DMAS Releases a HCBS Setting Fact Sheet

January 31, 2018

Senate Bill 310 was introduced in the General Assembly on behalf of a parent group interested in forming an “intentional community” for individuals with developmental disabilities.  The bill states:
§ 32.1-325.04. Waiver services; place of residence. The Department shall not reduce, terminate, suspend, or deny services for an individual enrolled in a waiver who is otherwise eligible for such services on the basis of such individual’s informed choice of place of residence in the Commonwealth.” So the issue on the surface is the issue of choice.  DMAS has maintained that an “intentional community” may have the effect of isolating the individuals who live there; such intentional isolation would be contrary to the provisions of the HCBS Final Rule and would conflict with what Virginia has assured as part of our State-wide Transition Plan.  What is not clear, and in the new CMS Administration in Washington is becoming somewhat less clear, is whether the creation of such a community, with services funded by Medicaid Waiver, would put all, or only the specific part, of the Federal Medicaid funds in jeopardy.  DMAS has felt obligated to make the case that all funds could be in peril. Yesterday, DMAS issued a FACT Sheet.  The information contained is informative of the specific question, but may also be useful for existing providers who are attempting to transition from larger to smaller settings.  Larger “disability specific gated/campus style communities . . . may be compliant if the setting(s) demonstrates the characteristics of an HCBS setting.”  The bar will be set very high, but it may be possible to overcome. The elements of compliance are here. There would, of course, be some prohibited residential choices, for example, an ICF-IID would not qualify as a “choice” as the program requires that services meet all the needs and the entire cost is borne by Medicaid.