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On January 24, 2018 the Division of Disability and Rehabilitative Services (DDRS) issued the Update Home and Community Based Settings Rule bulletin to inform stakeholders that the Family and Social Services Administration (FSSA) was suspending activities associated with the Home and Community Based Settings Rule (HCBS) in order to review and reconsider planned Statewide Transition Plan (STP) activities and revisit STP timeframes given the extended timeline offered to states for HCBS compliance by 2022. You can read the full bulletin here. Since issuing the bulletin, FSSA divisions, including DDRS, and the Indiana State Department of Health (ISDH) have been engaged in internal meetings around the HCBS Settings Rule. On March 14, 2018, Dr. Jennifer Walthall, FSSA staff, and ISDH staff met with a large group of external stakeholders including INARF to provide a “Midpoint update” on the internal discussions by State agencies around the settings rule. The update is attached here for your reference. Please note, this is a draft document. It will change. Every State, including Indiana may be subject to changing their HCBS transition plan to be in compliance in the event CMS provides additional Settings Rule guidance. If you feel like you have been “on hold” since March of 2014 regarding how the Settings Rule will impact individuals, families, and providers, you are not alone. As a part of that conversation with stakeholders, FSSA and ISDH revealed a draft Settings Rule Transition Value Statement to be used by State agencies in developing policies regarding HCBS settings rule implementation. FSSA and ISDH emphasized their focus on a person-centered philosophy in achieving compliance with the Settings Rule. FSSA Secretary Walthall indicated there are five internal workgroups focused on five key topics which include: • Presumed Institutional and Heightened Scrutiny • Day Services • Memory Care • Leases • Physical Plant Below I have highlighted information from each topic that is most pertinent to our members. Heightened Scrutiny One of the next steps identified by the State is to “develop uniform criteria/rubric for heightened scrutiny process”. This is very important to all INARF members, particularly many day service settings that the State has indicated have characteristics that isolate persons with disabilities. For settings that have characteristics that isolate, Dr. Walthall indicated several times FSSA’s intent and desire to work collaboratively with consumers, advocates and providers to develop thoughtful remediation strategies and work to remediate these settings prior to having CMS complete their heightened scrutiny process. Day Services/Sheltered Work A part of the discussion on day services was focused on supports to persons with IDD and part of the discussion included unique challenges to achieving HCBS setting rule compliance for “sheltered workshops.” Page 7 of the document includes recommendations regarding day service settings and next steps that have been identified by the State. These include the following next steps: • Discuss day services Settings Rule compliance with CMS • Schedule site visits with community-integrated day services providers who may be the most compliant with Settings Rule currently. • Determine if sheltered workshops can remain Settings Rule compliant Please note some key wording in these next steps “day service providers who may be the most compliant”. This may infer that final determinations are yet outstanding and/or it may indicate the belief that no current day service provider is fully compliant. We just do not know enough yet to draw any definite conclusions. Waiver Residential Settings A great deal of the conversation around residential settings was focused on supports to persons who are aging, but there was discussion regarding the requirement for residents to have leases in provider owned/controlled settings. I encourage any residential provider with provider owned/controlled housing to study page 9 regarding leases and service agreements very carefully. Physical Plant I encourage providers to review page 10 regarding physical accessibility, privacy, and individual choice; particularly Example C. We are aware that providers may already have policies and procedures in place in the event that a resident would like to have visitors. If members have information about these policies and procedures and the planning and logistics required by teams to make this possible, we encourage you to share this information. Key Takeaways The State intends to use the full time period until March of 2022 to achieve compliance. Between now and 2021, the State will work with consumers, families, and providers to identify remediation strategies for settings that they believe do not comply, but could comply with yet undetermined/identified remediation strategies. January of 2021 is a key date in the overall timeline. At this point, it is anticipated that settings that have chosen not to begin remediating, will be settings where the State shifts their focus to transitioning the HCBS recipients to a setting that is or will be Settings Rule compliant. Action Needed INARF has been invited to submit questions and comments to the State regarding the draft plan no later than March 30, 2018. In order to achieve this, we are asking you to submit comments and questions to Sarah Chestnut at sarah@inarf.org no later than 12 PM (EDT) on Wednesday, March 28. The next stakeholder meeting will be held April 24. The feedback submitted regarding the draft plan will be discussed at that time. INARF will update members regarding the discussion following the meeting. If you have questions, please contact Steve or Sarah.