CLASS Waiver Suggested Public Comment Text

INSTRUCTIONS: Please copy-and-paste the entire text below into your public comment as your request to HHSC after you have written your personal story. You also can download this text as a PDF and attach it to your public comment or to view the formatting of how the text should appear in your document.

We are pleased to see that HHSC has listened to the hundreds of voices from across Texas and deleted §259.5(93)(L) and added new language consistent with 42 CFR §441.301(c)(5)(v) regarding settings that are presumed to have the qualities of an institution and that address a heightened scrutiny review conducted by CMS.

We believe this helps HHSC achieve consistency in the HCS waiver with the Final Settings Rule and hopefully will make it easier for CMS to give Final Approval to the Texas Statewide Transition Plan by the March 2023 deadline.

However, other important elements from the Final Settings Rule are missing in this proposed rule draft, elements necessary to achieve consistency with the Final Settings Rule.

Specifically, I request that you add the following language (underlined) to the proposed new rule:

§259.59. Requirements for Service Settings.

(a) …

        (2) …

               (D) receive services in the community, to the same degree of access as individuals not receiving Medicaid HCBS.

        (3) The setting is selected by the individual from among setting options, including non-disability specific settings and an option for a private unit in a residential setting. The setting options are identified and documented in the person-centered service plan and are based on the individual’s needs, preferences, and, for residential settings, resources available for room and board.

[Source: The 2 sections above can be found in the CMS Final Settings Rule under §441.301(c)(4)(i-ii)]

        (4)(3) ensures the individual's rights of privacy, dignity and respect, and freedom from coercion and restraint; and

        (5)(4) optimizes, not regiments, individual initiative, autonomy, and independence in making life choices, including choices regarding daily activities, physical environment, and with whom to interact.

        (6) facilitates individual choice regarding services and supports, and who provides them.

[Source: The sections above can be found in the CMS Final Settings Rule under §441.301(c)(4)(v)]