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HCBS Statewide Transition Plan

Heightened Scrutiny - Category 3 settings

UPDATE: Oct. 25, 2021 

SCDHHS submitted the revised South Carolina HCBS Statewide Transition Plan, and Appendices O and P with the Category 3 settings, to CMS on Oct. 25, 2021.

The public notice and comment period for Category 3 heightened scrutiny submissions was Aug. 23 - Oct. 1, 2021. 

View the public notice and Category 3 settings submission. The webinar and a map of South Carolina counties by South Carolina Department of Disabilities and Special Needs (SCDDSN) regions are also available below.

Public Comment Information 

Public comments were to be received by 5 p.m. Oct. 1, 2021. Comments were submitted the following ways:

  • Online
  • Email - comments@scdhhs.gov
  • Mail:  
    • Office of Compliance
    • ATTN: Kelly Eifert, Ph.D.
    • South Carolina Department of Health and Human Services
    • P.O. Box 8206
    • Columbia, SC 29202-8206

Heightened Scrutiny  - Category 2 Settings

April 1, 2021 

SCDHHS submitted the revised South Carolina HCBS Statewide Transition Plan, and Appendix N with the Category 2 settings, to CMS on March 30, 2021.

Public webinar information: 

Feb. 17, 2021

Final Approval

The South Carolina Department of Health and Human Services (SCDHHS) received final approval from the Centers for Medicare and Medicaid Services (CMS) for the South Carolina Home and Community-Based Services (HCBS) Statewide Transition Plan. The revised plan that was submitted on Oct. 11, 2019, had two sets of technical revisions prior to final approval.  The public can view the  final approval letter,   the  revised HCBS Statewide Transition Plan with technical revisions, and the final approved Statewide Transition Plan  below.

Full South Carolina HCBS Statewide Transition Plan

South Carolina HCBS Statewide Transition Plan - Approved

CMS Initial Approval Letter for SC HCBS Statewide Transition Plan

South Carolina HCBS Statewide Transition Plan- Intial Approval 11-3-2016

Submissions

TAC Report 

In 2015, SCDHHS procured consultants to review supportive housing in South Carolina. The Technical Assistance Collaborative (TAC), Inc. was the winning bidder. As part of that consultation, TAC, Inc reviewed current residential settings options for HCBS compliance. View the report .

The following recommendations were made:

  1. Require provider staff, from the direct service personnel to the Directors, to be trained in how to insure that residents exercise informed choice.
  2. Verify that each individual living in a CRCF or CTH was offered a choice to live in a non-disability residential setting capable of meeting the individual’s needs.
  3. Address the lack of choice in daily activities/programs. Activities that are available to individuals without disabilities may be preferred by some residents.
  4. Require residential agreements or leases for all settings.
  5. As leases expire, disperse Supported Living apartments throughout complexes.
  6. Insure office areas and equipment are separate from resident living areas. Resident information must be kept confidential and staff communications should not be displayed for residents and visitors to view.
  7. Enhance skill-building in the residences…staff shouldn’t do the daily activities, such as cooking meals or shopping for groceries, because it’s quicker or easier than assisting the residents to work on skill development. It was difficult to tell in some settings how much, if any, skill-building was occurring.
  8. Conduct a random site cost-benefit analysis to assess the implications of converting use of large vans to smaller vehicles. Transporting residents using smaller vehicles is less stigmatizing, incents individualized trips and destinations and is likely to have cost efficiencies; these reduced costs may be offset, however, if more staff are needed for transporting.
Glossary of Terms 

Aged, Blind, and Disabled (ABD):  One category of the general population that Medicaid serves through Title XIX of the Social Security Act.

Case Management: Services which help beneficiaries gain access to needed medical, social, educational, and other services.

Centers for Medicare & Medicaid Services (CMS): The agency within the US Department of Health and Human Services responsible for the administration of several key federal health care programs, including Medicaid.

Code of Federal Regulations (CFR, C.F.R.):  A publication of all the regulations issued by Federal administrative agencies.

Community Long Term Care (CLTC): A division within SCDHHS that operates home and community-based waiver programs for persons eligible for nursing home care but who prefer to receive their services in their homes. The division is now called "Long Term Living."

Compliance:  Following established guidelines, specifications, or legislation.

Conflict-Free Case Management (CFCM): Case management services should be "conflict free." This requirement has the following characteristics:

  • Separation of case management from direct services. This helps assure free choice for participants in choosing services and providers. It also serves to prevent any influence from a case manager on a participant to choose the case manager's organization if the organization also provides direct services.
  • Separation of eligibility determination from direct services.
  • Case managers do not establish the levels of funding for individuals.
  • Anyone who is conducting evaluations, assessments and the plan of care/service plan cannot be related by blood or marriage to the individual or any of his or her paid caregivers.

Direct Care: The provisions of individual care by a staff member through a face-to-face encounter.  It may involve aspects of health care, counseling, self-care, education, and assistance with activities of daily living.

Federal Financial Participation (FFP): The distribution of federal dollars to states to pay for a percentage of every Medicaid service.

Federal Medical Assistance Percentage (FMAP):  The portion of the Medicaid program which is paid by the Federal government.

Healthy Connections:  South Carolina’s Medicaid program, operated by SCDHHS, which includes the State Plan services and Waiver Programs.

Home and Community-Based Services (HCBS): Services provided in the home or community to persons who meet an institutional level of care in an effort to keep people home and out of institutions.

Home and Community-Based Settings Requirement:  The actual location or place where an individual receives home and community-based (waiver) services. Home and community-based settings do not include:

  • Nursing homes;
  • Institutions for mental diseases (IMD);
  • Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID);
  • Hospitals; and
  • Any other location that has qualities of an institution.

Level of Care (LOC): The amount of assistance an individual requires to meet their needs.

Long Term Living (LTL) : Formerly CLTC, a division within SCDHHS that operates home and community-based waiver programs for persons eligible for nursing home care but who prefer to receive their services in their homes.

Medicaid: A medical assistance program that helps pay for some or all medical bills for the many people who cannot afford medical care. The program also assists individuals who are over 65 or have a disability with the costs of nursing facility care and other medical expenses. South Carolina Department of Health and Human Services operates the state's Medicaid Program, Healthy Connections.

Medicaid Targeted Case Management (MTCM): Case management services which are aimed specifically at special groups of Medicaid enrollees such as those with developmental disabilities or chronic mental illness.

Person-Centered Planning: A process with the beneficiary at the center that leads to the development of a person-centered service plan that reflects the services and supports important for the individual to meet their identified needs. 

Personal Health Information (PHI): Demographic information, medical history and diagnoses, test and lab results, insurance information, personal dietary plans, treatment information, and other data about an individual collected by a healthcare professional to determine and provide appropriate care.

Personally Identifiable Information (PII): Any data that could personally identify a specific individual.

Setting: The actual location or place where an individual receives home and community-based (waiver) services.

South Carolina Department of Disabilities and Special Needs (SCDDSN or DDSN): South Carolina’s state agency tasked with providing services for persons with intellectual disabilities, related disabilities, head injuries, spinal cord injuries, or autism spectrum disorder and their families.

South Carolina Department of Health and Human Services (SCDHHS or DHHS):  The Single State Agency designated as the administrator of all Medicaid Programs, known as Healthy Connections, in South Carolina. 

South Carolina Department of Mental Health (SCDMH): South Carolina's state agency that provides services and support for adults, children, and their families affected by serious mental illness and significant emotional disorders.

State Plan Services: Services available to all Medicaid-eligible persons, including individuals receiving services from a waiver program.

Waiver Program:  A Medicaid program states can create to provide tailored long-term care services in home and community-based settings rather than institutional settings. In South Carolina, we have seven (7) waiver programs:

  • Community Choices waiver program: Serves persons, 18 or older, who are unable to perform activities of daily living and who meet a nursing facility level of care criteria.
  • Community Supports (CS) waiver program: Serves persons diagnosed with intellectual disabilities or related disabilities and who meet the intermediate care facilities for individuals with intellectual disabilities (ICF/IID) level of care criteria.
  • Head and Spinal Cord Injury (HASCI) waiver program: Serves individuals diagnosed with severe physical impairments involving head and/or spinal cord injuries and who meet either nursing facility or intermediate care facilities for individuals with intellectual disabilities (ICF/IID) level of care criteria.
  • HIV/AIDS waiver program: Serves individuals diagnosed with HIV/AIDS and are considered at risk for hospitalization.
  • Intellectual Disabilities/Related Disabilities (ID/RD) waiver program: Serves persons diagnosed with intellectual disabilities or related disabilities and who meet the intermediate care facilities for individuals with intellectual disabilities (ICF/IID) level of care criteria.
  • Mechanical Ventilator Dependent waiver program: Serves persons, 21 or older, who are dependent on mechanical ventilation and who meet a nursing facility level of care criteria.
  • Medically Complex Children (MCC) waiver program: Serves children from birth to 18 who meet either nursing facility or intermediate care facilities for individuals diagnosed with intellectual disabilities (ICF/IID) level of care criteria.
  • Palmetto Coordinated System of Care (PCSC) waiver program : Serves youth with significant behavioral health challenges or co-occuring conditions who are in, or at imminent risk of, out-of-home placement.
Resources for Person-centered Planning

This section provides a listing of person-centered resources for waiver participants, their families, friends, and advocates.

Topic Areas

  • Waiver participants 
  • Person-centered resources 
  • Self-Determination 
  • Self-Advocacy 
  • Supported Decision Making 
  • Language 
  • Person-centered care 
  • Frequently Asked Questions 

Videos 

Self-Advocate : My Life, My Plan

Self-Advocates: What is Person-centered planning? (Minnesota Governor's Council on Developmental Disabilities)

Waiver Participants 

Links to information for people in Medicaid waiver programs or interested in accessing waiver programs.

Person-centered Resources 

Links to information on what person-centered planning is to help waiver participants

Self-Determination 

Links to resources to help people make their own choices

Self-Advocacy 

Links to resources on how you can speak up for yourself

For Students and the Individualized Education Program (IEP) Process: 

Supported Decision Making 

Links to resources on how people can create a support network to help with important life decisions

Language 

Links to information on appropriate language for people with disabilities

Person-centered Care 

Links to information on person-centered care in a clinical or hospital setting

Training

Click the button below to view all training resources.

Provider Training