Prior to filing with CMS, the State must seek input from the public for the proposed Statewide Transition Plan and any amendments, preferably from a wide range of stakeholders representing consumers, providers, advocates, families and others.

The public input process requires the State to provide at least a 30-day public notice and comment period regarding the Statewide Transition Plan that the State intends to submit to CMS for review and consideration. The State must provide a minimum of two statements of public notice and public input procedures. The State must ensure the Statewide Transition Plan is available to the public for public comment. The State must consider and modify the Statewide Transition Plan, as the State deems appropriate, to account for public comment. Upon submission of the Statewide Transition Plan to CMS, the State must include evidence of compliance with the public notice requirements and a summary of the comments received during the public notice period, why comments were not adopted, and any modifications to the Statewide Transition Plan based upon those comments.

The process for submitting public comment must be convenient and accessible. The Statewide Transition Plan must be posted on the State's website and include a website address for comments. In addition, the State must have at least one additional option for public input, such as a public forum. The Statewide Transition Plan must include a description of the public input  process.

State Activity

The State intends to reach out throughout the transition to State staff, providers, MCOs, advocates, and individuals receiving services and their families. Through various venues, the State plans to educate providers and MCOs about their responsibilities, help individuals understand their rights under the new HCBS requirements, and solicit input.

Based on public input in all phases of the transition process, HHSC, DADS, and DSHS are committed to using feedback to guide remediation and assessment strategies until the transition is complete. HHSC, DADS and DSHS continue to work with internal and external stakeholders through existing statutorily mandated committees, workgroups and stakeholder meetings. The State continues to refine remediation activities in response to public input where possible.

For any amendments made to the Statewide Transition plan, HHSC will distribute Tribal Notification to the tribal representatives in compliance with the 60 day federal and state requirements. The Tribal Notification will include contact information to request copies of the amendment provide comments and/or request information from the State via email, mail, or telephone. The State provides copies free of charge.

The Public Notice of Intent (PNI) will be published in the Texas Register, allowing a 30 day comment period in compliance with federal and state requirements. The Texas Register is published weekly and is the journal of state agency rulemaking for Texas. In addition to activities related to rules, the Texas Register publishes various public notices including attorney general opinions, gubernatorial appointments, state agency requests for proposals and other documents, and it is used regularly by stakeholders. HHSC publishes all Medicaid waiver submissions in the Texas Register in addition to many other  notices. The publication is available online and in hard copy at the Texas State Library and Archives Commission, the State Law Library, the Legislative Reference Library located in the State Capitol building, and the University of North Texas libraries. All of these sites are located in Austin, except for the University of North Texas, which is located in Denton. Printed copies of the Texas Register are also available through paid subscription; subscribers include cities, counties and public libraries throughout the state. The PNI provided contact information to request copies of the amendment provide comments and/or request information from the State via email, mail, or telephone. The State provides copies free of charge.

The Texas Register is located at the following website: http://www.sos.state.tx.us/texreg/pdf/backview/0410/index.shtml

HHSC will post the amendment to the Statewide Transition Plan on the HHSC, DADS, and DSHS websites at the following webpages:

The websites include mailing addresses and an electronic mailbox for comments and questions. HHSC will also send a request to the HHSC Office of Social Services to distribute notice of the amendment of the Statewide Transition Plan to 290 local eligibility offices with instructions to post the notice in public areas.

Submission of waiver specific plans, the Statewide Transition Plan and any amendments

On August 22, 2014, the State submitted an amendment to the Community Based Alternatives (CBA) waiver which started the 120 day clock for submission of the Statewide Setting Transition Plan. Initially, the State was required to submit waiver specific plans with all waiver submissions after March 17, 2014. Some of those waiver specific plans were submitted prior to the submission of the Statewide Transition Plan (the plan for all of the programs) and all of the waiver specific plans were submitted before approval of the Statewide Transition Plan. However, at this time, the State has been instructed by CMS, in a SOTA call held on May 14, 2015, to await approval on the Statewide Transition Plan before submitting any more waiver specific plans or amendments to waiver specific plans. When the State receives approval for the Statewide Settings Transition Plan, it will pull out those portions relevant to each specific waiver and submit a waiver specific plan for each waiver. However, please note that the State provided public notice and an opportunity for public input through waiver amendments to all 1915(c) waivers for these waiver specific plans. The State took these comments into consideration and made changes accordingly. The State also provided the comments and responses to CMS when the State submitted a waiver amendment that included a waiver specific plan.

In December 2014, the State submitted its first Statewide Transition plan to CMS for approval, and provided the appropriate tribal notice and public notice in the two months prior to the submission. The State considered and modified the Statewide Transition Plan, as the State deemed appropriate, to account for public comment, prior to submission of the plan to CMS. The State provided the comments and responses to CMS when the State submitted the Statewide Transition Plan to CMS.

In March 2015, the State submitted its first amendment to the Statewide Transition plan and provided the appropriate tribal notice and public notice in the two months prior to the submission. The purpose of the amendment to the Statewide Transition Plan was to include the HCBS settings for services provided through the Texas Healthcare Transformation Quality Improvement Program (THTQIP) 1115 Demonstration Waiver (to be referenced as the 1115 Demonstration waiver in this document going forward). The State considered and modified the Statewide Transition Plan, as the State deemed appropriate, to account for public comment, prior to submission of the plan to CMS. The State provided the comments and responses to CMS when the State submitted a waiver amendment that included a waiver specific plan.

In September 2015, HHSC received initial feedback from CMS regarding the STP. The feedback received from CMS is available at http://medicaid.gov/medicaid-chip-program-information/by-topics/long-term-services-and-supports/home-and-community-based- services/statewide-transition-plans.html. As a result of the CMS feedback, HHSC will be submitting an amendment to the STP and anticipates that the amendment will be submitted to CMS in February 2016. HHSC posted a notice to the tribes on September 29, 2015 to inform them that an upcoming amendment to the original plan would be posted.

In addition, the State has implemented the following public input strategy, aimed at achieving optimum public input:

  • Stakeholder education webinars: DADS conducted two webinars on September 11 and September 14, 2014, to provide all stakeholders an opportunity to learn about the new regulations.

  • Conference calls: Beginning January 2015 the State started holding regular conference calls with MCOs to discuss the Statewide Transition Plan as it relates to the HCBS services delivered under the 1115 Demonstration waiver. The same educational content of a webinar will  be provided. Starting January 2015 and throughout the process.

  • Stakeholder meetings: On October 13, 2014, the State held an open stakeholder meeting in Austin providing all 1915(c) stakeholders the opportunity to provide input on the new regulations. In addition, a meeting specifically for YES  stakeholders was held by the Hogg Foundation for Mental Health in Austin on December 2, 2014. The settings assessment and the new HCBS rules impact on the YES waiver were included as topics of discussion. An open stakeholder meeting was held on February 11, 2015 to provide all stakeholders with the opportunity to provide input on the addition of the 1115 Demonstration waiver specific portion to the Statewide Transition Plan. In the Fall of 2015 (October 22, 2015 - November 9, 2015), the state conducted twelve public forums in six different cities throughout the state. There were afternoon sessions and evening sessions for each location. These forums provided education regarding the HCBS federal regulations as well as seek public input related to the provider self- assessment and participant surveys, and notify stakeholders of the upcoming STP amendment.

  • Electronic notices: The State posted the Statewide Transition Plan on agency websites and in the Texas Register in November 2014. The DADS and DSHS assessments were also posted on the agency websites. The waiver specific transition plans for several of the waivers were posted in the Texas Register and on the agency websites. The amended Statewide Transition Plan, which incorporated the 1115 Demonstration waiver specific portion of the plan, was posted on the HHSC, DADS, and  DSHS websites on January 30, 2015.

  • Feedback mechanism: Dedicated electronic mail boxes and websites for HHSC, DADS, and DSHS are available to provide information about the new rules and accept feedback.  The websites and the option to make comments will remain active throughout the transition and the State will take any comments received into consideration until the State completes the transition. State websites are located at the following hyperlinks:

  • Presentations at advisory committees and stakeholder meetings: The State regularly provides updates to the following groups and offers them opportunities to comment on ongoing assessment and remediation activities:

    • Promoting Independence Advisory Committee: comprised of individuals receiving services, advocacy organizations, and providers across target populations. State staff provided an update on the Statewide Transition Plan to this group most recently on October 15, 2015.
    • Employment First Task Force: comprised of advocates and providers interested in employment issues.
    • Texas Council on Autism and Pervasive Developmental Disorders: comprised of parents of individuals with autism and professionals.
    • IDD Redesign Advisory Committee: comprised of individuals receiving services, advocacy organizations and providers. State staff provided an update on the Statewide Transition Plan to this group most recently on July 30, 2015.
    • STAR+PLUS Quality Council: comprised of managed care organizations, individuals receiving services and their representatives, advocacy organizations, and providers.
    • State Medicaid Managed Care Advisory Committee: comprised of managed care organizations, individuals receiving services and their representatives, advocacy organizations, and providers.
    • STAR+PLUS stakeholder meetings: attendees include managed care organizations, individuals receiving services, advocacy organizations, and providers.
    • IDD System Improvement workgroup: comprised of state agency staff, providers, and advocates. State staff provided an update on the Statewide Transition Plan to this group on May 20, 2015, June 5, 2015, August 14, 2015, and December 4, 2015.
    • IDD Directors Consortium: composted of IDD directors and attended by state agency staff. State staff provided an update on the Statewide Transition Plan to this group on September 11, 2015.
    • Consumer Directed Workgroup: comprised of state agency staff, providers, advocates and individuals utilizing consumer directed services. State staff provided an update on the Statewide Transition Plan to this group on October 23, 2015.
    • Tribal stakeholder conference call meetings: comprised of designees of federally recognized tribes. On January 27, 2015, the State conducted a tribal notice stakeholder conference call. During the call, the State gave an overview of the new CMS HCBS rules and of the State's Statewide Transition Plan. The State also provided information on how to access the full transition plan and submit comments, and on future public hearings; and the State solicited questions and feedback on the plan during the meeting. The State holds regularly scheduled conference calls with the tribes which will provide additional opportunities for stakeholder input. The State most recently provided updates related to the status of the Statewide Transition Plan to the tribal stakeholders on calls held on October 14, 2015, November 17, 2015, and December 16, 2015.
  • Presentations at agency workgroups: The agencies also have agency-established workgroups comprised of advocates and providers whose purpose is to examine ongoing rule and policy issues. Staff will continue to provide updates on HCBS transition activities and provide the workgroup members the opportunity to provide comments.

  • Presentations at conferences: Provider associations hold annual conferences and State staff have been invited to speak at these conferences. This provides access to a large number of providers for purposes of education, coordination and input regarding changes being made to rules and policy. State staff provided an update on the Statewide Transition Plan to the Private Providers Association of Texas at their annual conference on November 12, 2015.

  • Provider self-assessment surveys and participant surveys: Provider self-assessment and participant surveys for stakeholders were posted on the appropriate HHSC a n d DADS website. Providers and participants who are not a part of the multi-stage random sample used during the assessment phase, can still obtain and complete a self-assessment survey on the agency websites and provide data that will be considered as the State moves forward. The self-assessment and participant survey tools were posted on the agency websites in November 2015. A 30 day public comment period allowed for stakeholder feedback on the survey tools.

An individual may obtain a free copy of the amendment to the Statewide Transition Plan, ask questions, request additional information, or submit comments regarding this amendment to the STP by contacting Clare Seagraves by mail at Texas Health and Human Services Commission, PO Box 13247, Mail Code H-600, Austin, Texas 78711-3247, by fax at (512) 730-7477, or by email at Medicaid_HCBS_Rule@hhsc.state.tx.us. In accordance with 42 CFR §441.301, the State is required to consider and modify the Statewide Transition Plan, as the State deems appropriate, to account for public comment.

Public Input Activity and Notice Milestones
Action Items Proposed Initiation Proposed Completion COMPLETE
Presentations to advisory committees, other HHS Enterprise committees, stakeholder meetings, and workgroups that have provider and advocate membership will continue throughout the assessment process. July 2014 Continuing through the end of the transition period. No
Presentations at provider association annual conferences. August 2014 Continuing through the end of the transition period. No
HHSC, DADS and DSHS HCBS websites and electronic mailboxes are available to collect stakeholder input and allow public comment on the State's activities toward compliance with federal regulations September 2014 Continuing through the end of the transition period No
Stakeholder meetings and webinars providing individuals receiving services, legally authorized representatives, families, advocates, other interested persons and program providers an opportunity to provide input on the assessment phases and Statewide Transition Plan and amendments. October 2014 Continuing through the transition period No
A public stakeholder meeting providing individuals with an opportunity to contribute feedback on the assessment process, the waiver specific plans posted thus far, and implementation of the settings transition plans to all of the 1915(c) waivers. October 2014 October 2014 Yes
Waiver specific transition plans are available for ongoing public comment on HHSC, DADS and DSHS websites September 2014 Ongoing throughout the transition period No
The Statewide Transition Plan posted for public comment. November 2014 December 2014 Yes
Initial submission of Statewide Transition Plan to CMS December 2014 December 2014 Yes
A public stakeholder meeting held for input on the first amendment to the STP to include the 1115 Demonstration waiver. February 2015 February 2015 Yes
Submission of first amendment to the statewide transition plan (to CMS including 1115 Demonstration Project) March 2015 March 2015 Yes
Held six stakeholder meetings across the state to inform stakeholders on the HCBS regulations, survey assessment tools and revised STP October 2015 November 2015 Yes
The second amendment to the Statewide Transition Plan posted for public comment. December 2015 January 2016 Yes
Submission to CMS of the second amendment to the Statewide Transition Plan (in response to CMS request to provide more information) February 2016 February 2016 Yes
Review and include appropriate revisions to the Statewide Transition Plan. September 2018 September 2018 No
Public notice and public comment for review of the amendment to the Statewide Transition Plan October 2018 November 2018 No
Submit final amendment to the Statewide Transition Plan December 2018 December 2018 No

Texas Statewide Transition Plan Comments Summary

Public notice for the amendment to the statewide transition plan was given in the Texas Register and on the HHSC, DADS and DSHS websites. The Texas Register is published weekly and is the journal of state agency rulemaking for Texas. In addition to activities related to rules, the Texas Register publishes various public notices including attorney general opinions, gubernatorial appointments, state agency requests for proposals and other documents. HHSC publishes all Medicaid waiver submissions in the Texas Register in addition to many other notices. The publication is available online and in hard copy at the Texas State Library and Archives Commission, the State Law Library, the Legislative Reference Library located in the State Capitol building, and the University of North Texas libraries. All of these sites are located in Austin, except for the University of North Texas, which is located in Denton. The Texas Register is also available through paid subscription. The State provided public notice of the amendment to the statewide transition plan in the Texas Register (40 TexReg 9372) at the following hyperlink: http://www.sos.state.tx.us/texreg/pdf/backview/1218/1218is.pdf

The amended s tatewide transition plan was posted in its entirety for public comment on the HHSC, DADS, and DSHS websites at the following hyperlinks:

In addition, a webinar was held for stakeholder s on January 11, 2016 detailing the changes made to the statewide transition plan and providing information on where the amended statewide transition plan could be accessed and how to submit comments

During the December 2015-January 2016 public comment period for the amendment to the statewide transition plan, the State received written comments from Disability Rights Texas, Texas Council for Developmental Disabilities, Every Child, Inc., the Arc of Texas, Texas Council of Community Centers, United Healthcare, and Caregiver Homes of Texas. Any comments that were completely outside the scope of the settings requirements imposed under 42 CFR §441.301, will not be addressed.

A summary of the comments received during the public notice period, reasons why comments were not adopted, and any modifications to the statewide transition plan based upon those comments follows.

Please note that the STP also contains the following two appendices: (1) the State's internal (systemic) assessment of whether the settings in which these services are provided comport with the HCBS settings requirements and (2) an explanation of the State's external assessment methodology.

  1. Commenters: Commenters suggested that stakeholders should be involved in requests for additional legislative funding and rate increases to ensure compliance with HCBS regulations. Providers expressed rates may need to increase in order to ensure the capacity and appropriate resources to serve individuals with complex medical and behavioral needs.
    State Response: The State recognizes that changes to the delivery system as a result of the HCBS regulations may impact provider rates. The state is committed to working with stakeholders in all phases of the HCBS implementation. The state does provide opportunities for stakeholders to comment on the legislative appropriations request. Although the comment only references the 1915c waivers, the State has added clarification to the STP to also address that funding that may be needed for the 1115 waiver.

  2. Commenters: With regard to assessing the availability of choice, Commenters encourage HHSC, DADS, and DSHS expand the assessment of choice from just service coordinators and case managers to include providers as well.
    State Response: Participants in the Youth Empowerment Services (YES) Waiver operated by DSHS currently have availability of choice of comprehensive waiver providers, case managers, and direct service providers. The State appreciates these comments and will consider these comments when finalizing the provider surveys. No changes were necessary and none were made to the STP as a result of this comment.

  3. Commenters: With regard to Assisted Living Facilities (ALFs), beyond the Assisted Living Centers Bill of Rights, rules and policies should be updated to address how assisted living centers provide access to food at any time, privacy, engagement in the community, control of personal finances and protections against evection, including posting any rights and rights limitations (if any) in the facility and providing this information in writing when a person signs an agreement for facility services, including room and board. Involuntary ALF discharges should be followed up with a survey to the resident to determine the level of choice and satisfaction with the discharging facility.
    State Response: The State appreciates these comments related to ALFs and will consider these comments during the rule making and policy revision process outlined in the remediation sections of the STP. No changes were necessary and none were made to the STP as a result of these comments.

  4. Commenters: With regard to day habilitation/pre-vocational/employment assistance, rules and policies need to be revised to require routine opportunities for community participation, with an initial goal of at least 51% of an individual's services being in settings where individuals without disabilities are participating and according to preferred interests of individuals receiving these services.
    State Response: The State appreciates these comments related to day habilitation/pre-vocational/employment assistance and will consider these comments during the rule making and policy revision process outlined in the remediation sections of the STP. No changes were necessary and none were made to the STP as a result of these comments.

  5. Commenters: Establishing credentialing standards for day habilitation programs that focus on increasing person centered, individualized meaningful day activities and how and where those services occur (including providing or arranging for transportation through a transportation plan) is critically needed. Expectations for day habilitation services through standards and credentialing should begin to be developed immediately, with stakeholder input. Program and rule changes should support an individual's ability to decline day habilitation and access other waiver and non-waiver services during the day according to personal preferences, including no services or set daily schedule and/or control of one's own schedule.
    State Response: The State appreciates these comments and will consider these comments during the rule making and policy revision process outlined in the remediation sections of the STP. No changes were necessary and none were made to the STP as a result of these comments.

  6. Commenters: Access to and control of an appropriate personal spending allowance is needed. HHSC and DADS should provide oversight and remediation policies to ensure individuals are receiving a personal needs allowance, understand how much they are paying for room and board, what they are able to receive each month, how they can access their available funds and what their money is being spent on.
    State Response: The State appreciates these comments related to the personal spending allowance, and will consider these comments during the rule making and policy revision process outlined in the remediation sections of the STP. No changes were necessary and none were made to the STP as a result of these comments.

  7. Commenters: It would be helpful if providers were required to get State approval of their lease agreement templates.
    State Response: The State appreciates this comment and will consider this comment during the rule making and policy revision process outlined in the remediation sections of the STP. No changes were necessary and none were made to the STP as a result of this comment.

  8. Commenters: Commenters were concerned that individuals do not engage in choice of staff, especially in residential settings.
    State Response: The State appreciates these comments and will consider these comments during the rule making and policy revision process outlined in the remediation sections of the STP. No changes were necessary and none were made to the STP as a result of these comments.

  9. Commenters: The State should consider adding a participant direction option called Service Responsibility Option (SRO) to all HCBS services in Texas that currently do not include that option now.
    State Response: The state appreciates the suggestion regarding the SRO option; however no changes were necessary and none were made to the STP as a result of this comment.

  10. Commenters: Choice of provider of day habilitation, supported employment and employment assistance should allow for a consumer directed option (regardless of an individual's living arrangement). The extent to which an individual had choice of day program, supported employment and employment assistance should be incorporated into regulatory reviews.
    State Response: During the remediation process, the State will consider rule and policy changes that facilitate individual choice regarding services, supports and who provides them. No changes were necessary and none were made to the STP as a result of this comment.

  11. Commenters: Any change of residential setting or day habilitation (or switch from employment to day habilitation) should trigger heightened review by a service coordinator and involve the service planning team, consumer rights or regulatory services to ensure that the changes are participant driven and to monitor for outcomes such as choice, stability and satisfaction.
    State Response: The State appreciates this comment and will consider this comment during the rule making and policy revision process outlined in the remediation sections of the STP. No changes were necessary and none were made to the STP as a result of this comment.

  12. Commenters: Individuals with limited skills should select what they want to eat, not just when they want access to food. There should be an initiative to change the current practices that limit participant involvement in choice of food, meal planning, grocery shopping, paying for groceries with SNAP or personal funds and the use of food restrictions in residential settings. Medical contraindications for food access and choice, when necessary, should be well documented.
    State Response: The State appreciates these comments and will consider these comments during the rule making and policy revision process outlined in the remediation sections of the STP. No changes were necessary and none were made to the STP as a result of these comments.

  13. Commenters: Commenters suggested that developing a bill of rights for community based services that incorporates HCBS settings requirements and that it should go beyond the right to protection from abuse, exploitation and incorporate rights related to choice and control, privacy, choice of staff, control of personal funds and other rights consistent with the aims of HCBS settings requirements.
    State Response: The State will consider these comments during the rule making and policy revision process outlined in the remediation sections of the STP. No changes were necessary and none were made to the STP as a result of these comments.

  14. Commenters: CMS and the State should re-assess respite services and the settings where respite is offered now or is proposed to be offered in the future, including institutional settings such as nursing facilities (NFs), ALFs, and intermediate care facilities (ICFs). Greater effort should be made to develop and require respite options that are community-based.
    State Response: CMS has indicated that it intends to permit states to use institutional settings for the provision of respite services on a short-term basis. The state appreciates the suggestion; however, no changes are necessary and none were made to the STP as a result of this comment.

  15. Commenters: The State should continue all possible efforts to support individuals to access housing that is not provider controlled so that housing and services are not connected to the degree that if you want to make a choice or change it impacts housing options or access to preferred providers.
    State Response: In compliance with the HCBS rules, the State is using the person-centered planning process to support individual's choosing the housing option that is best suited to their needs. No changes were necessary and none were made to the STP as a result of this comment.

  16. Commenters: The STP does not provide information on how the State plans to bring providers into compliance if they are found to be noncompliant or partially noncompliant with the new HCBS rules. HHSC and DADS have identified settings that are not compliant or partially compliant. For each instance, they should identify how they plan to bring those settings into compliance or if those settings are not able to comply. While the updated plan includes the results from the 1115 systemic survey, it does not provide estimates of the number of settings that fully comply, do not comply but will with modifications, cannot comply with the federal settings requirements, or are presumed to have institutional characteristics.
    State Response: The State STP addresses compliance in the remediation section through remedial actions such as rule and policy changes, in combination with revisions to our current oversight process. Examples of current methods for ongoing oversight would be contract monitoring and enforcement of requirements via corrective action plan or assessment of other contract remedies. At this time, the State is not able to identify a specific number of settings that are non-compliant because the State is still completing the assessment process. No changes were necessary and none were made to the STP as a result of this comment.

  17. Commenters: The STP does not explain the validation method that will be used to link the provider and participant surveys.
    State Response: The State explains the validation method in Appendix II of the STP. Appendix II outlines the State's use of management information systems to link the provider to a particular individual. The multi-stage random sampling methodology takes into account provider settings and individuals served within those settings to ensure individual surveys are linked to providers. No changes were necessary and none were made to the STP as a result of this comment.

  18. Commenters: While the STP recognizes that the State will develop remedial actions if they find compliance issues, the STP does not provide a detailed explanation of remedial action.
    State Response: The State is still assessing the settings and therefore, specific remedial actions are still under discussion. The survey results will inform the State of specific remedial actions (e.g. changes to rule, policy and contract monitoring). No changes to the STP will be made at this time based on this comment.

  19. Commenters: The updated STP does not identify how the State will include the individual who is being relocated in the relocation planning process. The STP should detail in full how the State will implement a person centered plan to relocate the individual to a residence of their choice. It also does not explain how choice will be provided to the individuals.
    State Response: As referenced in the STP, the relocation process is driven by person-centered planning (described by the HCBS regulations). The STP outlines that information will be provided to the individual, including what will happen if the individual chooses to remain in a non-compliant setting. If relocation becomes necessary, the individual will indicate his or her choice of a new setting. The current plan will be revised in this amendment to provide greater clarification in the 1115 demonstration waiver section of the STP.

  20. Commenters: With regard to day habilitation and pre vocational programs, new licensure and credentialing oversight from HHSC and DADS can be implemented to ensure these programs are individualized based on person centered plans, fully integrated in community life where individuals are learning from and meeting people without disabilities, and are not scheduled around group activities and outings where individuals do not have choice of participation. A new licensure and credentialing process would also allow HHSC and DADS to identify all of the programs that are providing services to individuals through state funding. HHSC and DADS cannot ensure compliance if they are not able to identify all existing programs.
    State Response: The State appreciates the suggestion, however although licensing could be used with some entities to ensure compliance, it is not appropriate for all entities. All licensed entities serve both Medicaid and non-Medicaid populations, thus in many instances specific HCBS requirements are more appropriately applied through contracting requirements targeted at individuals receiving Medicaid in HCBS programs. For the above reasons, no changes to the STP will be made as a result of these comments.

  21. Commenters: Outcome based employment services that link success to the individual's person directed plan, trains consumers in settings that are not facility-based, and secures employment for at least minimum wage are all ways HHSC and DADS can update policies to ensure employment services are compliant with HCBS rules.
    State Response: The State appreciates these comments and will consider this comment during the rule making and policy revision process outlined in the remediation sections of the STP. No changes were necessary and none were made to the STP as a result of this comment.

  22. Commenters: Commenters suggested use of the NCI to the greatest extent possible during the assessment phase to help benchmark lack of, partial, or full compliance with HCBS requirements. The State should consider using relevant National Core Indicators (NCI) questions that are more oriented to self-determination and accessible to individuals with cognitive limitations. We strongly encourage DADS and HHSC, if using NCI is not feasible, to re-write the participant surveys so that people with IDD can understand them and provide meaningful feedback. It is our understanding that based on stakeholder feedback; certain modifications (including limited open ended questions) may be incorporated in the final participant surveys.
    State Response: The State used the NCI as the basis for some of the survey questions developed for the participant and provider surveys. The actual NCI questions do not mirror all of the requirements in the settings rule and therefore, could not be used verbatim in the survey. The State did receive comments on the survey from stakeholders and used this stakeholder feedback to revise the questions. No changes to the STP were necessary and none were made as a result of this comment.

  23. Commenters: The participant surveys seem to assume that the questions are to address the current "place" where services are being provided now. We believe that the surveys and required service delivery settings improvements need to align with the aspirations of choice, control and integration and not an endorsement of current settings or a narrow focus on what happens in current settings.
    State Response: The State received comments on the survey and used stakeholder feedback to revise the questions. No changes to the STP were necessary and none were made as a result of this comment.

  24. Commenters: Commenters encourage DADS and HHSC to contract with an entity that understands and has experience supporting people with IDD and have participated in a person-centered thinking training.
    State Response: The State appreciates the commenters concerns and is contracting with entities that have experience working with individuals with cognitive disabilities. No changes were necessary and none were made to the STP as a result of this comment.

  25. Commenters: Commenters hope that the individuals filling out the "Provider Self-Assessments" will have worked directly with the individuals supported by the services they are reporting on.
    State Response: The State recognizes the benefits of specific provider staff completing the surveys and will include that in guidance given to providers during the assessment process. No changes were necessary and none were made to the STP as a result of this comment.

Updated: March 29, 2016