Provider Update: April 28, 2017

HCBS Community Integration Plan

Pursuant to additional guidance from the Center for Medicare and Medicaid Services (CMS), the Medicaid Services Unit- Quality Assurance/Improvement department will enhance the Consumer-Focused Quality Care Review (C-FQCR) regarding evaluation of community integration for residential and non-residential settings.  This offers Home and Community Based (HCB) Settings providers (Adult Day Services and Assisted Living providers) to have input into an appropriate community integration plan for their network. Three key elements will be reviewed to determine if this requirement is met:

1. Provider Community Integration Plan
• This plan must be submitted for approval as outlined below.
2. Member's person-centered service plan must include community integration (e.g. the individual's strengths or limitations to community integration, goals, interests, etc.)
• The person-centered service plan must be available in the Member's chart.
• A plan of care can be used for this purpose, but must be forwarded to the Member's Case Manager for inclusion in the person-centered plan.
3. Member's chart must include documentation of participation or non-participation in accordance with the community integration plan as outlined in #2 above.

The Home and Community Based (HCB) Setting must integrate and support an individual's access to the greater community, and must offer opportunities for individuals to gain knowledge of or access to information regarding age, skill, and ability-appropriate activities outside of the HCB Setting.  These opportunities include, but are not limited to:  competitive work, shopping, attending religious services, medical appointments, dining out, etc. The HCB Setting must also identify the person(s) responsible for implementation of various aspects of the Community Integration Plan.

The Adult Day Health (ADH) and Assisted Living (AL) Providers must develop a Community Integration Plan and submit for approval by May 22, 2017, via SmarterMail at qaihcbs@aau.okdhs.org to remain on the Certified Agency Report. 

The following guidelines are to assist you in developing your Community Integration Plan:

The ADvantage ADH and AL must ensure individuals receiving services in the community have equal access as individuals not receiving Medicaid HCBS.  This includes, but is not limited to: 

• Informing the Member of opportunities & activities available in the greater community (such as shopping, attending religious and community services, recreational activities, employment opportunities, personal appointments, etc.)
• How will the Provider inform the Member?
• What types of opportunities and activities will the Member be informed of?
• Who is responsible for obtaining & distributing this information to the Member?
• How often will the information be provided to the Member?
• Informing the Member of opportunities & activities available at the HCBS (such as religious services, recreational activities, etc.)
• How will the Provider inform the Member?
• What types of opportunities and activities will the Member be informed of?
• Who is responsible for obtaining & distributing this information to the Member?
• How often will the information be provided to the Member?
• Facilitating & supporting activities for the Member to integrate into the community regularly & frequently.
• Who is responsible for planning & supporting these activities?
• What types of activities are offered?
• How often will these activities occur?
• What is the process for obtaining/providing/paying for transportation?
• What is the process for accepting or rejecting participation in activities?
• Documenting Member preferences of community integration in the person-centered plan. 
• Who is responsible for this documentation?
• Where is documentation found of each Member's access and decision to/not to attend?
• Documenting Member participation or non-participation in the Member's community integration preferences in the provider/Member chart. 
• Who is responsible for this documentation?
• Where will this documentation be maintained?

An example template is attached.  Feel free to use this to create the Community Integration Plan for your agency or create your own using this as a resource.

​If you have any questions regarding the information provided above, please feel free to contact us via SmarterMail at:  aauproviderquestion@aau.okdhs.org.