I have been reading the Draft State Transition Plan which every state is required to
develop to ensure full compliance with the new Centers for Medicare & Medicaid
(CMS) Rules on Home & Community-Based Services (HCBS).

These new rules certainly emphasize person-centered systems that promote
employment, community inclusion, and individual choice that The Arc categorically
supports. Yet, it is hard for me to see how the underfunded community system that
here in Illinois promotes services in clusters is going to meet the intent of these rules.
These new rules will require substantial changes in the system within five years or
less. This is only magnified by the revenue crisis this state is now experiencing.

I am providing the following information as a reference for the new CMS Rules on
Community-Based Services to assist you in your public comment on the draft
Statewide Transition Plan
. Feel free to share this with other advocates.

I hope this guide proves to be helpful.

Regional Public Listening Forums & Webinar

The Arc is hosting a Listening Forum, 2:00 – 3:30 p.m., on Wednesday, February
4th, at 20901 S. LaGrange Road, Frankfort, IL, 60423. We are in the Old Plank
Trail Bank Building next to Mariano’s. The session is in the Community Room on
the lower level. HFS Staff will begin with a brief 15 minute overview of the new
CMS Rules.

Complete list of listening forums and information on the webinar for comment.

Submit Your Comments by email to HFS.SWTransitionPlan@illinois.gov
The Statewide Transition Plan

The Dept. of Health Care & Family Services has posted the draft of the Statewide
Transition Plan
for compliance with the New HCBS Medicaid Waiver Rules.


Statewide Plan Index

The Statewide Transition Plan is divided into seven sections:
Overview, page 1
Appendix A, The Plan to Affirm Compliance with Codes & Statutes, page 13
Appendix B, Residential Settings Report, page 42
Appendix C, Non-Residential Services Report, page 79
Appendix D, Public Notice & Forums, page 110
Appendix F, Flyer New Medicaid Rules, page 113
Appendix G, Action Steps & Timetable for Compliance, page 114

Waivers Covered in the Statewide Plan

Illinois Statewide Transition Plan applies to the following 1915(c) waivers currently
operating in Illinois that need to be in compliance:

1. Adults with Developmental Disabilities
2. Children and Young Adults with Developmental Disabilities
3. Medically Fragile/Technology Dependent Children
4. Persons who are Elderly
5. Persons with Brain Injury
6.  Persons with Disability
7  Persons with HIV/AIDS
8. Residential Services for Children and Young Adults with Developmental
9. Supportive Living Program

CMS Qualities of Home and Community-Based Settings

The final CMS rule describes and defines those qualities that HCBS settings must
have based on the needs of individual enrollees, as indicated in their person-
centered service plan. The rule provides additional flexibility for including other HCBS
setting qualities, as the HHS Secretary determines appropriate. The five HCBS setting
qualities outlined in the final rule are as follows:

1. Integrated Setting. The setting is integrated in and supports access to the greater
community, including opportunities to seek employment and work in competitive
integrated settings, engage in community life, control personal resources, and receive
services in the community, to the same degree of access as individuals not receiving
Medicaid HCBS.

2. Setting Choice. The setting must be selected by an individual from among setting
options, including non-disability specific settings, and an option for a private unit in a
residential setting.

3. Individual Rights. The setting must ensure an individual’s rights of privacy,
dignity and respect, and freedom from coercion and restraint.

4. Personal Independence. The setting optimizes individual initiative, autonomy,
and independence in making life choices, including but not limited to daily activities,
physical environment, and interpersonal interaction.

5. Service and Provider Choice. The setting facilitates individual choice of
services and supports, and who provides them.

Provider-Owned Residential Settings

The final CMS rule also describes additional requirements for provider-owned or
provider-controlled residential settings. These settings, such as a group home or an
assisted living facility, must have the above five HCBS setting qualities as well as
meet the following conditions:

Tenancy. The unit or dwelling is owned, rented, or occupied under a legally
enforceable agreement by the individual receiving services. Individuals have the
same responsibilities and protections from eviction as all tenants under landlord
tenant laws of the state, county, city, or other designated entity. If tenant laws do not
apply, the state must ensure that a lease, residency agreement, or other written
agreement is in place providing such protections to address eviction processes and
appeals comparable to those provided under the jurisdiction’s landlord tenant

Privacy. Individuals have privacy in their sleeping or living unit, which has
lockable entrance doors, with the individual and appropriate staff having keys to
doors as needed. Individuals have a choice of roommates when sharing a unit, and
the freedom to furnish and decorate sleeping or living units within the lease or other

Freedom. Individuals have freedom and support to control their own schedules
and activities, and have access to food at any time.

Visitation. Individuals may have visitors of their choosing at any time.
• Accessibility. The setting is physically accessible to the individual.

Helpful documents on the New CMS Rules

CMS Final Rule Medicaid Home & Community-Based Service – PowerPoint

Exploratory Questions to Assist States in assessment of Residential Home and
Community-Based Service (HCBS) Settings

Exploratory Questions to Assist States in Assessment of Non-Residential Home
and Community-Based Service (HCBS) Settings

The Arc’s Advocacy Guide on the New CMS Rules.

Tony Paulauski
Executive Director
The Arc of Illinois
20901 S. LaGrange Rd. Suite 209
Frankfort, IL 60423
815-464-1832 (OFFICE)
815-464-1832 (CELL)