Pennsylvania will transition its current Medicaid Home and Community Based Waiver (HCBS) services system to a system that delivers services in integrated settings.
In 2014 the Centers for Medicaid and Medicare (CMS) issued new regulations requiring states to comply with the integration mandates the Supreme Court articulated in Olmstead v. LLC. CMS administers the HCBS Waiver program that provides services for people with disabilities in the community as an alternative to institutionalization. The Public Interest Law Center has long fought to end institutionalization of people with disabilities.
CMS found that many HCBS waiver services are being provided in institution-like settings that limit participant’s access to the greater community. The 2014 Final Rule clarified states’ obligations to ensure services are provided in integrated settings that afford full access to the community, to the same extent as a person not receiving services. States must comply with the Final Rule by 2019.
CMS required each state to submit a plan on how it will transform its current service delivery system to new integrated models. These plans must first be published for public comment.
We are troubled that two years after the Final Rule, Pennsylvania still has not stated what it means to be an integrated setting. Accordingly, the Plan does not state any goals other than “compliance” with CMS rules. Pennsylvania has also represented to CMS that none of its regulations, policies or licensing requirements are in conflict with the integration mandates. Yet Pennsylvania requires many services, such as licensed day habitation and prevocational services, be provided in licensed settings that serve exclusively people with disabilities. Pennsylvania must articulate an integration standard, provide guidance on those standards, and create a plan to transition providers with facility-based programs to community-based services. There is a lot of work to do before 2019 and Pennsylvania has not even taken the first step.