(1) CTS is a one-time service that funds non-recurring residential set-up expenses for an individual who is moving:

(i) from:

(a) an OPWDD operated or certified residential setting, including a family care home;

(b) a State funded private residential school, or State operated residential school; or

(c) a Medicaid funded institutional placement;

(ii) to a non-certified community living arrangement within New York State where the individual will be responsible for his or her own living expenses.

(2) CTS allowable expenses are those expenses that are specific to the establishment of a residence, and include:

(i) furniture;

(ii) window treatments (curtains, blinds, etc.), rugs, and lighting (lamps, bulbs, etc.);

(iii) food preparation items (small kitchen appliances, cookware, dishes, etc.);

(iv) bed and bath linens;

(v) set-up fees and utility deposits (telephone, electricity, heating, water, etc.);

(vi) pre-occupancy services necessary for the person's health and safety (e.g., pest eradication, allergen control, or cleaning before occupancy);

(vii) moving expenses;

(viii) the security deposit for a residential lease; and

(ix) other expenses prior approved by OPWDD.

(3) CTS allowable expenses must be incurred within ninety days before and ninety days after the date the individual moves into the qualifying non-certified living arrangement.

(4) Recurring expenses are not CTS allowable expenses. These expenses include, but are not limited to:

(i) monthly rental or mortgage expenses;

(ii) regular (monthly, quarterly, etc.) utility charges;

(iii) regular (monthly, quarterly, etc.) cable, telephone, or internet expenses;

(iv) food; and

(v) hygiene supplies.

(5) Expenses for items that solely provide diversion or recreation, such as televisions, computers, stereos, DVD players, and video games, are not CTS allowable expenses.

• Section 635-10.5 is amended by the addition of a new subdivision (ae) as follows:

(1) Community Transition Services (CTS) provides a once in a lifetime payment for residential set up expenses. CTS can only be provided by a Non-State provider agency that is approved by OPWDD to provide Fiscal Intermediary (FI) services. Payment for CTS will be made to the approved FI services provider.

(2) CTS is administered by the FI services provider. The FI services provider must:

(i) retain receipts to support allowable expenditures; and

(ii) bill for allowable expenditures in $10 increments.

(3) Payment to the FI for CTS requires authorization from OPWDD. The authorization will be based on the following criteria:

(i) the individual's choice of CTS must be documented in his or her Individualized Service Plan (ISP) in the format specified by OPWDD; and

(ii) the individual must be enrolled in the Home and Community Based Services (HCBS) Waiver.

(4) CTS expenses must be allowable in accordance with the provisions of subdivision 635-10.4(i) of this Subpart.

(5) The unit of service for CTS is a cumulative one-time expenditure.

(6) Effective November 1, 2014, the CTS payment for each individual will be the lesser of:

(i) the total of CTS allowable expenses, rounded down to the nearest $10; or

(ii) $3,000.

1. Statutory Authority:

a. OPWDD has the statutory responsibility to provide and encourage the provision of appropriate programs and services in the area of care, treatment, rehabilitation, education and training of persons with developmental disabilities, as stated in the New York State (NYS) Mental Hygiene Law Section 13.07.

b. OPWDD's has the authority to adopt rules and regulations necessary and proper to implement any matter under its jurisdiction as stated in the NYS Mental Hygiene Law Section 13.09(b).

c. OPWDD has the statutory authority to adopt regulations concerning the operation of programs and provision of services and facilities pursuant to the NYS Mental Hygiene Law Section 16.00.

2. Legislative Objectives: The proposed amendments further the legislative objectives embodied in sections 13.07, 13.09, and 16.00 of the Mental Hygiene Law. The proposed amendments establish standards for the provision and funding of Community Transition Services (CTS) under the Home and Community-Based Services (HCBS) waiver.

3. Needs and Benefits: The purpose of CTS is to fund residential set up expenses for individuals with developmental disabilities who are moving out of OPWDD certified or operated residential facilities, residential school programs, or Medicaid funded institutional placements and into non-certified community living arrangements where the individuals will be responsible for their own living expenses. This service supports OPWDD's commitment to the federal Centers for Medicare and Medicaid Services to move people receiving services from institutional settings and other certified settings into the most integrated community settings, by providing a once in a lifetime reimbursement for allowable expenses, such as the purchase of furniture or other household goods needed to establish a home.

OPWDD certified or operated residential facilities, residential schools, and Medicaid funded institutional settings are required to furnish, equip, and maintain the facilities to meet the needs of the individuals who live there. Most individuals who reside in these settings do not own household goods and do not have sufficient personal funds to purchase them or to afford other expenses such as utility deposits or moving expenses.

The proposed regulations outline requirements pertaining to the provision and funding of this new service.

OPWDD considers CTS a valuable support for independent living, consistent with implementation of Governor Andrew M. Cuomo’s New York State Olmstead Plan for community integration of individuals with developmental disabilities.

4. Costs:

a. Costs to the Agency and to the State and its local governments:

CTS will result in some costs for the State in its role as paying for Medicaid. OPWDD expects that during the first year (2014 - 2015), the service will be provided to approximately 109 individuals who resided in OPWDD operated or certified facilities and will cost up to $3000 for each individual receiving CTS (a total of $327,000). OPWDD also expects that approximately 40 individuals who resided in other qualifying residential or institutional settings will receive CTS (an additional total of $121, 000) during the first year. OPWDD expects that during the second year (2015-2016), the service will be provided to approximately 206 individuals, at a similar fee. OPWDD is not able to quantify additional costs during subsequent years There will also be limited additional costs for Fiscal Intermediary (FI) services to administer CTS for individuals who receive CTS, but do not otherwise use FI services to self-direct their services.

OPWDD expects some overall long term savings in that CTS, as a support for independent living, will contribute to successfully moving individuals from more costly Medicaid funded institutional, residential school, and certified group living environments to less costly non-certified independent living environments with a variety of Medicaid funded and non-Medicaid funded services and supports. However, OPWDD cannot quantify the expected savings.

The regulations will not have any fiscal impact on local governments as the contribution of local governments to Medicaid has been capped. Chapter 58 of the Laws of 2005 places a cap on the local share of Medicaid costs and local governments are already paying for Medicaid at the capped level.

OPWDD will not incur costs as a provider of services, because CTS will not be provided by OPWDD.

b. Costs to private regulated parties:

CTS will be provided by Non-State provider agencies that are approved to provide Fiscal Intermediary (FI) services. CTS will be administered through the FI and will result in no costs to the provider agencies beyond those incurred by the FI. The FI will be paid a fee for the FI services. The maximum $3000 CTS reimbursement is a pass through.

5. Local Government Mandates: There are no new requirements imposed by the rule on any county, city, town, village; or school, fire, or other special district.

6. Paperwork: There is some paperwork associated with this service. The proposed regulations require providers to retain documentation, including receipts for allowable expenditures. In addition, payment for Community Transition Services requires prior authorization from OPWDD based on criteria, including documentation of the individual's choice of the services in his or her Individualized Service Plan (ISP). This paperwork will be completed through the provider agency's FI services.

7. Duplication: The proposed amendments do not duplicate any existing State or Federal requirements that are applicable to these services.

8. Alternatives: Alternatives: OPWDD only considered one significant alternative to the proposed amendments. This alternative was excluding security deposits from reimbursable costs. OPWDD rejected this alternative for two reasons. First, when OPWDD described the CTS service to the federal Centers for Medicare and Medicaid Services for inclusion in the HCBS waiver, reimbursing security deposits was an important element of the service design. Second, reimbursing security deposits will remove an obstacle faced by individuals who are moving from institutions to community settings.

9. Federal Standards: The proposed amendments do not exceed any minimum standards of the federal government for the same or similar subject areas.

10. Compliance Schedule: OPWDD is planning to adopt the proposed regulations effective November 15, 2014. Provider agencies that opt to offer CTS will need to become familiar with the service delivery, documentation, and billing requirements in advance of providing the service, and any individual interested in receiving the service will need to work with his or her service coordinator to add the service to his or her ISP. OPWDD plans to provide all necessary information and guidance to providers regarding the new requirements with enough lead time that they can begin to provide the new service on November 15, 2014. In addition, if providers are not ready to provide the service on November 15, 2014, providers can opt to begin the provision of the new service at a later date.

1. Effect on Small Business: OPWDD has determined, through a review of the certified cost reports, that most OPWDD-funded services are provided by non-profit agencies that employ more than 100 people overall. However, some smaller agencies that employ fewer than 100 employees overall would be classified as small businesses. OPWDD is unable to estimate the portion of these agencies that may be considered to be small businesses. OPWDD anticipates that some of these agencies will opt to provide the new Community Transition Services (CTS) established in the proposed regulation; however, OPWDD is unable to estimate the number of agencies that will opt to provide the new service and that will be subject to the proposed regulations.

The proposed regulations have been reviewed by OPWDD in light of their impact on these small businesses and on local governments. OPWDD has determined that the proposed regulations will not have any negative effects on small business providers of CTS.

The proposed regulations establish standards for the provision and funding of CTS under the Home and Community-Based Services (HCBS) waiver. The purpose of CTS is to fund residential set up expenses for individuals with developmental disabilities who are moving out of OPWDD certified or operated residential facilities, residential school programs, or Medicaid funded institutional placements and into non-certified community living arrangements where the individuals will be responsible for their own living expenses.

2. Compliance Requirements: CTS can only be provided by Non-State provider agencies that are approved to provide Fiscal Intermediary (FI) services. The proposed regulations will impose compliance requirements on agencies that opt to provide CTS and FI services. These provider agencies will be responsible to ensure that individuals receiving services meet eligibility requirements; that expenses are allowable and are incurred within the required timeframe; and that appropriate documentation is retained to support allowed expenses.

OPWDD considers that the compliance requirements are necessary to ensure the proper use of federal and state public funds and considers that they are not burdensome for small business providers of CTS and FI services.

The amendments will have no effect on local governments.

3. Professional Services: There are no additional professional services required as a result of these proposed regulations and the regulations will not add to the professional service needs of local governments.

4. Compliance Costs: CTS will be administered through the FI and will result in no costs to the provider agencies beyond those incurred by the FI. The FI will be paid a fee for the FI services. The maximum $3000 CTS reimbursement is a pass through.

5. Economic and Technological Feasibility: The proposed regulations do not impose the use of any new technological processes on regulated parties.

6. Minimizing Adverse Impact: The purpose of CTS is to fund residential set up expenses for individuals with developmental disabilities who are moving out of OPWDD certified or operated residential facilities, residential school programs, or Medicaid funded institutional placements and into non-certified community living arrangements where the individuals will be responsible for their own living expenses. OPWDD considers CTS a valuable support for independent living, consistent with implementation of Governor Andrew M. Cuomo’s New York State Olmstead Plan for community integration of individuals with developmental disabilities. The proposed regulations outline requirements pertaining to the provision and funding of this new service. Providers will be fully reimbursed for CTS allowable expenses made by or on behalf of the individual receiving services. The administration of CTS, such as billing and retaining documentation of expenses, will be provided through the provider agencies' FI services. The FI will be paid a fee for the FI services. The maximum $3000 CTS reimbursement is a pass through.

OPWDD reviewed and considered the approaches for minimizing adverse economic impact as suggested in section 202-b(1) of the State Administrative Procedure Act (SAPA). OPWDD considered including the administration of CTS and a set minimum amount of allowable expenses in the once in a lifetime fee for CTS, but OPWDD determined that the administration of the service through an agency's FI services and establishment of a maximum once in a lifetime fee would be less burdensome on provider agencies.

7. Small Business Participation: OPWDD met with representatives of provider agencies to discuss HCBS Waiver services, including CTS, during March 2014. These representatives included the New York State Association of Community and Residential Agencies (NYSACRA), which represents some providers that have fewer than 100 employees. OPWDD is planning to adopt the proposed regulations effective November 15, 2014. OPWDD plans to provide all necessary information and guidance to providers, including small business provider agencies, regarding the new requirements with enough lead time that they can begin to provide the new service on November 15, 2014. In addition, if providers are not ready to provide the service on November 15, 2014, providers can opt to begin the provision of the new service at a later date.

8. (IF APPLICABLE) For rules that either establish or modify a violation or penalties associated with a violation: The proposed regulations do not establish or modify a violation or penalties associated with a violation.

1. Description of the types and estimation of the number of rural areas in which the rule will apply: OPWDD services are provided in every county in New York State. 43 counties have a population of less than 200,000: Allegany, Cattaraugus, Cayuga, Chautauqua, Chemung, Chenango, Clinton, Columbia, Cortland, Delaware, Essex, Franklin, Fulton, Genesee, Greene, Hamilton, Herkimer, Jefferson, Lewis, Livingston, Madison, Montgomery, Ontario, Orleans, Oswego, Otsego, Putnam, Rensselaer, St. Lawrence, Schenectady, Schoharie, Schuyler, Seneca, Steuben, Sullivan, Tioga, Tompkins, Ulster, Warren, Washington, Wayne, Wyoming and Yates. Additionally, 10 counties with certain townships have a population density of 150 persons or less per square mile: Albany, Broome, Dutchess, Erie, Monroe, Niagara, Oneida, Onondaga, Orange, and Saratoga.

The proposed regulations have been reviewed by OPWDD in light of their impact on rural areas. OPWDD has determined that the proposed regulations will not have any negative effects on rural area providers of CTS.

The proposed regulations establish standards for the provision and funding of CTS under the Home and Community-Based Services (HCBS) waiver. The purpose of CTS is to fund residential set up expenses for individuals with developmental disabilities who are moving out of OPWDD certified or operated residential facilities, residential school programs, or Medicaid funded institutional placements and into non-certified community living arrangements where the individuals will be responsible for their own living expenses.

2. Compliance requirements: CTS can only be provided by Non-State provider agencies that are approved to provide Fiscal Intermediary (FI) services. The proposed regulations will impose compliance requirements on agencies that opt to provide CTS and FI services. These provider agencies will be responsible to ensure that individuals receiving services meet eligibility requirements; that expenses are allowable and are incurred within the required timeframe; and that appropriate documentation is retained to support allowed expenses.

OPWDD considers that the compliance requirements are necessary to ensure the proper use of federal and state public funds and considers that they are not burdensome for rural area providers of CTS and FI services.

3. Professional services: There are no additional professional services required as a result of these regulations and the regulations will not add to the professional service needs of local governments.

4. Compliance costs: CTS will be administered through the FI and will result in no costs to the provider agencies beyond those incurred by the FI. The FI will be paid a fee for the FI services. The maximum $3000 CTS reimbursement is a pass through.

5. Minimizing adverse economic impact: The purpose of CTS is to fund residential set up expenses for individuals with developmental disabilities who are moving out of OPWDD certified or operated residential facilities, residential school programs, or Medicaid funded institutional placements and into non-certified community living arrangements where the individuals will be responsible for their own living expenses. OPWDD considers CTS a valuable support for independent living, consistent with implementation of Governor Andrew M. Cuomo’s New York State Olmstead Plan for community integration of individuals with developmental disabilities. The proposed regulations outline requirements pertaining to the provision and funding of this new service. Providers will be fully reimbursed for CTS allowable expenses made by or on behalf of the individual receiving services. The administration of CTS, such as billing and retaining documentation of expenses, will be provided through the provider agencies' FI services. The FI will be paid a fee for the FI services. The maximum $3000 CTS reimbursement is a pass through.

OPWDD reviewed and considered the approaches for minimizing adverse economic impact as suggested in section 202-b(1) of the State Administrative Procedure Act (SAPA). OPWDD considered including the administration of CTS and a set minimum amount of allowable expenses in the once in a lifetime fee for CTS, but OPWDD determined that the administration of the service through an agency's FI services and establishment of a maximum once in a lifetime fee would be less burdensome on provider agencies.

6. Participation of public and private interests in rural areas: OPWDD met with representatives of provider agencies to discuss HCBS Waiver services, including CTS, during March 2014. These representatives included the New York State Association of Community and Residential Agencies (NYSACRA), which represents some rural area provider agencies. OPWDD is planning to adopt the proposed regulations effective November 15, 2014. OPWDD plans to provide all necessary information and guidance to providers regarding the new requirements with enough lead time that they can begin to provide the new service on November 15, 2014. In addition, if providers are not ready to provide the service on November 15, 2014, providers can opt to begin the provision of the new service at a later date.

OPWDD is not submitting a Job Impact Statement for this proposed rulemaking because this rulemaking will not have a substantial adverse impact on jobs or employment opportunities.

The purpose of Community Transition Services (CTS) is to fund residential set up expenses for individuals with developmental disabilities who are moving out of OPWDD certified or operated residential facilities, residential school programs, or Medicaid funded institutional placements and into non-certified community living arrangements where the individuals will be responsible for their own living expenses. CTS can be provided only once in a lifetime to an individual receiving services.

CTS will be provided by Non-State provider agencies that are approved to provide Fiscal Intermediary (FI) services. CTS will be administered through the FI services and OPWDD expects that those administration duties will be absorbed by existing FI staffing arrangements.

Therefore, the proposed regulations will not have any substantial adverse impact on jobs or employment opportunities.