The Centers for Medicare & Medicaid Services released some new rules on what constitutes Home and Community Based Services/Supports (HCBS) early this year. I was personally quite pleased about the progress the rules represented. You can get a decent overview via slides on the HCBS Final Rule on CMS’s website. They have a page on Medicaid and HCBS where you can get additional information about the rules and so forth, including the text of the rules themselves.
Each state has to develop a transition plan that shows how they are going to approach making their state’s service system fall in line with these rules. Right now Pennsylvania’s is in a comment period. There are likely better people to go into the details about PA’s transition plan– my basic feel for them was that it could definitely have been more extensive, and I was disappointed that the person centered aspects were pushed to a different transition plan for sometime in the future.
As part of the process for the transition plan involves public comment. The final public hearing session, in Harrisburg, is the afternoon of the publish date on this post. However, you can still submit comments until September 16th, 2014 via mail or email. (Details on how to submit a comment on this issue.)
To speak at the public hearings, you had to register that you wanted to submit comments. I registered and attended the Pittsburgh session. At the beginning, the staff running it went over the bare basics of what the rules were and said that they had moved the person centered aspects to a different plan because CMS had some stricter processes for that aspect of the rule. Which meant that the big points that I was interested in emphasizing, and many of the others were interested in addressing, were less on topic than we expected, because that point was not clear in the registration for the hearings. Each person was assigned 5 minutes to speak, and there was live transcription. Speakers were expected to also mail or email their comments.
I had decided to basically remind everyone about the Keeping the Promise paper (link below) and the fact that it heavily influenced CMS’s final rule, but to focus on an experience from the interview process that I felt would highlight some of the difficulties that need addressed in order to make sure this actually changes people’s lives and experience of community. You can read my comments below, with a couple of edits in square brackets to make it make more sense here. And don’t forget to submit comments of your own!
Hello, my name is Savannah Logsdon-Breakstone, and I’m an Autistic adult from Venango County. I wanted to remind you all about a paper called Keeping the Promise which informed the rules on HCBS that CMS released. This paper was based on interviews with a wide range of self advocates from around the country, including some from Pennsylvania, conducted by a team of primarily self advocates with the help of some allies.
I was a part of creating that paper as someone who conducted interviews and gave some input and I have to say when the rules came out I was pleasantly surprised- some of the recommendations we gave were not only followed, but some of the language lifted word by word. This was important, as the recommendations from that paper were ones that came from both the lived experiences and the dreams of self advocates thinking about what community living should look like for themselves.
My experience interviewing self advocates for this paper also highlighted something even beyond the paper itself for me though that I believe could contribute to addressing our state’s writing of and effective implementation of the new regulations. Specifically I want to give you a concrete example.
While I was interviewing people, I met an older woman with ID and some mobility issues. By most standards she was well supported, and her staff engaged about her access to community both on local and national levels. We had been given a fairly basic set of questions asking what community was and wasn’t and what those we were interviewing wanted in their lives, all in plain language. I sat down with this woman and her staff and was writing down her responses as she was unable to write them down herself, and she gave pretty straight forward responses, usually not terribly long and sometimes her staff would ask her to elaborate on something she said.
I don’t remember what question specifically it was, but at one point she said to me and to her staff that she wanted to live in an apartment with maybe one friend. The staff exclaimed that this was the first time she’d heard this, and when asked if she had been thinking about this for a long time, the woman said yes. She had been in the same group home, which was a little on the large side, for 20 years. For a decent chunk of that time, she wanted something else for her life, but no one had been asking the right questions of her in a way that was accessible to her and given her time to think and answer and be listened to.
Being there when she was able to express her wishes was an honor, but it had me thinking. This was a woman who by all outward observations was well supported to engage in self advocacy. And yet she had not been having her own planning team ask her in a way she could respond to and understand what she wanted in her life. And it was all very simple basics- nothing elaborate or super detailed or hard to do.
This experience illustrated to me and I hope illustrates to you that having a truly person centered, community based plan is about more than a check list and outside observations. It is about making sure our supports coordinators, our support staff, and our entire teams are truly coming in with the intent to make the person the one making the big decisions about what their life should look like, and following through by making sure their questions are asked accessibly and understood and a that the responses the person makes are truly listened to in whatever form they come. It might take extra time, but it is important.
I have printed out a copy of the Keeping the Promise paper for [the staff administering the and have emailed both my comments and the paper to the email provided for the purpose [the day of the hearing]. If anyone else wants to read the paper it can be found [on the Administration for community Living’s website as a PDF: Keeping the Promise].