Housing & Health Care Policy
October 2014
Burning Questions
Home & Community Based Standards
(HCBS) and Settings that Isolate
DOJ
HEARTH Act –
Homeless Programs
HUD
Translation Chart for this
Conversation
Housing has…
• HUD or IRS or USDA
Services has…..
• Health & Human Services
(HHS)
• SNAPS, Multifamily, Public
Housing, etc
• Centers for Medicaid
Services (CMS)
• Con Plan
• Annual Action Plan, QAP
• State Plan
• State Plan Amendment
(SPA)
• Eligible Activities
• Service Definition
• Grantees/Contractors
• Providers
Home & Community Based
Standards (HCBS)
1915 (b)
Mental
Illness
1915 (c)
Developmental
Disabilities
1915 (i)
Elderly
Last Year When We Met
• Proposed Rules
– Disability specific complex
– “designed”
Final Rules
• Disability specific complex – that phrase
was replaced with “any other setting
that has the effect of isolating
individuals receiving Medicaid HCBS
from the broader community of
individuals not receiving Medicaid
HCBS …”
Definitely not HCBS
• Nursing facility
• Institution for mental diseases (IMD)
• Intermediate care facility for individuals
with intellectual disabilities (ICF/IID)
• Hospital
Probably not HCBS
• Settings in a publicly or privately-owned
facility providing inpatient treatment
• Settings on grounds of, or adjacent to, a
public institution
• Settings with the effect of isolating individuals
from the broader community of individuals not
receiving Medicaid HCBS
Next Steps
• NC DHHS currently working on a State Plan Amendment with
numerous stakeholders. That plan says how we will bring HCBS
Waivers into compliance.
– NC will operationalize your regulations by and come into compliance with
these new regulations by doing these things ….
– NC will operationalize the definitions in your regulations by ……
• NC DHHS is required to submit that plan to CMS by March 15,
2015
CMS provides feedback
• A back and forth can go on for quite a while
• The steps outlined in the plan are required to be completed by
2019.
• A draft of the NC plan will be posted for public comment later
this year or early next year.
Any Ideas What One Might
Look Like?
• First state plan was approved by CMS –
Indiana’s Community Integration and
Habilitation Waiver renewal- effective
10/1/14
Beds vs. Units
“any other setting that has the effect of isolating
individuals receiving Medicaid HCBS from the
broader community of individuals not
receiving Medicaid HCBS …”
It’s easier to understand how HCBS applies to
facilities with beds
CMS says they will provide additional guidance
related to housing units
Heightened Scrutiny
• Review of HCBS to determine if a residence meets
Standards –
– Yes, it meets standards
– No, it doesn’t meet standards
– Presumptively non HCBS, State must provide evidence for
or against
• Heightened Scrutiny Process, CMS reviews evidence
provided by state and Stakeholders
• If Determined not to be Home and Community Based
Setting or Service there are 3 options –
– Individuals move to a setting that meets home and
community based setting or
– Services are funded using non waiver services (i.e. State $)
– Individuals receive no services
HUD – HEARTH Act
• A few policy U-turns
• Fortunately, the turns are based on
research and data
Most relevant for this
conversation…..
SHELTER
TRANSITIONAL HOUSING
TREATMENT PROGRAM
Delineating the Track
Shelter
? If Dave enrolls in the program
today, and next week you find an
apartment that would work for
Dave, do you help him to move
into that apartment, or do you
tell Dave you’d prefer he stay in
your program until X
intervention has been
completed?
Treatment Program
Department of Justice
• Olmstead Decision of the Supreme
Court
• Americans with Disabilities Act (ADA)
• Settlement Agreement
• August 23, 2012
Housing Components of
Settlement Agreement
• 3,000 people over 8 years
• Preference for single occupancy
– 1 bedroom units
• Maximum 20% required saturation in a
community
• NO licensed housing options
• Roommate with informed choice
• Tenancy Supports
• Diversion from Adult Care Homes (ACH)
Diversion
• 1000 of the 3000 Housing Slots are for
persons who are being diverted
• Additional persons being diverted are
still expected to be given community
housing options
Are licensed facilities bad?
• NO
• They are appropriate for some people
• DOJ determined that the state lacked
community based housing options and wants
the state to invest in creating more of those
options
– Some are viable options for non-housing slot
Diversion
NC Supportive Housing Program
• Guaranteed rental assistance
– Administered by Quadel
• Guaranteed Tenancy Supports
– Through Assertive Community Treatment
(ACT) Teams
Or
– Coordinated by Quadel
Rental Assistance
• State voucher for up to $360
• If additional rent assistance is needed, it
comes from the tenant’s Supplemental
Assistance-In Home payment, or a
Community Living Assistance Payment
– Those funds will come to the landlord from the
tenant as part of the tenant’s portion of the rent
Tenancy Supports
• Relationship with landlord and
neighbors
– Tenant must give consent for worker to talk
directly with landlord
•
•
•
•
Cleaning
Maintenance
Healthy social relationships
Unexpected time away
Quality Control
• SocialServe.com (nchousingsearch) will
contact landlords on a regular basis
unless asked not to by the landlord
Interested in Participating?
• NC Quadel
• John Rowland – Managing Director
– (919) 319-1838
– [email protected]
Martha Are
Housing & Homeless Unit Manager
919-855-4994
(c) 919-559-6193
[email protected]