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Medicaid Overview Team Medicaid Department of Health and ...

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Rebecca Oliver, Policy Analyst AdvancedOffice of Health Services
Background and Introduction
Home and Community- Based Setting Final RuleCMS issued this final rule on January 16, 2014It became effective on March 17, 2014Full Compliance is required by March 2019The final rule lists many items HCBS providers must comply with to receive Medicaid payment.
ValidationStrategiesProvider Surveys almost complete, working on data analysisConduct Onsite VisitsPlanning now, starting this summerObtain Consumerand StakeholderFeedback/ReviewsImplementing participant surveysRemediation PlanSending providers letters explaining the regulation and providing feedback on which questions they indicated noncompliance onCorrective Actions Plan to be proposed by providers based on the letter
Community Settings RuleUpdate
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Community Settings Rule Update
Alternatives For Individuals Impacted By Settings That Do Not/ Will Not Comply With RuleParticipants Must Be:Provided With Reasonable Notice & Due ProcessGiven Opportunity, Information And Supports To Make Informed Choice Of Alternate SettingsState Must Ensure:Critical Services And Supports Are In Place For Participants Prior To Transition
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Community Settings Rule Update
Ongoing Monitoring & Quality AssuranceWorking site visits/ assessments into revalidation processes for all programsSTP updates to go out for public comments around July 31STP is currently on our website
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Provider Survey Analysis
Analysis is based on865provider survey questionnairesSeparated into four categoriesGroup 1: These sites have failed 0 -4 questions. DHMH considers these sites to be mostly in compliance with federal regulations, though minor changes may be necessary.Group 2: These sites have failed 5-10 questions. DHMH recommends these sites make minor changes to become compliant with the federal regulations.Group 3: These sites have failed 11-15 questions. DHMH recommends these sites make major changes to become compliant with the federal regulations.Group 4 :These sites have failed 16+ questions. DHMH recommends these sites work with DHMH to overhaul their programs to become compliant with federal regulations.*This is preliminary analysis and will be updated as needed, based on Hilltop’s additional data
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Group 1
There are 299 sites that have failed 0-4 questions on the survey. This accounts for 34% of the total sites.
Group 2
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There are 414 sites that have failed 5-10 questions on the survey. This accounts for 47% of the total sites.
Group 3
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There are 139 sites that have failed 11-15 questions on the survey. This accounts for 16% of the total sites.
Group 4
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There are 23 sites that have failed 16 + questions on the survey. This accounts for 3% of the total sites.

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Medicaid Overview Team Medicaid Department of Health and ...