HRC will post updates on on this page that we receive about the Self Determination Program, and the state's (Department of Developmental Services) application for approval of federal funding for implementation.
As part of its standard waiver review and approval process, Centers for Medicare and Medicaid Services (CMS) sent a letter to the State asking questions about, and requesting more information on, specific sections in the Self-Determination Program Waiver Application. The Department of Developmental Services, through the Department of Health Care Services, continues to have discussions with CMS to resolve their remaining questions. They hope to provide written responses to answer CMS' questions and secure approval of the waiver in the near future.
As previously reported, DDS must receive approval of a federal Waiver application before California can begin to implement the Self Determination Program. We have been informed that the Center for Medicare and Medicaid Services (CMS) continues to have approximately 30 remaining questions for the Department of Developmental Services (DDS). They are hopeful that in these ongoing discussions, they will be able to resolve any remaining questions from CMS, and then submit what they hope will be a final and successful Waiver application in early 2017 (perhaps in February).
We have been informed that the federal Centers for Medicare and Medicaid Services (CMS) has provided additional questions to DDS regarding their application for a Self Determination Program waiver, which they are working to address.
Therefore the application was not submitted as planned by the end of August. Once all of CMS’ questions have been addressed, the waiver application will be posted on the DDS website for public comment and officially resubmitted to CMS for consideration.
Although last reported that they would resubmit the application to CMS in March, DDS now reports they plan to resubmit by the end of August, (after posting for public comment).
Summary and Update Provided to the Legislature March 2016
"On December 31, 2014, DDS submitted an HCBS Waiver application to CMS seeking federal funding for the Self-Determination Program (SDP). Under the authority of Senate Bill (SB) 468 (Chapter 683, Statutes of 2013) and upon CMS approval, DDS will implement the SDP, allowing regional center consumers and their families more freedom, control and responsibility in choosing services and supports to help them meet objectives in their individual program plans. Under the provisions of SB 468, participation will be limited to 2,500 individuals for the first three years of implementation.
After the Waiver application was originally submitted in December 2014, CMS indicated that it must be withdrawn since DDS had not met public participation policies (specifically posting the application prior to submitting). Additionally, CMS was concerned that the application did not adequately address how the program complied with the new regulations concerning HCBS settings. Subsequently, after working with CMS, the application was revised and resubmitted in September 2015. In a letter dated December 11, 2015, CMS asked for more information regarding information in the application. This is part of the typical review process when applications are submitted to CMS.
In general, some themes in CMS’ questions relate to:
How the settings (where services are provided) comply with the HCBS requirements.
Oversight of providers since regional center vendorization is not required (except for Financial Management Services providers.)
Clarification of service definitions
Clarification of measurements DDS will use to report back to CMS regarding how the self-determination program is meeting federal assurances.
In addition to working through the questions from CMS, in conjunction with the self-determination workgroup DDS is finalizing training materials that will be used for training of regional centers, as required by statute. The Department expects to begin the training in the next few months with participation from workgroup members. Other current activities of the workgroup include identifying suggested qualifications and other requirements for Financial Management Services providers.
While DDS has made a great deal of progress towards implementation, there is notable frustration from Advocates that the program has not moved further along. DDS states that the process for obtaining federal approval typically does not occur quickly under ordinary circumstances, and positions that since self-determination is a new program in California (from CMS’ perspective), these are not ordinary circumstances."
DDS Update December 21, 2015
- As noted in previous updates, the Department submitted the Home and Community-Based Services Waiver application for the Self-Determination Program to the Centers for Medicare and Medicaid Services (CMS) in September of this year. As part of its standard waiver review and approval process, CMS sent a letter to the State asking questions about, and requesting more information on, specific sections in the Self-Determination Program Waiver Application. Following the normal process, the Department will work through the Department of Health Care Services to provide written responses to answer CMS' questions and secure approval of the waiver. Questions about this process can be submitted to the Department via email at email@example.com.
DDS Update October, 2015
- The Self-Determination Program Waiver Application was formally resubmitted to the Centers for Medicare and Medicaid Services on September 29, 2015. DDS is awaiting further questions or direction from CMS.
DDS Update August 7, 2015
- "At the request of the federal government, new language was added to the Self-Determination Program (SDP) Waiver application describing how homes and settings where SDP participants will reside and receive services meet the requirements of the federal home and community-based settings rules that became effective in March 2014. As a result of this change, the Department is required to repost the Waiver application for at least 30 days. The Waiver application will be formally resubmitted to the Centers for Medicare and Medicaid Services shortly after the public comment period, which ends on September 7, 2015. Comments or requests to review a hardcopy of the application can be submitted via email at firstname.lastname@example.org, by phone at (916) 653-7710, or in writing to the Department, Attention Community Services Division, 1600 Ninth Street, Room 320, MS 3-8, Sacramento, CA 95814.