Defining "Community" and other HCBS Waiver Proposals: VOR Comments

VOR’s comments relate to the three substantive sections of the proposed federal rule:

(I) Target Groups;
(II) HCBS settings (defining “community”); and
(III) Person-Centered Planning.

Click here to read VOR Comments: CMS-2296-P, April 15, 2011


VOR Submits Federal Comments on Medicaid and Community

On August 17, 2009, VOR submitted its comments in response to the federal Advance Notice of Proposed Rulemaking (ANPRM), released by the Centers for Medicare and Medicaid Services (CMS), the federal agency within the U.S. Department of Health and  Human Services which oversees Medicaid programs. The ANPRM asked for comments relating to allowing states to combine home and community-based services (HCBS) waivers for people with different disabilties who have similar functional needs. CMS also sought input on how to define "community."

In its comment, VOR expressed significant concern that current state budget woes and administrative conveniences would prove too great of temptations to States, leading to dangerous comingling of people with incompatable disability-types, leading to tragic consequences. Many real life examples were cited to reinforce VOR's stated concerns. With regard to defining community, VOR pointed out that both facilities and smaller settings can be "integrated." Our comments reinforce the need for choice, and Olmstead's support for choice.


VOR Members Respond to State Home and Community Based Services Transition Plans

The federal regulation defining Home and Community-Based Settings (HCBS) for the purpose of Medicaid HCBS funding requires that States align their Medicaid plans and settings (residential and employment) with the new regulation’s requirements. States must submit a “transition” plan which describes for CMS why current programs are, or will become, aligned with the new regulation. Before submitting their transition plans, the regulation requires states provide for public comment.

In two States – Kentucky and Pennsylvania – VOR members have submitted comments.

Additional VOR member comments will be posted on VOR’s website as they are received. Unless stated otherwise, member comments were developed and submitted independent of VOR.
To see when your State will be submitted its transition plan, visit

VOR's Georgia Affiliate Submits Comment in Response to State's I/DD Remedial Plan

August 26, 2014

In March 2014, the Independent Reviewer overseeing the Settlement Agreement in U.S. v. Georgia cited State non-compliance in areas affecting the health and well-being of affected citizens with intellectual and developmental disabilities (tragedies that were also reported in the press). In addition to ordering a continued moratorium on the transitions of individuals with I/DD from State Hospitals (Medicaid licensed Intermediate Care Facilities for Individuals with Intellectual Disabilities), the Independent Reviewer required that the State write a plan by June 30, 2014 that is designed to bring the State’s support coordination system into compliance.”

The VOR Georgia affiliate, East Central Regional Hospital Family Council, with VOR’s support, recently offered its comments in response to this “Priority Plan.”

Read the Family Council/VOR letter here


VOR’s Kansas State Coordinator, Joan Kelly, Delivers Testimony Before KanCare Oversight Committee

August 12, 2014

Testimony on KanCare Oversight: Challenges and Outcomes for our Most Vulnerable
Before the Robert G. (Bob) Bethell Joint Committee On Home And Community Based Services And Kancare Oversight

Delivered by Joan Kelly, Stakeholder and Legal Guardian
[Vice President, Kansas Neurological Parent Group; VOR Kansas State Coordinator]

Good afternoon, Chairman David Crum and members of the Committee,

Thank you for the opportunity to give presentation today, and I want to commend this
Committee for your ongoing work and service.

As a stakeholders who believe in community, my husband and I utilized an array of community based services for our profoundly disabled grandson in the State of Kansas beginning 1998.

Our loved one currently lives at KNI, the Kansas Neurological Institute, residing there since the fall of 2008. He was placed there after exhausting every community option, and although we have sought reintegration, our search continues, as unfortunately, a number of community providers have refused to serve him.

People as Pendulums: Deinstitutionalization and People with Intellectual and Developmental Disabilities

By Tamie Hopp, VOR Director of Government Relations & Advocacy in Nonprofit Quarterly, July 16, 2014 (and reprinted in the Summer 2014 Nonprofit Quarterly Print edition)

Early reforms were quite properly motivated by the need for a system of care and supports that responded to the very individualized and diverse needs of the entire population of people with I/DD. These reforms, however, also set the stage for decades of ongoing deinstitutionalization, resulting in the elimination of specialized housing, employment and education options for people with I/DD, leaving some to question the price of “progress.”

The Pendulum Swings

Even though initial reforms were motivated by a lack of service options (an over-reliance on the ICF/IID program), it was not long before efforts to “rebalance” our system of care shifted from the expansion of options to the dramatic reduction of ICFs/IID and other specialized options.

In 1999, the Supreme Court handed down its landmark Olmstead v. L.C. decision, which should have settled the deinstitutionalization debate. 

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