All states must create a Statewide Transition Plan that outlines the process by which the state will ensure all settings where Medicaid-funded Home and Community-Based Services (HCBS) are being delivered fully meet the standards of the HCBS Settings rule. States are required to submit an Initial Statewide Transition Plan to CMS for review and approval, followed by the final plan. States are required to fully implement the final plan and bring all settings into compliance by March 17, 2023.
CMS will not provide Medicaid funding for any home and community-based service delivered in a setting that is not in full compliance by March 17, 2023.
What is at stake if Maine does not bring its HCBS system into compliance with the HCBS Settings Rule by March 17, 2023?
Medicaid programs are funded through a partnership between the state and federal governments. Federal funding makes up nearly two-thirds (63.8%) of the total funds used to operate the Home and Community-Based Services programs in Maine. This means that in state fiscal year 2019 for every $1 in funding, the federal government provided almost $0.64 while the state funded $0.36. Maine receives approximately $333,021,477 in federal funds to operate its HCBS programs, which serve over 6,500 individuals across the state.
All HCBS settings must meet full compliance with the HCBS Settings Rule by March 2023 to allow for continued funding. The HCBS Settings rule requires that members shall not experience a disruption in services as a result of settings that do not meet full compliance. In the event that some HCBS settings are deemed not to be in compliance with the HCBS Settings rule requirements, the state will lose the federal funding for each setting. This means that reimbursement rates for HCBS would need to be reduced by almost two-thirds (a 63.8% rate reduction) for non-compliant settings. Maine cannot afford this option. Therefore, Maine – like all states – must come into full compliance with the HCBS Settings Rule by March 2023.
Are other states recognizing their obligation to comply with the HCBS Settings Rule?
Yes. To date, 46 states have submitted an Initial Statewide Transition Plan and had these initial plans approved. To date, 18 states have submitted a final Statewide Transition Plan and had these plans approved. Some states have already completed their transition to compliance by fully implementing their approved Statewide Transition Plans.
What about Maine’s Statewide Transition Plan?
Maine must develop an Initial Statewide Transition Plan that describes the clear path that we will take to ensure our HCBS programs and settings are in full compliance by the March 2023 deadline. The plan must include a description of how we will engage with stakeholders, including how we will educate people receiving services, their family members, advocates, service providers, and partner systems (e.g. mental health, vocational rehabilitation) about the HCBS Settings Rule requirements, our transition plan, and our progress toward implementation.
The Initial Statewide Transition Plan will inform CMS about how Maine plans to ensure services are delivered in accordance with the HCBS Settings Rule. If Maine determines that policy changes (such as how people are supported to create their person-centered service plans, licensing requirements, and other MaineCare Benefits Manual changes) are needed to ensure full compliance with the HCBS Settings Rule, then the Initial Statewide Transition Plan must outline the steps Maine is taking to change specific policies.