In 2016, the Centers for Medicare and Medicaid Services implemented federal rules to ensure that people receiving services and supports through Medicaid Home and Community-Based Services programs are afforded full access to community living.
Ohio continues to work toward building a system that supports people who use waiver-funded home and community-based services to have opportunities to fully access community life through waiver settings in their community, expanded day service options, and assurance of privacy and rights at home.
Ohio's suitability of services and settings rule OAC 5123:2‐9‐02, outlines standards to ensure that waiver services maximize opportunities for people enrolled in a waiver to access the benefits of community living and receive services in the most integrated setting and in the least restrictive manner.
Five required characteristics of settings that offer waiver-funded services
Settings that offer waiver-funded services must meet five required primary characteristics outlined by the Centers for Medicare and Medicaid Services.
This applies to residential and non-residential settings, including facility-based employment and day programs.
1. The setting is integrated and supports the person accessing services to have full access to the greater community. This includes opportunities to
- Work in integrated settings
- Engage in community life
- Receive services in the community to the same degree of access as people not enrolled in waivers
2. The setting is selected by the person from among non-disability specific settings.
3. The setting ensures individual's rights of privacy, dignity and respect, and freedom from coercion.
4. The setting optimizes, but does not regiment, individual initiative, autonomy and independence in making life choices.
5. The setting facilitates individual choice regarding services and supports and who provides them.
These definitions are designed to be outcome-oriented and experiential. This means a determination about whether or not a setting meets these characteristics is based upon the needs of the people receiving services there, as reflected in their person-centered plans. It is not based upon the physical location of the setting, the size of the setting, or a prescribed duration or number of community-based activities.
Providers of waiver services
Providers must offer opportunities for everyone served to get involved in their community.
This may include community employment or participating in community-based events and activities.
Providers must offer opportunities that are meaningful
People accessing waiver services must have opportunities to chose the activities that they want to participate in. They must have opportunities that are age appropriate, meaningful to them, that support their personal interests and service plan outcomes.
Providers must provide necessary services and supervision
Because each person's health and welfare needs are different, the things that support health and welfare should be outlined in each person's service plan. Health and welfare needs must also be considered while a person is participating in community events and activities or employment.
Where waiver services will be provided
When providers are certified by DODD they attest that they will comply with the requirements of Medicaid, which include requirements for integration and inclusion.
Providers continue to follow the settings suitability rule OAC 5123:2-9-02 and keep their provider certification up to date for setting locations. Providers may need to make changes to their services to ensure full access to the community for the people they serve.
A new location or setting where waiver services will be provided, whether established by a new or existing provider agency, must meet the five required characteristics of settings that offer waiver services established by CMS, immediately as the new location opens.
A provider may not establish a new setting for waiver services in a public or private facility, including ICFs, nursing homes or hospitals, or on the grounds of or adjacent to a public facility.
Any new setting must immediately meet the HCBS community integration standards in rule. As county boards plan to privatize services, their plan must include steps to meet the HCBS community integration standards, both before and after privatization.
New provider agencies
New provider agencies who wish to offer adult day support or vocational habilitation services should work with their county board of developmental disabilities before establishing the location where waiver services will be provided. A county boards service and support administrator, or SSA will confirm that the setting is not located in a public or private facility nor located on the grounds of or adjacent to a public facility.
Once the location begins offering services, as part or regular monitoring an SSA will visit to identify any areas of concern that may indicate the service is not being provided in accordance with HCBS standards.
The SSA will look to see that people accessing services at the location
- are being offered meaningful experiences tailored to their interests and the outcomes of their individual service plan, and
- are given the opportunity to have experiences through community-based events and activities specific to their needs and desires.
The SSA will contact the department to request additional follow-up if they find cause for concern, which might include things like
- Day support or vocational habilitation are offered on a campus which includes a residential setting.
- A setting offers little to no variances in service options during the day.
- A setting offers limited to no options to receive services or activities outside the facility.
Existing providers or provider agencies
Once the new location begins serving people, a service and support coordinator from the county board of developmental disabilities will visit the setting as part of regular monitoring, to identify any areas of concern in meeting the five required characteristics of settings that offer waiver services.