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Delaware General AssemblyDelaware RegulationsMonthly Register of RegulationsJune 2015

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Delaware Health and Social Services ("Department") / Division of Medicaid and Medical Assistance (DMMA) made available for public review and comment Delaware Medicaid's Proposed Statewide Transition Plan for Home and Community-Based Services (HCBS) Settings. The Department's proceedings to amend its regulations were initiated pursuant to 29 Delaware Code Section 10114 and its authority as prescribed by 31 Delaware Code Section 512.
The Department published its notice of proposed regulation changes pursuant to 29 Delaware Code Section 10115 in the March 2015 Delaware Register of Regulations, requiring written materials and suggestions from the public concerning the proposed regulations to be produced by March 31, 2015 at which time the Department would receive information, factual evidence and public comment to the said proposed changes to the regulations.
This regulatory posting is to provide public notice and to receive public comments for consideration regarding Delaware Medicaid’s Proposed Statewide Transition Plan for Home and Community-Based Services (HCBS) Settings. The purpose of the transition plan is to ensure Medicaid beneficiaries are receiving HCBS in settings that meet the quality requirements specified in the final rule and are appropriate based on the needs of the individual as indicated in their person-centered service plan.
Section 1915 of the Social Security Act, Provisions respecting inapplicability and waiver of certain requirements of this title
42 CFR §441.301, Contents of request for a waiver
42 CFR §441.710, State plan home and community-based services under section 1915(i)(1) of the Act
My name is XXXX. I am a Program Manager at XXXX. [It] is my honor to work at XXXX, and [I] have been here for one year. I believe that ALL people should be fully integrated into the community. I realize that those we serve will be able to be fully integrated into the community without a lot more financial support than what is currently available. I realize that providers in Delaware are currently are UNDER funded by $32 million. Where are the additional financial resources going to come from? I also realize that to move people to the community will take a lot more Transportation resources, which means more money. I believe that if we try to put everyone in the community without the proper resources, which means money, the safety of the people we serve will be compromised, and the safety of the public in some cases will also be put at risk. I also know that many of the people we serve and their families do not want to receive services in the community. I believe our State should provide more choices, not eliminate choices. I also know that other states have affirmed that they are keeping facility-based services as a service option. Delaware has NOT done that. We would like to see our State affirm that facility-based programs will remain in our state for those who would choose it as an option and for those who need it to build skills to move to a community-based program. The people we serve are unable to advocate for themselves, and we have a responsibility to make sure their voices and concerns are heard
1. In determining what constitutes the least restrictive environment practicalities should be a major determining factor. In an ideal and theoretical format each such individual would have all the support and freedom to reside & function in a fully integrated system with one-on-one assistance. However, by the very nature of the fact that such individuals as my daughter need supervision and guidance on a regular basis and learn as well as work more comfortably in an environment that is structured to their needs as well as one that gives them the safety and comfort to function it is not only realistic but imperative that this be given serious weight when considering whether the entity and place providing the service fulfills the guidelines. To be sure we do not want to go back to the days of warehousing such individuals in massive enclaves where they are cutoff from the rest of the world and exist in isolation. But from a practical and economical view it is only reasonably to have a limited number of such individuals who choose of their own to reside and work together as part of a larger whole community. It is akin to like-minded professionals or ethnic communities who congregate in order to satisfy mutual goals and needs. So long as the individuals who choose to do so do it of their own volition why should there be an arbitrary number assigned that would limit their ability to choose such options. If using stringent specifications denies individuals like my daughter the privilege of being able to grow, live and function to their fullest potential then that totally defeats the purpose of helping such individuals and instead restricts the opportunities available to them thus relegating them to a life of isolation, with nothing to keep them active and productive, ensuring their decline. I believe that in applying the criteria of least restrictive environment the barometer to judge and temper it should be the benefit or lack thereof to each individual's needs and conditions. A universally applied and fixed number without consideration of the individuals needs severally handicaps their ability to achieve their full potential and removes viable options that would work for that individual.
Agency Response: Delaware Health and Social Services/Division of Medicaid and Medical Assistance (DHSS/DMMA) appreciates your sincere and thoughtful comments. We acknowledge your questions and concerns and would like to offer the following information:
THEREFORE, IT IS ORDERED, that the proposed regulation to make available for public review and comment Delaware Medicaid's Proposed Statewide Transition Plan for Home and Community-Based Services (HCBS) Settings, is adopted and shall be final effective June 10, 2015.
Last Updated: December 31 1969 19:00:00.
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