The Oregon Caregiver Fall/Winter 2016

18 / 30

The Oregon Caregiver Fall/Winter 2016 18
Oregon Transitions to New CMS
Home & Community Based
Services (HCBS) Standards
By Linda Kirschbaum and Gwen Dayton, J.D., Oregon Health Care Association
Legal & Regulatory
In January 2014, the Centers for
Medicare and Medicaid Services (CMS)
adopted regulations that define settings
where it is permissible for states to cover
Medicaid Home and Community-Based
Services (HCBS). In Oregon, aging
service programs subject to the federal
regulations are: adult day programs,
adult foster homes, assisted living (ALF),
residential care (RCF), and ALF or RCF
memory care.
The purpose of these additional federal
standards is to ensure individuals
who receive HCBS are integrated into
and have full access to the greater
community. This includes opportunities
to work, if applicable, engage in
community life, control personal
resources, and receive services in the
community to the same degree as anyone
in society.
Oregon was required to submit a HCBS
Transition Plan to CMS. The Transition
Plan outlines how the Department of
Human Services and Oregon Health
Authority will align HCBS systems
with the new federal regulations. The
transition is not overly onerous for
Oregon due to the state's three decades
of experience in providing community
based services. However, the transition
plan is robust and includes five phases:
• Phase I – Initial Regulatory
Assessment
• Phase II – Statewide Training and
Education Efforts
• Phase III – Provider Self-Assessment
and Individual Experience
Assessment
• Phase IV – Heightened Scrutiny
Process
• Phase V – Remediation Activities
• Phase VI – Ongoing Compliance and
Oversight
As Oregon presses forward to meet plan
benchmarks, the rollout of the “Phase
IV – Heightened Scrutiny Process” is
still relatively vague for memory care
providers, and additional guidance
from CMS is anticipated to better
understand how to apply the process
to this specialized area of care. As we
know, quality memory care is a balance
of upholding federal and state resident
rights to person centered principles
such as dignity, respect, independence,
autonomy and choice while assuring
the health, safety and welfare of the
individual. We expect CMS to take this
view of memory care into consideration
as it begins to work out more details of
the Phase IV process.
In addition, the Center for Excellence
in Assisted Living (CEAL) has engaged
with CMS on two areas that needed
additional clarification for assisted
living and residential care providers:
setting location and secured assisted
living and residential care communities
designed to serve people with dementia,
both areas of which are related to
the concept of heightened scrutiny.
CEAL is a collaborative assisted living
organization with a focus on promoting
quality practice, public policy, technical
expertise, and research. The national
organization is comprised of eleven
organizations including AARP, the
Alzheimer’s Association, Assisted Living
Nurses Association, National Center for