Inside Medicaid HCBS for Autism, Part 2: The Settings Rule, with Melissa Harris, CMS

In Part 2 of our discussion with Melissa Harris, Deputy Director, Disabled and Elderly Health Programs Group, Centers for Medicare and Medicaid Services (CMS), we focus on the Home and Community Based Services (HCBS) Settings Rule. The Settings Rule has been the source of much discussion, debate and dread. We discuss the rules around person-centered plans, unfunded mandates, "settings that isolate," and heightened scrutiny in the states.
••• Please pardon the technical difficulties, Ms. Harris had some difficulties with her connection but in almost all cases the audio can be understood.

[@irenetanzman3976]

The most important takeaway is that the National Council on Severe Autism has reached out to CMS, and hopefully, they will be willing to listen further to the issues that the severe autism community faces. It's going to take a while for the folks in power to understand the terrible discrimination this population faces in accessing services, but at the very least, Jill has taken the first steps. Thanks for doing this.

[@angelabiesecker9489]

I live in PA and have spoken with Melissa and others with CMS for ten years regarding the disparity of HCBS services in private homes versus group homes. Families providing constant care in their private homes are criminally prosecuted by PA Attorneys General for timesheets and group homes get away with abuse neglect and death without criminal prosecution

[@angelabiesecker9489]

The disparity in how private homes (families caring for disabled) and group homes that receive close to 2,000$ a day per person is that group homes may be monitored or audited every 2-3 years and receive a slap on the hand for neglect of care but families in private homes are denied monitoring/ quality assurance instead are turned over to PA Attorneys General that criminally prosecutes timesheet errors without an independent investigation by adult protective services or any program violations under 1915c HCBS waiver. This disparity violates civil and due process rights. CMS has been informed since 2013 that PA violates all statutory requirements under 1915c waivers and has stayed silent.