waiver. One of the key provisions of Section 1915(i) is that eligibility criteria for these services must be less stringent than the institutional level of care criteria required under waivers. DDS has two approved 1915(i) State Plan Amendments (SPA) which allow DDS to access federal funding for community services provided to individuals who do not meet the eligibility criteria of the current HCBS Waiver.
- May 1, 2013 - DDS Press Release (PDF)
- State Plan Amendment for Habilitation Services, et al (SPA 09-023A) (PDF)
- State Plan Amendment for Speech, Hearing, and Language Services (SPA 11-041) (PDF)
CMS Home and Community-Based Services Regulations (Rules)
In early 2014, CMS published final regulations affecting 1915(c) waiver programs, 1915(i) State Plan programs, and 1915(k) Community First Choice State Plans for HCBS provided through Medicaid. (42 CFR Part 430, 431, et al.) The purpose of the regulations is to ensure that individuals receive HCBS in settings that are integrated in and support full access to the greater community. The regulations also aim to ensure that individuals have a free choice of where they live and who provides services to them, and that individual rights and freedoms are not restricted, among other provisions. CMS has moved away from defining HCBS settings based on specific locations, geography, or physical characteristics, to defining them by the nature and quality of the individual's experiences. Basically, the regulations set higher standards for HCBS settings in which it is permissible for states to pay for services using federal financial participation under Medicaid. The regulations became effective March 17, 2014, and allow states up to five years to implement home and community-based settings requirements.
More information on the new federal regulations and the activities to implement the specific requirements is available on the CMS Home and Community-Based Services Regulations webpage.
On December 31, 2014, DDS submitted an HCBS Waiver application to CMS seeking federal funding for the Self-Determination Program (SDP). Under the authority of Senate Bill (SB) 468 (Chapter 683, Statutes of 2013) and upon CMS approval, DDS will implement the SDP, allowing regional center consumers and their families more freedom, control and responsibility in choosing services and supports to help them meet objectives in their individual program plans. Under the provisions of SB 468, participation will be limited to 2,500 individuals for the first three years of implementation.
More information is available on the Self-Determination Program webpage.