Home and Community Based Services Transition Plan Survey Question Title * 1. I am Waiver service recipient Parent/guardian of a waiver service recipient Provider Agency/Administrator of waiver services Direct Care worker Advocate State employee Other (please specify) Question Title * 2. I found out about the Transition Plan from: Public Notice My case manager/care coordinator/support coordinator Word of mouth/email Other (please specify) Question Title * 3. I have reviewed the proposed Transition Plan. Yes No Question Title * 4. The Transition Plan section that addresses Identification (identifying all elements of waiver services policy and regulation that are subject to new regulations) is reasonable. Yes No If no, please suggest changes. Question Title * 5. The Transition Plan section that addresses Assessment (describing how and what will be assessment and the assessment process) is reasonable. Yes No If no, please suggest changes. Question Title * 6. The Transition Plan section that addresses Remediation (the plan to fix or change those elements of waiver policy that require changing) is reasonable. Yes No If no, please suggest changes. Question Title * 7. The Transition Plan section that addresses Outreach and Engagement (describing how public input is incorporated in the process) is reasonable. Yes No If no, please suggest changes. Question Title * 8. Following my review of the Transition Plan, I understand the direction the state is trying to take to address the new CMS regulations around home and community-based services settings. Agree Somewhat Agree Somewhat Disagree Disagree Question Title * 9. The opportunity to provide feedback to this process is meaningful. Agree Somewhat Agree Somewhat Disagree Disagree Done