In this webinar, Roberta Newton, manager of the Los Angeles Office of the State Council on Developmental Disabilities speaks about: > The importance of the Centers for Medicare and Medicaid Services (CMS) and Home & Community Based Services (HCBS) for people with developmental disabilities and their families. > What changes are coming to HCBS and and how people with developmental disabilities will be affected. > How to prepare for and participate in the development of new HCBS regulations.

1. Upcoming changes to Medicaid’s Home and
Community Based Services (HCBS)
Regulations
By Roberta Newton & Michelle Rojas Soto
January 29, 2015

2. Structure and Logistics
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3. Poll: Can you hear Roberta and
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4. About Michelle Rojas Soto
Moderator
USC UCEDD Director of Community Education,
Information Dissemination and Technical
Assistance
mrojassoto@chla.usc.edu
www.uscucedd.org
The USC University Center of Excellence in Developmental Disabilities at
Children’s Hospital Los Angeles (USC UCEDD) is one of 67 centers around the
country. Our mission is to provide leadership in strengthening family-centered,
culturally-competent services and systems for the benefit of individuals with, or
at risk for, developmental, behavioral and/or special health care needs and their
families in partnership with those who utilize the services.

5. About Roberta Newton
Presenter
Manager, Los Angeles Regional Office
State Council on Developmental Disabilities
Roberta.Newton@scdd.ca.gov
http://www.scdd.ca.gov/areaboard10.htm
The State Council on Developmental Disabilities is established by state and
federal law to ensure that individuals with developmental disabilities and their
families participate in the planning, design and receipt of the services and
supports they need which promote increased independence, productivity,
inclusion and self-determination. The Council supports 13 regional offices that
provide advocacy assistance, training, monitoring and public information.

6. Overview
What is CMS
and HCBS?
Why is CMS
and HCBS
important
for DD
families?
What
changes will
take effect
and when?
How will the
mandated
changes
impact
families?
Next steps

7. What is CMS and HCBS?
What is
CMS and
HCBS?
Why is HCBS
important for
DD families?
What changes
will take effect
and when?
How will the
mandated
changes impact
families?
Next steps
• CMS – Centers for Medicare & Medicaid Services
• HCBS – Home and Community Based Services
• HCBS includes the wide variety of services that people use to support them
in the community:
o Personal care attendants
o Supported living services
o Transportation, etc.
• With a few exceptions, nearly all the services offered by your regional center
are HCBS.

8. Why do CMS and HCBS matter?
What is CMS
and HCBS?
Why is
HCBS
important
for DD
families?
What changes
will take effect
and when?
How will the
mandated
changes impact
families?
Next steps
• CMS are a major source of funding for the developmental disability
service system. About 50% of regional centers’ budgets comes from CMS.
• When CMS announced changes to their rules, states paid close attention.
States know they may need to make changes to their services so that CMS
will continue to pay for those services.
• It is important for people who receive HCBS to also pay attention to the
new rules because your services could change as a result.
• HCBS include not only regional center services but some services provided
by the Departments of Health Care and Aging.

9. How will HCBS change?
What is CMS and
HCBS?
Why is HCBS
important for
DD families?
What
changes will
take effect
and when?
How will the
mandated
changes impact
families?
Next steps
• The purpose of the new rule is to make sure that HCBS services provide
real opportunities to work, live, and socialize in the community.
• Five Standards
 Integration into the community
 Individual Choice
 Individual Rights
 Autonomy
 Choice Regarding Services and Providers
More Info: http://autisticadvocacy.org/wp-
content/uploads/2014/09/Guide-for-Advocates-and-
Families.pdf

10. How will HCBS change?
What is CMS and
HCBS?
Why is HCBS
important for
DD families?
What
changes will
take effect
and when?
How will the
mandated
changes impact
families?
Next steps
• People must have the right to choose what services they receive and
from whom, through a person-centered planning process.
• Service settings that are institutional in nature, that keep people
segregated from their community, will probably not qualify for CMS
funding. However, the new rule does not explicitly target any specific
service categories for elimination.
• At this point , states are expected to begin assessing the various service
settings to determine which may not comply with the new standards.

11. How will families be impacted?
What is CMS and
HCBS?
Why is HCBS
important for
DD families?
What changes
will take effect
and when?
How will the
mandated
changes
impact
families?
Next steps
• States must encourage service recipients, advocates, and stakeholders to
participate in assessing HCBS.
• Teams will visit and/or survey locations where services are delivered.
• Emphasis on “person-centered planning”. The regional center Individual
Program Planning (IPP) process will probably change too.
• Some services or service categories may be eliminated.
• What is almost certain to change is how services look, how they operate
and what rules they follow. For example, there will likely be the
requirement that regional centers and providers document that a service
was freely chosen from among an array of choices.

12. Where do we go from here?
What is CMS
and HCBS?
Why is HCBS
important for
DD families?
What changes
will take effect
and when?
How will the
mandated
changes impact
families?
Next steps
• By March 17, 2015, each state has to submit a “Transition Plan” to CMS that
lays out the process they will follow for assessing their services and ensuring
full compliance.
• California submitted its Transition Plan in December 2014. It includes an
implementation timeline for education and outreach, assessments and
appeals.
• It is expected that CMS will reject the initial plan and require the state to
develop a more robust, detailed plan with greater stakeholder involvement.
• States are required to come into full compliance with the new rules by March
17, 2019.

13. Where do we go from here?
What is CMS
and HCBS?
Why is HCBS
important for
DD families?
What changes
will take effect
and when?
How will the
mandated
changes impact
families?
Next steps
• Review the state’s Transition Plan, track changes and new developments, and
volunteer to participate in the ongoing evaluation process:
http://www.dhcs.ca.gov/services/ltc/Pages/HCBSStatewideTransitionPlan.aspx
This web site was established by the Department of Health Care Services
(DHCS) because they are the lead agency for all HCBS waivers.
• Review the timeline:
http://www.dhcs.ca.gov/services/ltc/Documents/STPTimeline19Dec14.pdf
• Submit comments: STP@dhcs.ca.gov

14. Where do we go from here?
What is CMS
and HCBS?
Why is HCBS
important for
DD families?
What changes
will take effect
and when?
How will the
mandated
changes impact
families?
Next steps
• DDS will develop a transition plan and timeline specifically for the
developmental disabilities service system. The DDS HCBS Advisory Group is in
the process of being established and will begin its work in February 2015.
• Track progress and provide input:
http://www.dds.ca.gov/HCBS/index.cfm
• Additional HCBS Information:
http://hcbsadvocacy.org/
http://tash.org/wp-content/uploads/2015/01/Joint-Statement-by-HCBS.pdf

15. Poll: Do you have a better
understanding of HCBS and the new
rule now?

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