Update for NHTD and TBI on HCBS Final Rule 

Situation Report | July 6, 2021

The state Department of Health (DOH) has issued guidance for providers of Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury (TBI) Medicaid waiver regarding the federal Home and Community-Based Services (HCBS) Final Rule.

To continue receiving federal Medicaid funding, waiver providers must ensure that settings:

  • Are integrated in and support full access to the greater community.
  • Are selected from among options by the individual.
  • Ensure rights of privacy, dignity, respect, and freedom from coercion and restraint.
  • Optimize an individual’s autonomy and independence in making life choices.
  • Facilitate an individual’s informed choice about their services and who provides them.
  • Are physically accessible to the individuals supported.
  • Provide freedom and support for individuals to control their own schedules and activities.
  • Provide individuals access to food (meals and/or snacks) and visitors at any time.

The last two standards are the only ones that are modifiable, under certain conditions.

In addition to the settings standards above, the federal HCBS rule also requires a person-centered planning process. This process must:

  • Provide necessary information and support to the individual to ensure that they can direct their planning process as much as possible.
  • Include people chosen by the individual.
  • Be timely and occur at least annually at times and locations of the individual’s convenience.
  • Assist the person in achieving outcomes they define for themselves, and in the most integrated community setting(s) they desire.
  • Ensure delivery of services in a manner that reflects personal preferences and choices.
  • Help promote the health and welfare of those receiving services.
  • Take into consideration the culture of the person served.
  • Use plain language.
  • Include strategies for solving disagreement(s).
  • Offer choices regarding the services and supports the person receives, and from whom.
  • Provide a method for the individual to request updates to their plan.
  • Indicate what entity or person will monitor the primary or main person-centered plan.
  • Identify individual’s strengths, preferences, needs (both clinical and support), and desired outcomes.

DOH is sponsoring the Person-Centered Planning Comprehensive System Transformation Statewide Training Initiative. The trainings, learning opportunities, and upcoming person-centered planning online toolkit are being offered at no cost. Participation can demonstrate efforts towards compliance.

Additional information regarding New York’s HCBS Rule Statewide Transition Plan can be found here.

For general questions, please email waivertransition@health.ny.gov.