DRO raises concerns about state Transition Plan for CMS rule changes

January 16, 2015 / Transition

The state of Ohio last month released its proposed Transition Plan for home and community-based services (HCBS) in response to new federal rules issued by the Centers for Medicare and Medicaid Services (CMS). CMS has defined “home and community-based settings” for the first time in these new rules, and within five years states will only be allowed to spend Medicaid waiver funding on services in these types of settings. Each state must provide a Transition Plan to CMS explaining how it will comply with the new rules over the coming years and must first provide an opportunity for the public to provide input on its plan.

These new CMS rules and Ohio’s Transition Plan are a wonderful opportunity for people with disabilities, families, advocacy organizations and providers to work collaboratively with the state of Ohio to create a system that supports people with disabilities in their chosen goals, allows them the ability to live and work and spend their days integrated in our communities, and maximizes their independence and autonomy.

DRO encourages everyone (particularly people with disabilities and their families) to submit comments on Ohio’s proposed Transition Plan, express support for these new CMS rules, and provide specific input on the plan itself. Here are some important points DRO raises in its own comments:

  • The opinions of people with disabilities and their families should be the most important part of Ohio’s Transition Plan. Ohio did not include their input in deciding whether certain types of residential and non-residential waiver settings should be considered home and community-based settings. People with disabilities, families and advocates should be involved at all levels of this process. Each person with a disability enrolled in a waiver program has a unique and important perspective on whether the settings in which they are receiving services actually is integrated in and supports access to the broader community, provides them opportunities to engage in community life, and allows them independence in making life choices, as is required by the rule. Their viewpoint is essential.
  • These new rules are especially important to make sure people can receive employment and day services in integrated settings if they would choose to do so.
  • Ohio placed too much reliance on provider self-assessments to determine whether a setting is home and community-based or not and in deciding which settings require on-site evaluations. Their opinions are helpful, but their perspectives often differ from those of people with disabilities and their families, and should be only one part of the Transition Plan. Ohio should plan on doing on-site evaluations for a broad sample of settings, regardless of the provider’s self-assessment of compliance with the new CMS rules. And they must speak to people with disabilities in these settings and their families to get their perspectives on the services they receive.
  • Ohio needs to commit to ongoing education about the new CMS rules, what changes to the system will happen in the coming years, and the rights of people with disabilities to live and work and spend time in their communities. There has been a lot of confusion and misinformation.

There are some settings, like those that have the effect of isolating people with disabilities enrolled in waiver programs, that will undergo “heightened scrutiny” by CMS. Ohio must include people with disabilities and the public in determining which settings cause isolation from the community and how it defines isolation. It cannot rely solely on a provider’s self-assessment of the way a particular setting isolates people from their communities.
Ohio needs to create a plan for increasing capacity for the types of things people with disabilities will need to be truly integrated in our communities, including housing, transportation and community employment.
Comments are due on Friday, January 23, 2015. Comments can be submitted in any of the following ways:

By e-mail: HCBSfeedback@medicaid.ohio.gov

By written comments sent to:
Ohio Department of Medicaid
ATTN: HCBS Transition Plan
P.O. Box 182709, 5th Floor
Columbus, Ohio 43218

By fax: 614-466-6945 (include Attn. HCBS Transition Plan in the subject line)

By calling toll-free to leave a voicemail message: 1-800-364-3153.


Related Resources

There are a number of good resources for advocates about the new CMS rules:




Make a Donation

Please give. To the best of your ability.