hcbs compliance …alw provider self-assessment · 2017. 7. 31. · ohio assisted living...

Ohio Assisted Living Association 2016 1

HCBS Compliance…ALW Provider Self-Assessment

Jean B. ThompsonOALA Executive Director

June 14, 2016

Welcome!

Jean B. Thompson, OALA Executive Director

• Password to log-in on your computer: HCBS

• Please type your questions in the “question box” ☺

• If you are having trouble connecting, call or e-mail us 614-481-1950 (leave message) [email protected] …please not to Jean


HCBS Compliance has begun

Implementation of Ohio’s Plan to bring all

waivers into compliance with

new federal definition of HCBS

(includes both “traditional” ALW & MyCare)

**********Your Setting Evaluation Tool************

needs to be completed before July 1

• CMS requirement by March 2019, but Ohio is expecting provider compliance much sooner!

• Part of provider application process in future & checked on all structural compliance reviews

Current ALW providers placed in Category B or C, based on state’s initial review:

� Category B: Currently does not meet HCBS characteristics, but can with modifications

� Category C: Presumed to have effect of isolating, & may be subject to “Heightened Scrutiny”


ALW Providers received

April letter

with your designated category

If… Category B:

• Complete Evaluation Tool by July 1

• Keep it …checked during next structural review

If… Category C: (only 39 RCFs, without “meaningful distinction” from “institution”)

• Evaluation Tool + Written remediation planmailed or e-mailed to ODA by Sept. 1.

• State will conduct onsite evaluation, beginning in October.

Setting Evaluation Tool (ODM 10172)

• For each ALW community to determine if they meet the new requirements

• Provide “evidence of compliance” for each

Confusing: Same form being used

for different waivers & provider types

Many of OALA’s suggestions were included in

online training material on how to fill out the form

http://ohiohcbs.pcgus.com/evaluation/index.html

(printable transcript files on OALA website)


Answer every question

Generally….

• Yes: Provide “Evidence of Compliance”

• No: Requires a “remediation plan” (process similar to

“plan of correction”)

*But …some questions backwards (where yes means plan

needed) … training modules addition will specify.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

First questions - general requirements for all HCBS settings

Second set - additional questions for “Provider

Owned or Controlled Settings” (AL)

What kind of evidence documentation will the AAA staff be looking for?

• ODA will be training each of the AAAs on reviewing HCBS compliance

• Suggest having your documentation evidence together (notebook, folder)

• AAA review staff will also be checking compliance through “observation”

• Appeal process for any structural compliance review item.


Additional PossibleEvidence of Compliance

• Information provided at move-in

• ODH survey findings, no citation in area

• ALW structural compliance review results

• Resident Satisfaction Survey results (choice & meal related questions)

• Staff residents’ rights training curriculum highlighting HCBS items

… Absence of a policy to the contrary

Category C must demonstrate “meaningful distinction” from NH: • Minimal administrative, financial

interconnectedness• Separate entrances & signage• Cross-training of NH staff• Integrated in larger outside community

General Requirements for all HCBS settings


• Separate AL Manager

• Signage “separation effect” (…you are now entering the AL)

• Train all staff - ALW requirements (handout)

• Community events (people in & out)

AL choice documented in AAA Care Plan

Welcome to the Assisted Living

(Part of Our Town)

• Can someone not on Medicaid live there?

• Are residents on Medicaid treated differently? … or can

they interact with others & utilize all “common areas”?

• Could someone without a disability choose to live there

(e.g. spouse)?

• Do members of the larger community come into the AL?

… Can residents go/visit outside the AL?

Does not isolate …from “broader community”


• Examples of Community Interaction (community room used by Rotary)

• Resident outings (restaurants, shopping, events)

• RCF rule compliance (newspaper, bus schedule) ORC 3701-17-61

• Residents’ Rights: No difference in provision of service based on payment source. ORC 3721.13(A)3

• Having private pay residents(resident agreement)

• Although not the norm,…could someone that was

employed live there?

• Would staff assist them to get ready and leave

“on their outing”? Could services be provided when they

were in the building, taking into consideration their

regularly scheduled “outing”?

Perhaps a “policy statement” of your willingness to support

a resident who is employed (to the extent you can).

Employment


• Authorization requirements, resident access to funds (banking hours), notification, accounting, dispersal safeguards. ORC 3721.15

• RCF rules: The management of resident funds cannot be a condition of admission OAC 3701-17-61(C)

�RCF rule & law being followed.

Control Personal Resources

• Access to telephone for private calls OAC 3701-17-65 H

• Physical & chemical restraints prohibited in RCFs, OAC

3701-17-57 (B) 3 …& Residents’ Rights ORC 3721.13(A)13

• IF you have a secured unit: Yes, with explanation

…individual modification for safety (need documented)

• Ohio law required Grievance Committee, with all residents

informed on how to file a complaint ORC 3721.12(A)2

Protecting Rights


• Can chose Home Health, Hospice, or other provider.

OAC 371-17-59.1(D)2e

AL choice documented in AAA care plan

• Care can not be “imposed upon” OAC 3701-17-51(C);

Residents’ Right to participate in decisions OAC

3721.13A; ALW supports “choice” OAC 173-39-02.16

• No requirement to follow a set schedule. Not forced to

attend any activity. Range of hours for dining room,

menu choices. …Asked schedule preferences.

Make choices & Control schedule

• Residents can use all community “common areas” that residents not on Medicaid can.

• Residents’ Rights: No difference in provision of service based on payment source. ORC 3721.13 (A)3

Choices regarding physical environment


• No practice of assigning seats in dining room. Residents can choose where, and who to sit with; or not to go/attend activities.• Private apartment with area for “socialization” required. OAC173-39-02.16 B(2)c(v) • Other accessible quiet areas (library, chapel, computer area, etc…)

Choice with whom to interact

• Resident Council meetings (if you hold)• Other feedback from residents (“suggestion box”,

input on menu, etc…)• Procedure to contact Case Manager to assist

resident when care plan changes are needed• Choice of Home Health or Hospice agency.

OAC 371-17-59.1(D)2e

Choice …services & agency


Additional Requirements (Provider-Owned or Controlled)

�Privacy (sleeping/living unit)

• ALW rules require private unit, unless existing

relationship. OAC 173-39-02.16 B2a

… AL service “supports privacy”

• Resident Right to privacy ORC 3721.12

• RCF rules OAC 3701-17-64 – unit to ensure privacy

(window covering, bathroom)

• Room & Board rate for ALW set by state • Also a set ALW service package.• Any modifications to the resident’s care plan,

must be made by AAA Case Manager• Nonpayment policy - Room & Board ALW

resident’s responsibility

� Room & board


• RCF resident agreement requirements & other

information required to be provided

OAC 3701-17-57; also ORC 3721.12

• Residents’ Rights concerning transfer/discharge

required in RCF rules OAC 3701-17-58

• Ohio law for all “licensed homes” (30 day notice,

right to hearing & appeal) ORC 3721.16-.162

Agreement …responsibilities & “eviction”

• ALW rules require unit with lock that allows consumer to control access OAC 173-39-02.16 B(2)c(iii)

• Physician approved (annual) exception documented in

Care Plan

Lockable unit


• RCF rules requirement for staff to have access to a locked unit, but limits to “in case of emergency” OAC 3701-17-65 (I)5

• Suggest policy (when the key is used, by whom)

Staff Key

• RCF rules: Right of residents to personalize their space, bringing personal furnishings & items OAC 3701-17-65 (D)

• Community Transition Servicefunding available for furnishings if moving from NH OAC 173-39-02.17

Furniture & Decor


• Absence of policy/practice requiring a set schedule

• Resident’s preferences discussed on admission as part

of orientation; also in Care Plan

• Floor plan: private unit, “common areas” for all residents

(Medicaid & Private Pay)

• Residents’ Right to participate in decisions

OAC 3721.13A

(Laundry included in ALW service package)

Control schedules & activities

• 3 meals a day included in ALW rules service package

OAC 39-02.16 B

• Timing of meals & availability of evening snack in RCF

rules OAC 3701-16-60 (schedule required, meal mid-point

4 hours a part)

• Range of dining times available; provisions made if

resident misses meal, snack area (fruit out, machines),

food storage/prep area in unit. (private unit, common

areas, picnic table)

Food …available at all times


• Residents’ Right ORC 3721.13(21) to private communications & visits

• If policy, inform residents prior to move in (front door locked at 8 p.m. for safety, process for after hours visitors: call to be admitted, code); same for both waiver & private pay residents

RCFs must balance rights of all residents:

visitors, safety, noise

Visitors …at any time

• RCF rules require providing information on physical accessibility to resident prior to admission OAC 3701-17-57 E(6)

• Bathroom grab bars (non-skid surface) required. OAC 3701-17-64

• Exit cannot be barred per the Ohio Fire Code

Physically accessible


What about secured units?

If you have a secured unit in your AL, even if no ALW certified units in it, you would respond…

Provide explanation:

• Any ALW resident living in it would have a modification for safety in their person centered care plan

• All residents would have need documentation in resident record (RCF rules)

• Other individuals (staff, spouse, visitors) have code and can enter and exit.

• Already requirement for provider to contact the case manager.

• Only CM can modify care plan.

Policy (or stated procedure)

mirroring requirement

Contacting Case Manager


WHY are we filling this out?

To be compliant with the new rules …in July

• HCBS Settings Rule

• Person Centered Care Planning Rule

Category B: Just keep it

(Checked on next structural

compliance review.)

Category C: Written

remediation plan to ODA

by September 1

Category C (only!):

By September 1…

Mail or e-mail written remediation plan to:Ohio Department of Aging

Attn: Provider Network Management

246 N. High St., 1st Floor

Columbus, OH 43215-2406

[email protected]

State will begin onsite evaluations for Category C, starting in October


HCBS Setting Rule

OAC 5160-44-01

General setting requirements:

• Integrated in, access to broader community

• Setting selected from among options

• Privacy, dignity, respect, no coercion or restraint

• Individual initiative, autonomy, independence

• Facilitates individual choice regarding activities, schedule, services & supports and who provides them

Additional Qualities Provider Owned/Controlled Settings (AL)

• “Legally enforceable agreement”, protections,

responsibilities, relocation circumstances; review,

appeal

• Privacy in sleeping/living unit (“choice” of roommate)

• Setting and unit lockable by individual; appropriate

staff having keys

• Freedom to furnish/decorate within agreement limits

• Freedom/support to control their own schedule &

activities; access to food at any time

• Visitors at any time

• Setting is physically accessible


Modifications only permitted• for an individual• if justified in their care plan

…………………………………………….…….

HCBS Person-Centered Care Planning Rule

OAC 5160-44-02

How the person-centered care plan developed.

HCBS service provider (RCF) can not develop it!

…the responsibility of the AAA case manager.

Thank you!Save the Date:

Summer Webinar:

The Anatomy of a Medical Record: Presented by Heather Baird & Janet Feldkamp,

Benesch Law

June 21, 2016 1:00-3:00 p.m.

Assisted Living ED/Administrator CourseMost Extensive RCF Rule Training of the Year

August 2 & 3, 2016-Fairfield Inn - OSU, Columbus


Questions? …Call us

The Ohio Assisted Living Specialists!

hcbs compliance …alw provider self-assessment · 2017. 7. 31. · ohio assisted living...

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