Training Agenda • Welcome and Introductions • Presentation from KDADS • Presentation from WSU CEI • Questions from You • Introduction to Upcoming Provider Learning Collaboratives • Breakout Room Scenarios
Provi vider er R Remed ediation Next Steps on the Road to Compliance for Final Rule in Kansas Presenters: LaTonia Wright, KDADS Russell Bowles, KDADS
This training w will a address… • The remediation process and expectations • Remediation strategies • Accessing the remediation tab and submitting a remediation plan • Technical supports and resources
Rev eview w of K Key ey P Phases • Systemic Assessment • Provider Self Assessment • Heightened Scrutiny • Transition • Ongoing Monitoring • New Providers/Sites
Tim imelin line R Revie iew • 03/14/2014 – CMS published HCBS Settings Final Rule • 09/15/2019 – Provider Self-Assessment opened in Kansas • 02/29/2020 – Provider Self-Assessment closed in Kansas • 07/01/2020 – Heightened Scrutiny Categories 1 and 2 must be submitted to CMS • 10/30/2020 – Heightened Scrutiny Category 3 must be submitted to CMS • 07/01/2021 – All setting(s) remediation evidence must be submitted to community connections (KDADS) • 03/17/2022 – All settings must be in compliance with the Final Rule (CMS)
Systemic c As Asse sessm ssment • Kansas has and continues working to modify systemic documents to come into compliance with the Final Rule, which includes a review of statutes, regulations, policies, procedures and contracts. • There will be opportunities for stakeholders to review and provide feedback on changes during public comment periods.
Provid ider S Self lf-Ass ssessm ssment • This phase has been completed for those in attendance (Yes/No)! • KDADS continues to review assessments to determine what areas providers need to remediate. • Remediation for Kansas is based on the idea that all providers and settings willing to come into compliance - will be able to do so. • Remediation notifications are being processed for provider notifications.
Heightene ned d Scrutiny • HS is triggered by the provider self-assessment. • Heightened Scrutiny (HS) has 3 categories. • Category 1: Settings that are located in a building that is also a publicly or privately operated facility that provides inpatient institutional treatment • Category 2: Settings that are in a building located on the grounds of, or immediately adjacent to, a public institution • Category 3: Any other settings that have the effect of isolating individuals receiving Medicaid home and community-based services (HCBS) from the broader community of individuals not receiving Medicaid HCBS.
Heightene ned d Scrutiny • Due to triggered flags during the self-assessment regarding location and/or physical characteristics of the setting, an on-site visit by KDADS must be completed to determine if the setting is HCBS compliant. • Heightened Scrutiny notifications to schedule a site visit will come from the Heightened Scrutiny Director or team. This will be a second notification from the remediation notification. • A provider must have overcome HS and be willing to collaborate with KDADS during the process in a timely manner in order to meet federal deadlines for implementation of the Final Rule.
Transition • Settings choosing not to come into compliance or unable to come into compliance with Final Rule will not receive HCBS Medicaid funding after March 17, 2022. • HCBS clients must transition to a compliant setting before March 18, 2022 to continue receiving HCBS funding. • All remediation evidence must be submitted to communityconnectionsks.org by July 1, 2021.
Transition • The July 1, 2021 date will allow time for KDADS desk review of submitted evidence and to work with the provider to come into compliance before March 17, 2022. • Please note that if submitted evidence shows a setting is unable to meet final rule requirements by March 17, 2022, it will no longer receive HCBS funding beginning March 18, 2022. • Transition notifications to persons served must begin no later than October 1, 2021.
On Ongoi oing Monitor oring • After a setting comes into full compliance with the Final Rule, ongoing monitoring will ensure it remains in compliance. • The ongoing monitoring process is still being reviewed at KDADS to determine who will complete these ongoing tasks. • State regulations are in the process of being updated.
New and Cl Closed Se Settin ings • New settings will have an onboarding process at a later date in 2020. • KDADS is currently working on IT supports to enhance the database system. • New Setting After 2/29/20? • Provider should use toolbox documents found at communityconnectionsks.org under the “Support Tab” to assess setting(s) for HCBS compliance characteristics. • Use missed deadline form located at communityconnectionsks.org to notify KDADS of a new setting or closed setting. • KDADS will follow-up with provider once onboarding process is available. • All HCBS settings will be tracked in the database system, including closed settings. Closed settings are not deemed compliant. A new assessment will be required for a closed setting if it reopens in the future and is seeking to utilize HCBS funding.
Road to Com ompliance Coming into compliance - • Provider – review and consider each setting’s physical location, policies, procedures and practices when identifying strategies to come into compliance with the Final Rule. The requirements are to not have institutional like characteristics in HCBS settings. • It is okay as a provider to have blanket policies, procedures and practices across multiple settings if possible. • Most providers are not yet fully compliant, and that is okay. • Wyoming – 4.62% of settings in full compliance after initial assessment • Tennessee – 14% of settings in full compliance after initial assessment
Remedia iatio ion: N : Notif ific icatio ion • Once the Self-Assessment/Validation/Desk Review Phases Concludes: • An email and letter is sent to the provider (for each setting) describing what needs to be remediated. • If there is nothing to be remediated, the provider will get a letter of compliance (for each setting). • The email and letter describes the remediation process and instructs providers toward a timeline of plan submission for the setting.
Remedi diation n Plan • For each self-assessment question that needs to be remediated, the provider will select a remediation strategy and a timeframe for when the strategy will be completed. Timeframes are required as part of the remediation plan.
What C Can Be Used ed As E Eviden ence? ce? • Photographs- These can be from internet map sources and/or photos taken by the agency. • Policy/Procedures- These are agency documents that explain how an agency provides guidance in different areas. • Handbooks- This is a document that supports or clarifies agency policies/procedures. • Manuals- This is a document that supports or clarifies agency policies/procedures. • Other Documentation (i.e., agency forms, agency brochures, agency pamphlets, rental agreements, support plans etc. - If these documents are used, they should provide support or clarification to policies, procedures, handbooks or manuals. Providers, please do not submit PHI on any evidence.
Remediation St Strategies – Guidance ce On On: • Writing Policy and Procedure • What policy should look like. • What procedure should like. • Handbooks and Manuals • What handbooks/manual should look like. • What policies support the handbook/manual? • Staff and Volunteer Training • What constitutes “good” training. • What policies support the training manual?
Writ itin ing P Polic licie ies and P Procedures • Policies and/or procedures are the preferred documents for setting evidence. • Policies and/or procedures should have the following qualities at a minimum: • Organization Identification. • Policy Title and/or Policy Number ( what is this policy about ). • Policy effective date ( revised date is acceptable ). • Regularly review for updates as needed.
Ha Handbooks • Handbooks should support and/or clarify a policy and/or procedure. • Handbooks should have the following qualities at a minimum: • Organization Identification. • Purpose of Handbook ( can be seen in the title or stated in a purpose statement ). • What policy and/or procedure does the handbook support? • Is it a handbook for persons served or staff? • Effective Date ( can be on document or as evidenced by a signature/date page or initials/date ). • Does the handbook answer the question?
Manuals • Manuals should support and/or clarify a policy and/or procedure. • Manuals should have the following qualities as a minimum: • Organization Identification. • Purpose of Manual ( can be seen in the title or stated in a purpose statement ). • What policy and/or procedure does the handbook support? • Is it a handbook for persons served or staff? • Effective Date ( revised date is acceptable ). • Does the manual answer the question? • Review and update as needed.
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