Our mission at Evergreen Service Providers is to provide the Individuals we serve with dignity, stability, and growth in an environment that enables them to thrive both individually and as part of the community. Community and government agencies aid in fulfilling those objectives by providing guidelines, oversight or various services.
The Centers for Medicare & Medicaid Services (CMS) released a rule for Home and Community Based Services (HCBS) Settings that details federal requirements to ensure each Individual’s personal choice, freedoms and privacy and that their living situations meet certain standards. Organizations like Evergreen are in the process of implementing some changes to comply with this new rule which is built on two key provisions – a person-centered planning process and settings requirements.
Person-Centered Planning Process
The Person-Centered Planning (PCP) process emphasizes the Individual’s perspective in the service planning process and the opportunity for self-guidance, and identifies areas a service plan should address. A Person Centered Plan:
• Is driven by the Individual and includes the participation of others who are chosen by the individual
• Provides necessary information and support to the Individual to help them direct the process to the maximum extent possible
• Occurs at times and locations that are convenient for the individual
• Reflects cultural competency and uses plain language
• Includes strategies for resolving disagreements
• Offers the Individual choices regarding the services and support they can receive
• Provides a method to request plan updates
Home and Community Based Services (HCBS) Settings Requirements
The HCBS Settings Requirements were developed to ensure that Individuals have opportunities to be fully integrated into their communities, and to increase protections for Individuals wherever they receive HCBS services. In general, all HCBS settings must have the following characteristics:
• Integration with the Community: Settings must be integrated into the community and support “full access” for the Individual to their community. Settings that provide integration with the community provide individuals with opportunities to engage in community life and control personal resources.
• Choice: The Individual must be able to choose from various settings options, including non-disability specific settings. The opportunity is provided for Individuals to choose the setting from other options, including non-disability specific settings which reflect the Individual’s needs and preferences, provide policies to ensure informed choice for the Individual, and ensure the opportunity for the Individual to choose to combine more than one service delivery setting, or the type of HCBS service they receive in any given day or week.
• Rights: The Individual must have rights to privacy, dignity, respect and freedom from coercion and restraint. All information about the Individual is kept private. Staff interacts and communicates respectfully, and addresses the Individual in the same manner that they want to be addressed. Informed consent is granted prior to the use of restraints and/or restrictive interventions. The setting offers a secure place for the Individual to store personal belongings.
• Independence: Settings must encourage and provide the independence to optimize the opportunity for an Individual to make life choices and decisions including, but not limited to daily activities, physical environment, and with whom to interact; services and supports, and who provides them; services, provider, settings, and the opportunity to visit and understand the options.
The requirements for the PCP Process and HCBS Settings apply across all residential and non- residential HCBS settings. Following are key requirements that apply to residential settings, including those of our Host Home Providers:
• Privacy in their living/sleeping unit
• A choice of roommates
• Units with lockable entrance doors
• Freedom to furnish and decorate
• Freedom and support to control schedules and activities
• Access to food any time
• Freedom to have visitors at any time
• Physically accessible to the individual
• Modifications to these requirements are allowed when supported by a specific assessed need. Proper documentation is required as well as informed consent.
Evergreen is working with our Host Home Providers (HHPs) to ensure that the following specifications are in place in the home environment for each Individual and that Final Settings Rule standards are met.
• Individuals have a key to the home. Individuals should have access to their home environment and allowed to enter and exit at their will, unless otherwise indicated in their individual plan.
• Individuals have locks on their bedroom doors. Individuals should be able to lock their bedroom door and have privacy.
• Bathroom doors have locks. Bathroom locks provide individuals the ability, if they choose, to lock the door and have privacy.
• Residential Agreement. Each Individual living in an Evergreen host home will have a Residential Agreement between that Individual and the Host Home Provider that provides protections comparable to those in a lease agreement.
The Final Settings Rule exists essentially to ensure that home environments are community-based and not institutional in nature and that Evergreen’s services are person-centered. The Federal compliance deadline for implementation of these standards is March 2023. However, Colorado has chosen to implement the standards earlier with a statewide compliance date of March 2021.
Colorado is working directly with Program Approved Service Agencies (PASAs) like Evergreen to ensure that they comply well before the deadline. All PASAs which provide residential services are required to submit a Provider Transition Plan (PTP) for each Individual to whom services are provided that details the steps being taken to comply with the Settings Final Rule in each home. PTPs are reviewed by the state, which then provides feedback on any areas that need work. At this time, Evergreen is in compliance with all its PTPs!
We believe these changes will further empower the Individuals in our care to thrive, both individually and within the community. We embrace this opportunity to enhance our services and host homes for these very deserving Individuals.