Centers for Medicare and Medicaid Services (CMS) Exploratory Questions The Department of Health Care Services (DHCS) and the California Department of Aging (CDA) have convened a series of Stakeholder meetings to develop a Home and Community-Based (HCB) Settings transition plan for the Community-Based Adult Services (CBAS) program, to be incorporated into California’s Statewide Transition Plan. Objective: To develop a transition plan for bringing CBAS centers into compliance with requirements of the HCB Settings rule as specified in California’s 1115 Bridge to Reform Demonstration Waiver, Special Terms and Conditions (STCs) Items 95 and 96. The CBAS stakeholder process will utilize the CMS Statewide Transition Plan Toolkit including the “Exploratory Questions to Assist States in Assessment of Non-Residential Home and Community-Based Service (HCBS) Settings” to guide the development of the CBAS Transition Plan. The following is a link to these documents: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By- Topics/Long-Term-Services-and-Supports/Home-and-Community-Based-Services/Home-and-Community-Based-Services.html

CBAS Waiver Requirements Specific to HCB Settings Rule

STC 95(c) Home and Community-Based Settings

The state must ensure that home and community-based settings have all of the qualities required by 42 CFR 441.301(c)(4), and other such qualities as the secretary determines to be appropriate based on the needs of the individual as indicated in their person-centered plan. In a provider owned or controlled setting, the additional qualities required by CFR 441.301(c)(4)(vi) must be met. The state will engage in a CBAS stakeholder process to amend the HCB settings statewide transition plan to ensure that all home and community-based settings found in the 1115 Demonstration have all of the qualities required by 42 CFR 441.301(c)(4). The state will amend the statewide transition plan to include all HCBS settings used by individuals in the 1115 Demonstration and submit to CMS no later than September 1, 2015, to ensure complete compliance with HCB Settings by March 17, 2019.

CBAS Waiver Requirements Specific to HCB Settings Rule

STC 96(c) Individual Plan of Care (IPC)

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The IPC is a written plan designed to provide the CBAS beneficiary with appropriate treatment in accordance with the assessed needs of the individual, as determined by the CBAS center and as specified in State law. The IPC is submitted as supporting documentation for level of service determination with the treatment authorization request.

The person-centered planning process will, with further development in the CBAS stakeholder process to be completed no later than September 1, 2015, comply with the requirements at 42 CFR 441.301(c)(1) through (3) including specifying: 1) How the plan will identify each enrollee’s preferences, choices and abilities and the strategies to address those preferences, choices and abilities; 2) How the plan will allow the enrollee to participate fully in any treatment or service planning discussion or meeting, including the opportunity to involve family, friends and professionals of the enrollee’s choosing; 3) How the plan will ensure that the enrollee has informed choices about treatment and service decisions; and 4) How the planning process will be collaborative, recurring and involve an ongoing commitment to the enrollee.

The IPC is prepared by the CBAS center’s multidisciplinary team based on the team’s assessment of the beneficiary’s medical, functional, and psychosocial status, and includes standardized components approved by the State Medicaid Agency. Development of the IPC is based on principles of Person-Centered Planning, which is an individualized and ongoing process to develop individualized care plans that focus on a person’s abilities and preferences for the delivery of services and supports. Person- Centered Planning includes consideration of the current and unique bio-psycho-social- cultural and medical needs and history of the individual, as well as the person’s functional level, support systems, and continuum of care needs. CBAS center staff, the beneficiary, and his/her support team shall review and update the beneficiary’s IPC at least every six months or when there is a change in circumstance that may require a change in benefits. Such review and updates must include an evaluation of progress toward treatment goals and objectives, and reflect changes in the beneficiary’s status or needs. The IPC shall include at a minimum:

i. Medical diagnoses. ii. Prescribed medications. iii. Scheduled days at the CBAS center. iv. Specific type, number of service units, and frequency of individual services to be rendered on a monthly basis.

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v. Elements of the services that` need to be linked to individual objectives, therapeutic goals, and duration of service(s). vi. An individualized activity plan designed to meet the needs of the enrollee for social and therapeutic recreational activities. vii. Participation in specific group activities. viii. Transportation needs, including special transportation ix. Special diet requirements, dietary counseling and education, if needed. x. A plan for any other necessary services that the CBAS center will coordinate. xi. IPCs will be reviewed and updated no less than every six months by the CBAS staff, the enrollee, and his/her support team. Such review must include a review of the participant’s progress, goals, and objectives, as well as the IPC itself.

Questions in CBAS Waiver STC 96(c) Specific to Individual Plan of Care (IPC) Comments/Questions

1. How the plan will identify each enrollee’s preferences, choices and abilities and the strategies to address those preferences, choices and abilities?

2. How the plan will allow the enrollee to participate fully in any treatment or service planning discussion or meeting, including the opportunity to involve family, friends and professionals of the enrollee’s choosing?

3. How the plan will ensure that the enrollee has informed choices about treatment and service decisions?

4. How the planning process will be collaborative, recurring and involve an ongoing commitment to the enrollee?

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Item # CMS EXPLORATORY QUESTIONS FOR NON-RESIDENTIAL SETTINGS 1 ACCESS TO GREATER COMMUNITY The setting is integrated in and supports full access of individuals receiving Medicaid HCBS 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. 42 CFR 441.301(c)(4)(i)/441.710(a)(1)(i)/441.530(a)(1)(i)

Answer the Yes/No/ Explain Comments/Questions following Not (Include Relevant Citations) questions for Applicable/ CBAS setting Unsure (Y/N/NA/?) 1a Does the Y Activities laws and regulations for Question must be considered in setting CBAS (WIC 14550 and 14550.5, context of CBAS setting. provide T-22 54309 and 54339) require opportunities daily activities that are planned, Participants are living in the for regular therapeutic, purposeful, and community, not at the center. meaningful designed to suit individual needs non-work and preferences, encourage self- IPC focuses on participants’ activities in care and resumption of normal needs. Need to consider staff integrated activities, and stimulate social ratios required to accomplish. community interaction. Current ratios in regulations don’t settings for support. period of time desired by the individual? 1b Does the Y Regulations require CBAS In answering this question the group setting afford providers and participants to enter made assumptions about what opportunities into a participation agreement “schedules” means. Specifically, for individual (WIC 14530(c) and T-22 54217). that it applies to the schedule of

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Item # CMS EXPLORATORY QUESTIONS FOR NON-RESIDENTIAL SETTINGS 1 ACCESS TO GREATER COMMUNITY The setting is integrated in and supports full access of individuals receiving Medicaid HCBS 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. 42 CFR 441.301(c)(4)(i)/441.710(a)(1)(i)/441.530(a)(1)(i)

Answer the Yes/No/ Explain Comments/Questions following Not (Include Relevant Citations) questions for Applicable/ CBAS setting Unsure (Y/N/NA/?) 1a Does the Y Activities laws and regulations for Question must be considered in setting CBAS (WIC 14550 and 14550.5, context of CBAS setting. provide T-22 54309 and 54339) require opportunities daily activities that are planned, Participants are living in the for regular therapeutic, purposeful, and community, not at the center. meaningful designed to suit individual needs non-work and preferences, encourage self- IPC focuses on participants’ activities in care and resumption of normal needs. Need to consider staff integrated activities, and stimulate social ratios required to accomplish. community interaction. Current ratios in regulations don’t settings for support. period of time desired by the individual? 1b Does the Y Regulations require CBAS In answering this question the group setting afford providers and participants to enter made assumptions about what opportunities into a participation agreement “schedules” means. Specifically, for individual (WIC 14530(c) and T-22 54217). that it applies to the schedule of

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Item # CMS EXPLORATORY QUESTIONS FOR NON-RESIDENTIAL SETTINGS 1 ACCESS TO GREATER COMMUNITY The setting is integrated in and supports full access of individuals receiving Medicaid HCBS 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. 42 CFR 441.301(c)(4)(i)/441.710(a)(1)(i)/441.530(a)(1)(i)

Answer the Yes/No/ Explain Comments/Questions following Not (Include Relevant Citations) questions for Applicable/ CBAS setting Unsure (Y/N/NA/?) 1a Does the Y Activities laws and regulations for Question must be considered in setting CBAS (WIC 14550 and 14550.5, context of CBAS setting. provide T-22 54309 and 54339) require opportunities daily activities that are planned, Participants are living in the for regular therapeutic, purposeful, and community, not at the center. meaningful designed to suit individual needs non-work and preferences, encourage self- IPC focuses on participants’ activities in care and resumption of normal needs. Need to consider staff integrated activities, and stimulate social ratios required to accomplish. community interaction. Current ratios in regulations don’t settings for support. period of time desired by the individual? 1b Does the Y Regulations require CBAS In answering this question the group setting afford providers and participants to enter made assumptions about what opportunities into a participation agreement “schedules” means. Specifically, for individual (WIC 14530(c) and T-22 54217). that it applies to the schedule of

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Item # CMS EXPLORATORY QUESTIONS FOR NON-RESIDENTIAL SETTINGS 1 ACCESS TO GREATER COMMUNITY The setting is integrated in and supports full access of individuals receiving Medicaid HCBS 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. 42 CFR 441.301(c)(4)(i)/441.710(a)(1)(i)/441.530(a)(1)(i)

Answer the Yes/No/ Explain Comments/Questions following Not (Include Relevant Citations) questions for Applicable/ CBAS setting Unsure (Y/N/NA/?) 1a Does the Y Activities laws and regulations for Question must be considered in setting CBAS (WIC 14550 and 14550.5, context of CBAS setting. provide T-22 54309 and 54339) require opportunities daily activities that are planned, Participants are living in the for regular therapeutic, purposeful, and community, not at the center. meaningful designed to suit individual needs non-work and preferences, encourage self- IPC focuses on participants’ activities in care and resumption of normal needs. Need to consider staff integrated activities, and stimulate social ratios required to accomplish. community interaction. Current ratios in regulations don’t settings for support. period of time desired by the individual? 1b Does the Y Regulations require CBAS In answering this question the group setting afford providers and participants to enter made assumptions about what opportunities into a participation agreement “schedules” means. Specifically, for individual (WIC 14530(c) and T-22 54217). that it applies to the schedule of

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Item # CMS EXPLORATORY QUESTIONS FOR NON-RESIDENTIAL SETTINGS 1 ACCESS TO GREATER COMMUNITY The setting is integrated in and supports full access of individuals receiving Medicaid HCBS 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. 42 CFR 441.301(c)(4)(i)/441.710(a)(1)(i)/441.530(a)(1)(i)

Answer the Yes/No/ Explain Comments/Questions following Not (Include Relevant Citations) questions for Applicable/ CBAS setting Unsure (Y/N/NA/?) 1a Does the Y Activities laws and regulations for Question must be considered in setting CBAS (WIC 14550 and 14550.5, context of CBAS setting. provide T-22 54309 and 54339) require opportunities daily activities that are planned, Participants are living in the for regular therapeutic, purposeful, and community, not at the center. meaningful designed to suit individual needs non-work and preferences, encourage self- IPC focuses on participants’ activities in care and resumption of normal needs. Need to consider staff integrated activities, and stimulate social ratios required to accomplish. community interaction. Current ratios in regulations don’t settings for support. period of time desired by the individual? 1b Does the Y Regulations require CBAS In answering this question the group setting afford providers and participants to enter made assumptions about what opportunities into a participation agreement “schedules” means. Specifically, for individual (WIC 14530(c) and T-22 54217). that it applies to the schedule of

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Item # CMS EXPLORATORY QUESTIONS FOR NON-RESIDENTIAL SETTINGS 1 ACCESS TO GREATER COMMUNITY The setting is integrated in and supports full access of individuals receiving Medicaid HCBS 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. 42 CFR 441.301(c)(4)(i)/441.710(a)(1)(i)/441.530(a)(1)(i)

Answer the Yes/No/ Explain Comments/Questions following Not (Include Relevant Citations) questions for Applicable/ CBAS setting Unsure (Y/N/NA/?) 1a Does the Y Activities laws and regulations for Question must be considered in setting CBAS (WIC 14550 and 14550.5, context of CBAS setting. provide T-22 54309 and 54339) require opportunities daily activities that are planned, Participants are living in the for regular therapeutic, purposeful, and community, not at the center. meaningful designed to suit individual needs non-work and preferences, encourage self- IPC focuses on participants’ activities in care and resumption of normal needs. Need to consider staff integrated activities, and stimulate social ratios required to accomplish. community interaction. Current ratios in regulations don’t settings for support. period of time desired by the individual? 1b Does the Y Regulations require CBAS In answering this question the group setting afford providers and participants to enter made assumptions about what opportunities into a participation agreement “schedules” means. Specifically, for individual (WIC 14530(c) and T-22 54217). that it applies to the schedule of

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Item # CMS EXPLORATORY QUESTIONS FOR NON-RESIDENTIAL SETTINGS 1 ACCESS TO GREATER COMMUNITY The setting is integrated in and supports full access of individuals receiving Medicaid HCBS 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. 42 CFR 441.301(c)(4)(i)/441.710(a)(1)(i)/441.530(a)(1)(i)

Answer the Yes/No/ Explain Comments/Questions following Not (Include Relevant Citations) questions for Applicable/ CBAS setting Unsure (Y/N/NA/?) 1a Does the Y Activities laws and regulations for Question must be considered in setting CBAS (WIC 14550 and 14550.5, context of CBAS setting. provide T-22 54309 and 54339) require opportunities daily activities that are planned, Participants are living in the for regular therapeutic, purposeful, and community, not at the center. meaningful designed to suit individual needs non-work and preferences, encourage self- IPC focuses on participants’ activities in care and resumption of normal needs. Need to consider staff integrated activities, and stimulate social ratios required to accomplish. community interaction. Current ratios in regulations don’t settings for support. period of time desired by the individual? 1b Does the Y Regulations require CBAS In answering this question the group setting afford providers and participants to enter made assumptions about what opportunities into a participation agreement “schedules” means. Specifically, for individual (WIC 14530(c) and T-22 54217). that it applies to the schedule of

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Item # CMS EXPLORATORY QUESTIONS FOR NON-RESIDENTIAL SETTINGS 1 ACCESS TO GREATER COMMUNITY The setting is integrated in and supports full access of individuals receiving Medicaid HCBS 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. 42 CFR 441.301(c)(4)(i)/441.710(a)(1)(i)/441.530(a)(1)(i)

Answer the Yes/No/ Explain Comments/Questions following Not (Include Relevant Citations) questions for Applicable/ CBAS setting Unsure (Y/N/NA/?) 1a Does the Y Activities laws and regulations for Question must be considered in setting CBAS (WIC 14550 and 14550.5, context of CBAS setting. provide T-22 54309 and 54339) require opportunities daily activities that are planned, Participants are living in the for regular therapeutic, purposeful, and community, not at the center. meaningful designed to suit individual needs non-work and preferences, encourage self- IPC focuses on participants’ activities in care and resumption of normal needs. Need to consider staff integrated activities, and stimulate social ratios required to accomplish. community interaction. Current ratios in regulations don’t settings for support. period of time desired by the individual? 1b Does the Y Regulations require CBAS In answering this question the group setting afford providers and participants to enter made assumptions about what opportunities into a participation agreement “schedules” means. Specifically, for individual (WIC 14530(c) and T-22 54217). that it applies to the schedule of

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Item # CMS EXPLORATORY QUESTIONS FOR NON-RESIDENTIAL SETTINGS 1 ACCESS TO GREATER COMMUNITY The setting is integrated in and supports full access of individuals receiving Medicaid HCBS 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. 42 CFR 441.301(c)(4)(i)/441.710(a)(1)(i)/441.530(a)(1)(i)

Answer the Yes/No/ Explain Comments/Questions following Not (Include Relevant Citations) questions for Applicable/ CBAS setting Unsure (Y/N/NA/?) 1a Does the Y Activities laws and regulations for Question must be considered in setting CBAS (WIC 14550 and 14550.5, context of CBAS setting. provide T-22 54309 and 54339) require opportunities daily activities that are planned, Participants are living in the for regular therapeutic, purposeful, and community, not at the center. meaningful designed to suit individual needs non-work and preferences, encourage self- IPC focuses on participants’ activities in care and resumption of normal needs. Need to consider staff integrated activities, and stimulate social ratios required to accomplish. community interaction. Current ratios in regulations don’t settings for support. period of time desired by the individual? 1b Does the Y Regulations require CBAS In answering this question the group setting afford providers and participants to enter made assumptions about what opportunities into a participation agreement “schedules” means. Specifically, for individual (WIC 14530(c) and T-22 54217). that it applies to the schedule of

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Item # CMS EXPLORATORY QUESTIONS FOR NON-RESIDENTIAL SETTINGS 1 ACCESS TO GREATER COMMUNITY The setting is integrated in and supports full access of individuals receiving Medicaid HCBS 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. 42 CFR 441.301(c)(4)(i)/441.710(a)(1)(i)/441.530(a)(1)(i)

Answer the Yes/No/ Explain Comments/Questions following Not (Include Relevant Citations) questions for Applicable/ CBAS setting Unsure (Y/N/NA/?) 1a Does the Y Activities laws and regulations for Question must be considered in setting CBAS (WIC 14550 and 14550.5, context of CBAS setting. provide T-22 54309 and 54339) require opportunities daily activities that are planned, Participants are living in the for regular therapeutic, purposeful, and community, not at the center. meaningful designed to suit individual needs non-work and preferences, encourage self- IPC focuses on participants’ activities in care and resumption of normal needs. Need to consider staff integrated activities, and stimulate social ratios required to accomplish. community interaction. Current ratios in regulations don’t settings for support. period of time desired by the individual? 1b Does the Y Regulations require CBAS In answering this question the group setting afford providers and participants to enter made assumptions about what opportunities into a participation agreement “schedules” means. Specifically, for individual (WIC 14530(c) and T-22 54217). that it applies to the schedule of

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Item # CMS EXPLORATORY QUESTIONS FOR NON-RESIDENTIAL SETTINGS 1 ACCESS TO GREATER COMMUNITY The setting is integrated in and supports full access of individuals receiving Medicaid HCBS 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. 42 CFR 441.301(c)(4)(i)/441.710(a)(1)(i)/441.530(a)(1)(i)

Answer the Yes/No/ Explain Comments/Questions following Not (Include Relevant Citations) questions for Applicable/ CBAS setting Unsure (Y/N/NA/?) 1a Does the Y Activities laws and regulations for Question must be considered in setting CBAS (WIC 14550 and 14550.5, context of CBAS setting. provide T-22 54309 and 54339) require opportunities daily activities that are planned, Participants are living in the for regular therapeutic, purposeful, and community, not at the center. meaningful designed to suit individual needs non-work and preferences, encourage self- IPC focuses on participants’ activities in care and resumption of normal needs. Need to consider staff integrated activities, and stimulate social ratios required to accomplish. community interaction. Current ratios in regulations don’t settings for support. period of time desired by the individual? 1b Does the Y Regulations require CBAS In answering this question the group setting afford providers and participants to enter made assumptions about what opportunities into a participation agreement “schedules” means. Specifically, for individual (WIC 14530(c) and T-22 54217). that it applies to the schedule of

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Item # CMS EXPLORATORY QUESTIONS FOR NON-RESIDENTIAL SETTINGS 1 ACCESS TO GREATER COMMUNITY The setting is integrated in and supports full access of individuals receiving Medicaid HCBS 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. 42 CFR 441.301(c)(4)(i)/441.710(a)(1)(i)/441.530(a)(1)(i)

Answer the Yes/No/ Explain Comments/Questions following Not (Include Relevant Citations) questions for Applicable/ CBAS setting Unsure (Y/N/NA/?) 1a Does the Y Activities laws and regulations for Question must be considered in setting CBAS (WIC 14550 and 14550.5, context of CBAS setting. provide T-22 54309 and 54339) require opportunities daily activities that are planned, Participants are living in the for regular therapeutic, purposeful, and community, not at the center. meaningful designed to suit individual needs non-work and preferences, encourage self- IPC focuses on participants’ activities in care and resumption of normal needs. Need to consider staff integrated activities, and stimulate social ratios required to accomplish. community interaction. Current ratios in regulations don’t settings for support. period of time desired by the individual? 1b Does the Y Regulations require CBAS In answering this question the group setting afford providers and participants to enter made assumptions about what opportunities into a participation agreement “schedules” means. Specifically, for individual (WIC 14530(c) and T-22 54217). that it applies to the schedule of

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Item # CMS EXPLORATORY QUESTIONS FOR NON-RESIDENTIAL SETTINGS 1 ACCESS TO GREATER COMMUNITY The setting is integrated in and supports full access of individuals receiving Medicaid HCBS 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. 42 CFR 441.301(c)(4)(i)/441.710(a)(1)(i)/441.530(a)(1)(i)

Answer the Yes/No/ Explain Comments/Questions following Not (Include Relevant Citations) questions for Applicable/ CBAS setting Unsure (Y/N/NA/?) 1a Does the Y Activities laws and regulations for Question must be considered in setting CBAS (WIC 14550 and 14550.5, context of CBAS setting. provide T-22 54309 and 54339) require opportunities daily activities that are planned, Participants are living in the for regular therapeutic, purposeful, and community, not at the center. meaningful designed to suit individual needs non-work and preferences, encourage self- IPC focuses on participants’ activities in care and resumption of normal needs. Need to consider staff integrated activities, and stimulate social ratios required to accomplish. community interaction. Current ratios in regulations don’t settings for support. period of time desired by the individual? 1b Does the Y Regulations require CBAS In answering this question the group setting afford providers and participants to enter made assumptions about what opportunities into a participation agreement “schedules” means. Specifically, for individual (WIC 14530(c) and T-22 54217). that it applies to the schedule of

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Item # CMS EXPLORATORY QUESTIONS FOR NON-RESIDENTIAL SETTINGS 1 ACCESS TO GREATER COMMUNITY The setting is integrated in and supports full access of individuals receiving Medicaid HCBS 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. 42 CFR 441.301(c)(4)(i)/441.710(a)(1)(i)/441.530(a)(1)(i)

Answer the Yes/No/ Explain Comments/Questions following Not (Include Relevant Citations) questions for Applicable/ CBAS setting Unsure (Y/N/NA/?) 1a Does the Y Activities laws and regulations for Question must be considered in setting CBAS (WIC 14550 and 14550.5, context of CBAS setting. provide T-22 54309 and 54339) require opportunities daily activities that are planned, Participants are living in the for regular therapeutic, purposeful, and community, not at the center. meaningful designed to suit individual needs non-work and preferences, encourage self- IPC focuses on participants’ activities in care and resumption of normal needs. Need to consider staff integrated activities, and stimulate social ratios required to accomplish. community interaction. Current ratios in regulations don’t settings for support. period of time desired by the individual? 1b Does the Y Regulations require CBAS In answering this question the group setting afford providers and participants to enter made assumptions about what opportunities into a participation agreement “schedules” means. Specifically, for individual (WIC 14530(c) and T-22 54217). that it applies to the schedule of

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Item # CMS EXPLORATORY QUESTIONS FOR NON-RESIDENTIAL SETTINGS 1 ACCESS TO GREATER COMMUNITY The setting is integrated in and supports full access of individuals receiving Medicaid HCBS 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. 42 CFR 441.301(c)(4)(i)/441.710(a)(1)(i)/441.530(a)(1)(i)

Answer the Yes/No/ Explain Comments/Questions following Not (Include Relevant Citations) questions for Applicable/ CBAS setting Unsure (Y/N/NA/?) 1a Does the Y Activities laws and regulations for Question must be considered in setting CBAS (WIC 14550 and 14550.5, context of CBAS setting. provide T-22 54309 and 54339) require opportunities daily activities that are planned, Participants are living in the for regular therapeutic, purposeful, and community, not at the center. meaningful designed to suit individual needs non-work and preferences, encourage self- IPC focuses on participants’ activities in care and resumption of normal needs. Need to consider staff integrated activities, and stimulate social ratios required to accomplish. community interaction. Current ratios in regulations don’t settings for support. period of time desired by the individual? 1b Does the Y Regulations require CBAS In answering this question the group setting afford providers and participants to enter made assumptions about what opportunities into a participation agreement “schedules” means. Specifically, for individual (WIC 14530(c) and T-22 54217). that it applies to the schedule of

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Item # CMS EXPLORATORY QUESTIONS FOR NON-RESIDENTIAL SETTINGS

3 RIGHT TO PRIVACY, DIGNITY, RESPECT, FREEDOM FROM COERCION AND RESTRAINT The setting ensures an individual’s rights of privacy, dignity, and respect, and freedom from coercion and restraint. 42 CFR 441.301(c)(4)(iii)/ 441.710(a)(1)(iii)/441.530(a)(1)(iii)

Answer the following questions Yes/No/ Explain Comments/Questions for CBAS setting Not Applicable/Unsure (Include (Y/N/NA/?) Relevant Citations)

3a Is all information about Y Regulations Participant rights, confidentiality, individuals kept private? For specify that and privacy are supported by instance, do paid staff/providers CBAS CBAS program regulations and the follow confidentiality participants Health Insurance Portability and policy/practices and does staff have the right Accountability Act (HIPAA). within the setting ensure that, for to dignity and example, there are no posted privacy in Some centers utilize methods for schedules of individuals for PT, treatment and identifying participant status and OT, medications, restricted diet, to be insured needs on name tags, which is a etc., in a general open area? of the subject for further discussion to confidentiality ensure that the practice does not of treatment violate privacy. and providers must protect private information from unauthorized

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Item # CMS EXPLORATORY QUESTIONS FOR NON-RESIDENTIAL SETTINGS

3 RIGHT TO PRIVACY, DIGNITY, RESPECT, FREEDOM FROM COERCION AND RESTRAINT The setting ensures an individual’s rights of privacy, dignity, and respect, and freedom from coercion and restraint. 42 CFR 441.301(c)(4)(iii)/ 441.710(a)(1)(iii)/441.530(a)(1)(iii)

Answer the following questions Yes/No/ Explain Comments/Questions for CBAS setting Not Applicable/Unsure (Include (Y/N/NA/?) Relevant Citations)

disclosure (T- 22 78437, 54439).

CBAS providers are covered entities under HIPAA so must comply with HIPAA privacy rules. 3b Does the setting support Y Regulations Assistance with personal care is individuals who need assistance specify that based on ADL and IADL with their personal appearance to the core functional levels and is supported appear as they desire, and is multidisciplin by regulation. Respect of personal assistance provided in ary team (RN, participant’s preferences is central. private, as appropriate? Social

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Item # CMS EXPLORATORY QUESTIONS FOR NON-RESIDENTIAL SETTINGS

3 RIGHT TO PRIVACY, DIGNITY, RESPECT, FREEDOM FROM COERCION AND RESTRAINT The setting ensures an individual’s rights of privacy, dignity, and respect, and freedom from coercion and restraint. 42 CFR 441.301(c)(4)(iii)/ 441.710(a)(1)(iii)/441.530(a)(1)(iii)

Answer the following questions Yes/No/ Explain Comments/Questions for CBAS setting Not Applicable/Unsure (Include (Y/N/NA/?) Relevant Citations)

Worker, Activity Coordinator, Physical and Occupational Therapists) assess CBAS participants’ medical, functional, and psychosocial status and develop an individualized plan of care designed to meet those

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Item # CMS EXPLORATORY QUESTIONS FOR NON-RESIDENTIAL SETTINGS

3 RIGHT TO PRIVACY, DIGNITY, RESPECT, FREEDOM FROM COERCION AND RESTRAINT The setting ensures an individual’s rights of privacy, dignity, and respect, and freedom from coercion and restraint. 42 CFR 441.301(c)(4)(iii)/ 441.710(a)(1)(iii)/441.530(a)(1)(iii)

Answer the following questions Yes/No/ Explain Comments/Questions for CBAS setting Not Applicable/Unsure (Include (Y/N/NA/?) Relevant Citations)

needs (T-22 54211(b)(1) (2))

3c Does the setting assure that staff Y Regulations Regulations support, and increased interacts and communicates with specify that emphasis on training can reinforce. individuals respectfully and in a CBAS manner in which the person participants would like to be addressed, while have the right providing assistance during the to dignity and regular course of daily activities? humane treatment (T- 22 78437).

3d Do setting requirements assure Y Regulations Regulations support, HIPAA that staff does not talk to other specify that requires, and increased emphasis staff about an individual(s) in the CBAS on training can reinforce.

CBAS HCB Settings Stakeholder Process 2015 Page 24 of 51

Item # CMS EXPLORATORY QUESTIONS FOR NON-RESIDENTIAL SETTINGS

3 RIGHT TO PRIVACY, DIGNITY, RESPECT, FREEDOM FROM COERCION AND RESTRAINT The setting ensures an individual’s rights of privacy, dignity, and respect, and freedom from coercion and restraint. 42 CFR 441.301(c)(4)(iii)/ 441.710(a)(1)(iii)/441.530(a)(1)(iii)

Answer the following questions Yes/No/ Explain Comments/Questions for CBAS setting Not Applicable/Unsure (Include (Y/N/NA/?) Relevant Citations)

presence of other persons or in participants the presence of the individual as have the right if s/he were not present? to dignity and privacy in treatment and to be insured of the confidentiality of treatment and providers must protect private information from unauthorized disclosure (T- 22 78437, 54439).

CBAS HCB Settings Stakeholder Process 2015 Page 25 of 51

Item # CMS EXPLORATORY QUESTIONS FOR NON-RESIDENTIAL SETTINGS

3 RIGHT TO PRIVACY, DIGNITY, RESPECT, FREEDOM FROM COERCION AND RESTRAINT The setting ensures an individual’s rights of privacy, dignity, and respect, and freedom from coercion and restraint. 42 CFR 441.301(c)(4)(iii)/ 441.710(a)(1)(iii)/441.530(a)(1)(iii)

Answer the following questions Yes/No/ Explain Comments/Questions for CBAS setting Not Applicable/Unsure (Include (Y/N/NA/?) Relevant Citations)

3e Does the setting policy require Y 54217 – Use of restraints other than for that the individual and/or Participation postural supports is rare in the representative grant informed Agreement – CBAS setting. Postural support consent prior to the use of participant requires MD certification. restraints and/or restrictive gives consent interventions and document these for services The emphasis in CBAS is on interventions in the person- redirection and individualized centered plan? 78315 – programming to address Nursing participant needs and mitigate Services – problems such as agitation, self- Restraints harm, wandering, disruptive Soft restraints behaviors, etc. may be used only under the following circumstances:  Treat

CBAS HCB Settings Stakeholder Process 2015 Page 26 of 51

Item # CMS EXPLORATORY QUESTIONS FOR NON-RESIDENTIAL SETTINGS

3 RIGHT TO PRIVACY, DIGNITY, RESPECT, FREEDOM FROM COERCION AND RESTRAINT The setting ensures an individual’s rights of privacy, dignity, and respect, and freedom from coercion and restraint. 42 CFR 441.301(c)(4)(iii)/ 441.710(a)(1)(iii)/441.530(a)(1)(iii)

Answer the following questions Yes/No/ Explain Comments/Questions for CBAS setting Not Applicable/Unsure (Include (Y/N/NA/?) Relevant Citations)

ment restrai nts for protec tion during treatm ent and diagn ostic proce dures.  Suppo rtive restrai nts for positio

CBAS HCB Settings Stakeholder Process 2015 Page 27 of 51

Item # CMS EXPLORATORY QUESTIONS FOR NON-RESIDENTIAL SETTINGS

3 RIGHT TO PRIVACY, DIGNITY, RESPECT, FREEDOM FROM COERCION AND RESTRAINT The setting ensures an individual’s rights of privacy, dignity, and respect, and freedom from coercion and restraint. 42 CFR 441.301(c)(4)(iii)/ 441.710(a)(1)(iii)/441.530(a)(1)(iii)

Answer the following questions Yes/No/ Explain Comments/Questions for CBAS setting Not Applicable/Unsure (Include (Y/N/NA/?) Relevant Citations)

ning

3f Does the setting policy ensure Y Regulations Individual plans of care need to be that each individual’s supports specify that specific to address individual and plans to address behavioral the core needs. Centers vary with the needs are specific to the multidisciplin quality of the IPC’s they develop individual and not the same as ary team (RN, and the individualized everyone else in the setting Social programming they offer. There’s a and/or restrictive to the rights of Worker, need for provider training in this every individual receiving Activity area. support within the setting? Coordinator, Physical and The IPC needs to identify the Occupational behavioral approach specific to the Therapists) individual with behavioral assess CBAS problems. participants’ medical,

CBAS HCB Settings Stakeholder Process 2015 Page 28 of 51

Item # CMS EXPLORATORY QUESTIONS FOR NON-RESIDENTIAL SETTINGS

3 RIGHT TO PRIVACY, DIGNITY, RESPECT, FREEDOM FROM COERCION AND RESTRAINT The setting ensures an individual’s rights of privacy, dignity, and respect, and freedom from coercion and restraint. 42 CFR 441.301(c)(4)(iii)/ 441.710(a)(1)(iii)/441.530(a)(1)(iii)

Answer the following questions Yes/No/ Explain Comments/Questions for CBAS setting Not Applicable/Unsure (Include (Y/N/NA/?) Relevant Citations)

functional, and psychosocial status and develop an individualized plan of care designed to meet those needs (T-22 54211(b)(1) (2)).

CBAS HCB Settings Stakeholder Process 2015 Page 29 of 51

Item CMS EXPLORATORY QUESTIONS FOR NON-RESIDENTIAL SETTINGS # 4 INDIVIDUAL INITIATIVE, AUTONOMY, INDEPENDENCE IN LIFE CHOICES The setting optimizes, but does not regiment, individual initiative, autonomy, and independence in making life choices including but not limited to daily activities, physical environment, and with whom to interact. 42 CFR 441.301(c)(4) (iv)/ 441.710(a)(1)(iv)/441.530(a)(1)(iv)

Answer the following questions Yes/No/ Explain Comments/Questions for CBAS setting Not Applicable/ (Include Unsure Relevant (Y/N/NA/?) Citations)

4a Are there gates, Velcro strips, Y Adult Day Based on the needs of the locked doors, fences or other Health Care population served in CBAS, barriers preventing individuals’ (ADHC) including individuals with dementia entrance to or exit from certain licensing law who need protective supervision, areas of the setting? allows use of securing of perimeters may be perimeter appropriate and necessary. fences and egress control Some centers utilize delayed egress devices when and outside fences and gates. Low centers serve fences are utilized to reduce individuals institutional appearance. with Alzheimer’s Any securing of perimeters must be Disease and done in compliance with state law dementia. and with the approval of the state These fire marshal and California provisions, Department of Public Health. under Health

CBAS HCB Settings Stakeholder Process 2015 Page 30 of 51

Item CMS EXPLORATORY QUESTIONS FOR NON-RESIDENTIAL SETTINGS # 4 INDIVIDUAL INITIATIVE, AUTONOMY, INDEPENDENCE IN LIFE CHOICES The setting optimizes, but does not regiment, individual initiative, autonomy, and independence in making life choices including but not limited to daily activities, physical environment, and with whom to interact. 42 CFR 441.301(c)(4) (iv)/ 441.710(a)(1)(iv)/441.530(a)(1)(iv)

Answer the following questions Yes/No/ Explain Comments/Questions for CBAS setting Not Applicable/ (Include Unsure Relevant (Y/N/NA/?) Citations)

and Safety Question: Can we have access Code, codes to prevent participants with Section 1584, dementia who are mixed with specify participants without dementia from requirements going out and wandering, and are centers must we allowed to have locked gates meet to use which open up to car passages? fences and devices, including obtaining participant consent, protecting participant rights, conducting emergency

CBAS HCB Settings Stakeholder Process 2015 Page 31 of 51

Item CMS EXPLORATORY QUESTIONS FOR NON-RESIDENTIAL SETTINGS # 4 INDIVIDUAL INITIATIVE, AUTONOMY, INDEPENDENCE IN LIFE CHOICES The setting optimizes, but does not regiment, individual initiative, autonomy, and independence in making life choices including but not limited to daily activities, physical environment, and with whom to interact. 42 CFR 441.301(c)(4) (iv)/ 441.710(a)(1)(iv)/441.530(a)(1)(iv)

Answer the following questions Yes/No/ Explain Comments/Questions for CBAS setting Not Applicable/ (Include Unsure Relevant (Y/N/NA/?) Citations)

evacuation drills, and training staff regarding the use and operation of egress control devices. Also, the law specifies that egress control devices and fences shall not be used as a substitute for adequate staff.

CBAS HCB Settings Stakeholder Process 2015 Page 32 of 51

Item CMS EXPLORATORY QUESTIONS FOR NON-RESIDENTIAL SETTINGS # 4 INDIVIDUAL INITIATIVE, AUTONOMY, INDEPENDENCE IN LIFE CHOICES The setting optimizes, but does not regiment, individual initiative, autonomy, and independence in making life choices including but not limited to daily activities, physical environment, and with whom to interact. 42 CFR 441.301(c)(4) (iv)/ 441.710(a)(1)(iv)/441.530(a)(1)(iv)

Answer the following questions Yes/No/ Explain Comments/Questions for CBAS setting Not Applicable/ (Include Unsure Relevant (Y/N/NA/?) Citations)

4b Does the setting afford a variety Y Activities Regulations support and training of meaningful non-work laws and can reinforce. activities that are responsive to regulations the goals, interests and needs of for CBAS Question: What is the definition of individuals? Does the physical (WIC 14550 non-work activities? environment support a variety of and 14550.5, individual goals and needs (for T-22 54309, These specific needs are not example, does the setting provide 54339, and addressed on the IPC. Some centers indoor and outdoor gathering 78431) do this well, others struggle. spaces; does the setting provide require daily for larger group activities as well activities that as solitary activities; does the are planned, setting provide for stimulating as therapeutic, well as calming activities)? purposeful, and designed to suit individual needs and

CBAS HCB Settings Stakeholder Process 2015 Page 33 of 51

Item CMS EXPLORATORY QUESTIONS FOR NON-RESIDENTIAL SETTINGS # 4 INDIVIDUAL INITIATIVE, AUTONOMY, INDEPENDENCE IN LIFE CHOICES The setting optimizes, but does not regiment, individual initiative, autonomy, and independence in making life choices including but not limited to daily activities, physical environment, and with whom to interact. 42 CFR 441.301(c)(4) (iv)/ 441.710(a)(1)(iv)/441.530(a)(1)(iv)

Answer the following questions Yes/No/ Explain Comments/Questions for CBAS setting Not Applicable/ (Include Unsure Relevant (Y/N/NA/?) Citations)

preferences, encourage self-care and resumption of normal activities, and stimulate social interaction. Additionally, the regulations specify that centers may provide activities in the community

CBAS HCB Settings Stakeholder Process 2015 Page 34 of 51

Item CMS EXPLORATORY QUESTIONS FOR NON-RESIDENTIAL SETTINGS # 4 INDIVIDUAL INITIATIVE, AUTONOMY, INDEPENDENCE IN LIFE CHOICES The setting optimizes, but does not regiment, individual initiative, autonomy, and independence in making life choices including but not limited to daily activities, physical environment, and with whom to interact. 42 CFR 441.301(c)(4) (iv)/ 441.710(a)(1)(iv)/441.530(a)(1)(iv)

Answer the following questions Yes/No/ Explain Comments/Questions for CBAS setting Not Applicable/ (Include Unsure Relevant (Y/N/NA/?) Citations)

as indicated by participants’ needs and interests.

Facility regulations specify that space shall be available to accommodate both indoor and outdoor activities. 4c Does the setting afford Y Activities High risk participants may need opportunities for individuals to laws and different accommodations. Some choose with whom to do regulations centers utilize a “home table” where

CBAS HCB Settings Stakeholder Process 2015 Page 35 of 51

Item CMS EXPLORATORY QUESTIONS FOR NON-RESIDENTIAL SETTINGS # 4 INDIVIDUAL INITIATIVE, AUTONOMY, INDEPENDENCE IN LIFE CHOICES The setting optimizes, but does not regiment, individual initiative, autonomy, and independence in making life choices including but not limited to daily activities, physical environment, and with whom to interact. 42 CFR 441.301(c)(4) (iv)/ 441.710(a)(1)(iv)/441.530(a)(1)(iv)

Answer the following questions Yes/No/ Explain Comments/Questions for CBAS setting Not Applicable/ (Include Unsure Relevant (Y/N/NA/?) Citations)

activities in the setting or outside for CBAS participants are grouped according the setting or are individuals (WIC 14550 to needs, but they may choose to assigned only to be with a certain and 14550.5, move around and are not limited to group of people? T-22 54309, staying in one place. and 54339) require daily Individuals with a special diet activities that requiring supervision may sit are planned, together at lunch so that staff can therapeutic, assist. purposeful, and designed to suit individual needs and preferences, encourage self-care and resumption of

CBAS HCB Settings Stakeholder Process 2015 Page 36 of 51

Item CMS EXPLORATORY QUESTIONS FOR NON-RESIDENTIAL SETTINGS # 4 INDIVIDUAL INITIATIVE, AUTONOMY, INDEPENDENCE IN LIFE CHOICES The setting optimizes, but does not regiment, individual initiative, autonomy, and independence in making life choices including but not limited to daily activities, physical environment, and with whom to interact. 42 CFR 441.301(c)(4) (iv)/ 441.710(a)(1)(iv)/441.530(a)(1)(iv)

Answer the following questions Yes/No/ Explain Comments/Questions for CBAS setting Not Applicable/ (Include Unsure Relevant (Y/N/NA/?) Citations)

normal activities, and stimulate social interaction. 4d 1) Does the setting allow for NA One meal and between meal snacks individuals to have a meal/ are required in CBAS regulations. snacks at the time and The nutritional content of the daily place of their choosing? meal as well as requirements for the For instance, does the meal to meet individual cultural and setting afford individuals taste preferences and special dietary full access to a dining area needs based on medical conditions with comfortable seating are specified in regulation. But and opportunity to access to food as described in this converse with others question is not applicable in a day during break or meal program setting. times, afford dignity to the Some centers have meals delivered

CBAS HCB Settings Stakeholder Process 2015 Page 37 of 51

Item CMS EXPLORATORY QUESTIONS FOR NON-RESIDENTIAL SETTINGS # 4 INDIVIDUAL INITIATIVE, AUTONOMY, INDEPENDENCE IN LIFE CHOICES The setting optimizes, but does not regiment, individual initiative, autonomy, and independence in making life choices including but not limited to daily activities, physical environment, and with whom to interact. 42 CFR 441.301(c)(4) (iv)/ 441.710(a)(1)(iv)/441.530(a)(1)(iv)

Answer the following questions Yes/No/ Explain Comments/Questions for CBAS setting Not Applicable/ (Include Unsure Relevant (Y/N/NA/?) Citations)

diners (i.e., individuals are which makes it difficult to treated age-appropriately accommodate personal preferences and not required to wear other than what is medically bibs)? required.

2) Does the setting provide NA for an alternative meal and/or private dining if requested by the individual? 3) Do individuals’ have NA access to food at any time consistent with individuals in similar and/or the same

CBAS HCB Settings Stakeholder Process 2015 Page 38 of 51

Item CMS EXPLORATORY QUESTIONS FOR NON-RESIDENTIAL SETTINGS # 4 INDIVIDUAL INITIATIVE, AUTONOMY, INDEPENDENCE IN LIFE CHOICES The setting optimizes, but does not regiment, individual initiative, autonomy, and independence in making life choices including but not limited to daily activities, physical environment, and with whom to interact. 42 CFR 441.301(c)(4) (iv)/ 441.710(a)(1)(iv)/441.530(a)(1)(iv)

Answer the following questions Yes/No/ Explain Comments/Questions for CBAS setting Not Applicable/ (Include Unsure Relevant (Y/N/NA/?) Citations)

setting who are not receiving Medicaid-funded services and supports?

4e Does the setting post or provide Y Regulations In-service training is provided on information on individual rights? require participants’ rights. CBAS centers to inform participants of their rights and post in a prominent place in the center a list of participant rights in English and

CBAS HCB Settings Stakeholder Process 2015 Page 39 of 51

Item CMS EXPLORATORY QUESTIONS FOR NON-RESIDENTIAL SETTINGS # 4 INDIVIDUAL INITIATIVE, AUTONOMY, INDEPENDENCE IN LIFE CHOICES The setting optimizes, but does not regiment, individual initiative, autonomy, and independence in making life choices including but not limited to daily activities, physical environment, and with whom to interact. 42 CFR 441.301(c)(4) (iv)/ 441.710(a)(1)(iv)/441.530(a)(1)(iv)

Answer the following questions Yes/No/ Explain Comments/Questions for CBAS setting Not Applicable/ (Include Unsure Relevant (Y/N/NA/?) Citations)

any other predominant language (T- 22 78437(a) (5) and 78437(b)). 4f Does the setting prohibit ? ADHC Question doesn’t apply well to the individuals from engaging in regulations CBAS setting. To some degree legal activities (ex. voting when are silent activities are limited by virtue of the 18 or older, consuming alcohol regarding fact that it’s a day setting, not when 21 or older) in a manner smoking. residential. Also, some restrictions different from individuals in apply for the protection of similar and/or the same setting participants. Smoking is an example who are not receiving Medicaid of a legal activity that may be funded services and supports? restricted in CBAS, which is a licensed health facility. While smoking is never allowed in the facility, CBAS providers have

CBAS HCB Settings Stakeholder Process 2015 Page 40 of 51

Item CMS EXPLORATORY QUESTIONS FOR NON-RESIDENTIAL SETTINGS # 4 INDIVIDUAL INITIATIVE, AUTONOMY, INDEPENDENCE IN LIFE CHOICES The setting optimizes, but does not regiment, individual initiative, autonomy, and independence in making life choices including but not limited to daily activities, physical environment, and with whom to interact. 42 CFR 441.301(c)(4) (iv)/ 441.710(a)(1)(iv)/441.530(a)(1)(iv)

Answer the following questions Yes/No/ Explain Comments/Questions for CBAS setting Not Applicable/ (Include Unsure Relevant (Y/N/NA/?) Citations)

discretion regarding smoking outdoors on their grounds and may choose to operate as a non-smoking facility. CBAS participants may choose whether to attend a non- smoking CBAS center or not.

Some centers permit smoking and provide an outdoor space for smoking with supervision.

Some centers that do not have an outdoor space for smoking may decide to restrict smoking.

Many participants with behavioral health issues use smoking as a coping method. Prohibiting

CBAS HCB Settings Stakeholder Process 2015 Page 41 of 51

Item CMS EXPLORATORY QUESTIONS FOR NON-RESIDENTIAL SETTINGS # 4 INDIVIDUAL INITIATIVE, AUTONOMY, INDEPENDENCE IN LIFE CHOICES The setting optimizes, but does not regiment, individual initiative, autonomy, and independence in making life choices including but not limited to daily activities, physical environment, and with whom to interact. 42 CFR 441.301(c)(4) (iv)/ 441.710(a)(1)(iv)/441.530(a)(1)(iv)

Answer the following questions Yes/No/ Explain Comments/Questions for CBAS setting Not Applicable/ (Include Unsure Relevant (Y/N/NA/?) Citations)

smoking could result in increased agitation.

4g Does the setting afford the Y Regulations There are challenges in the CBAS opportunity for tasks and specify that setting providing services to activities matched to individuals’ the core individuals with varying functional skills, abilities and desires? multidisciplin and cognitive levels and even for ary team different genders. Providing (RN, Social activities for men can sometimes be Worker, a challenge. Activity Coordinator, Physical and Occupational Therapists) assess CBAS participants’ medical,

CBAS HCB Settings Stakeholder Process 2015 Page 42 of 51

Item CMS EXPLORATORY QUESTIONS FOR NON-RESIDENTIAL SETTINGS # 4 INDIVIDUAL INITIATIVE, AUTONOMY, INDEPENDENCE IN LIFE CHOICES The setting optimizes, but does not regiment, individual initiative, autonomy, and independence in making life choices including but not limited to daily activities, physical environment, and with whom to interact. 42 CFR 441.301(c)(4) (iv)/ 441.710(a)(1)(iv)/441.530(a)(1)(iv)

Answer the following questions Yes/No/ Explain Comments/Questions for CBAS setting Not Applicable/ (Include Unsure Relevant (Y/N/NA/?) Citations)

functional, and psychosocial status and develop an individualize d plan of care designed to meet those needs (T-22 54211(b)(1) (2))

Activities laws and regulations for CBAS (WIC 14550

CBAS HCB Settings Stakeholder Process 2015 Page 43 of 51

Item CMS EXPLORATORY QUESTIONS FOR NON-RESIDENTIAL SETTINGS # 4 INDIVIDUAL INITIATIVE, AUTONOMY, INDEPENDENCE IN LIFE CHOICES The setting optimizes, but does not regiment, individual initiative, autonomy, and independence in making life choices including but not limited to daily activities, physical environment, and with whom to interact. 42 CFR 441.301(c)(4) (iv)/ 441.710(a)(1)(iv)/441.530(a)(1)(iv)

Answer the following questions Yes/No/ Explain Comments/Questions for CBAS setting Not Applicable/ (Include Unsure Relevant (Y/N/NA/?) Citations)

and 14550.5, T-22 54309 and 54339) require daily activities that are planned, therapeutic, purposeful, and designed to suit individual needs and preferences, encourage self-care and resumption of normal activities, and

CBAS HCB Settings Stakeholder Process 2015 Page 44 of 51

Item CMS EXPLORATORY QUESTIONS FOR NON-RESIDENTIAL SETTINGS # 4 INDIVIDUAL INITIATIVE, AUTONOMY, INDEPENDENCE IN LIFE CHOICES The setting optimizes, but does not regiment, individual initiative, autonomy, and independence in making life choices including but not limited to daily activities, physical environment, and with whom to interact. 42 CFR 441.301(c)(4) (iv)/ 441.710(a)(1)(iv)/441.530(a)(1)(iv)

Answer the following questions Yes/No/ Explain Comments/Questions for CBAS setting Not Applicable/ (Include Unsure Relevant (Y/N/NA/?) Citations)

stimulate social interaction.

CBAS HCB Settings Stakeholder Process 2015 Page 45 of 51

Item CMS EXPLORATORY QUESTIONS FOR NON-RESIDENTIAL SETTINGS # 5 FACILITATES INDIVIDUAL CHOICE REGARDING SERVICES AND SUPPORTS The setting facilitates individual choice regarding services and supports, and who provides them. 42 CFR 441.301(c)(4) (v) 441.710(a)(1)(v)/441.530(a)(1)(v)

Answer the following Yes/No/ Explain Comments/Questions questions for CBAS Not Applicable/ (Include setting Unsure Relevant (Y/N/NA/?) Citations)

5a Was the individual provided Y Individuals Individuals can choose to a choice regarding the voluntarily participate or not. services, provider and participate in settings and the opportunity CBAS and CBAS does provide an Individual to visit/understand the may end Plan of Care. This question speaks options? participation to person-centered care which will at any time be further addressed as required in (T-22 the waiver. 54217(b)). Individual goals and those of health care providers and/or caregivers may not always be in agreement. 5b Does the setting afford Y Reassessment Participants reassessed at least individuals the opportunity of every six months and changes are to regularly and periodically participants made to their care plans. update or change their takes place at preferences? least every six months (WIC

CBAS HCB Settings Stakeholder Process 2015 Page 46 of 51

Item CMS EXPLORATORY QUESTIONS FOR NON-RESIDENTIAL SETTINGS # 5 FACILITATES INDIVIDUAL CHOICE REGARDING SERVICES AND SUPPORTS The setting facilitates individual choice regarding services and supports, and who provides them. 42 CFR 441.301(c)(4) (v) 441.710(a)(1)(v)/441.530(a)(1)(v)

Answer the following Yes/No/ Explain Comments/Questions questions for CBAS Not Applicable/ (Include setting Unsure Relevant (Y/N/NA/?) Citations)

14529(d)(3)), at which time a new individualize d plan of care is developed. 5c 1) Does the setting Y Regulations Refer to 5d. ensure individuals are specify that supported to make CBAS decisions and participants exercise autonomy to have the right the greatest extent to participate possible? in or decline treatment and to receive services designed to promote optimal

CBAS HCB Settings Stakeholder Process 2015 Page 47 of 51

Item CMS EXPLORATORY QUESTIONS FOR NON-RESIDENTIAL SETTINGS # 5 FACILITATES INDIVIDUAL CHOICE REGARDING SERVICES AND SUPPORTS The setting facilitates individual choice regarding services and supports, and who provides them. 42 CFR 441.301(c)(4) (v) 441.710(a)(1)(v)/441.530(a)(1)(v)

Answer the following Yes/No/ Explain Comments/Questions questions for CBAS Not Applicable/ (Include setting Unsure Relevant (Y/N/NA/?) Citations)

functional ability and encourage independence (T-22 78437).

2) Does the setting ? Stakeholders were unsure how to afford the individual interpret this question. with the opportunity to participate in meaningful non-work activities in integrated community settings in a manner consistent with the individual’s needs and preferences?

CBAS HCB Settings Stakeholder Process 2015 Page 48 of 51

Item CMS EXPLORATORY QUESTIONS FOR NON-RESIDENTIAL SETTINGS # 5 FACILITATES INDIVIDUAL CHOICE REGARDING SERVICES AND SUPPORTS The setting facilitates individual choice regarding services and supports, and who provides them. 42 CFR 441.301(c)(4) (v) 441.710(a)(1)(v)/441.530(a)(1)(v)

Answer the following Yes/No/ Explain Comments/Questions questions for CBAS Not Applicable/ (Include setting Unsure Relevant (Y/N/NA/?) Citations)

5d 1) Does the setting Y Regulations CBAS participants are assessed by policy ensure the specify that a multidisciplinary team who individual is supported the core develops an individualized plan of in developing plans to multidisciplin care. support her/his needs ary team and preferences? (RN, Social More can be done to promote the Worker, person-centered approach that is Activity already formalized in regulation to Coordinator, improve participant-specific Physical and preferences and identify them on Occupational the IPC. More training needs to be Therapists) provided in these areas. assess CBAS participants’ More clarification is needed medical, regarding “preferences.” functional,

CBAS HCB Settings Stakeholder Process 2015 Page 49 of 51

Item CMS EXPLORATORY QUESTIONS FOR NON-RESIDENTIAL SETTINGS # 5 FACILITATES INDIVIDUAL CHOICE REGARDING SERVICES AND SUPPORTS The setting facilitates individual choice regarding services and supports, and who provides them. 42 CFR 441.301(c)(4) (v) 441.710(a)(1)(v)/441.530(a)(1)(v)

Answer the following Yes/No/ Explain Comments/Questions questions for CBAS Not Applicable/ (Include setting Unsure Relevant (Y/N/NA/?) Citations)

and This is an area that requires psychosocial improvement. Some centers do this status and well, and other centers do not assist develop an much with these types of requests. individualize d plan of care designed to meet those needs (T-22 54211(b)(1) (2))

2) Is setting staff Y Refer to 5(d) Refer to 5(d)(1) knowledgeable about (1) the capabilities, interests, preferences and needs of individuals?

CBAS HCB Settings Stakeholder Process 2015 Page 50 of 51

Item CMS EXPLORATORY QUESTIONS FOR NON-RESIDENTIAL SETTINGS # 5 FACILITATES INDIVIDUAL CHOICE REGARDING SERVICES AND SUPPORTS The setting facilitates individual choice regarding services and supports, and who provides them. 42 CFR 441.301(c)(4) (v) 441.710(a)(1)(v)/441.530(a)(1)(v)

Answer the following Yes/No/ Explain Comments/Questions questions for CBAS Not Applicable/ (Include setting Unsure Relevant (Y/N/NA/?) Citations)

5e Does the setting post or ? Centers are not required to post provide information to such information. However, centers individuals about how to are required to provide various make a request for liaison functions, including with additional HCBS, or Medi-Cal managed care plans, changes to their current medical providers, family and HCBS? caregivers, IHSS, and other community services that assist the participant in remaining in the community.

Managed care plans have responsibility for providing their members with information about HCB options.

CBAS HCB Settings Stakeholder Process 2015 Page 51 of 51