HCBS Federal Regulations

On January 10, 2014 the Centers for Medicare and Medicaid Services (CMS) issued the Medicaid Home and Community-Based Services (HCBS) settings final rule (CMS-2249-P2).  The final regulation addresses several sections of Medicaid law under which states may use federal Medicaid funds to pay for HCBS. The rule establishes requirements for the qualities of settings that are eligible for reimbursement for Medicaid HCBS provided under sections 1915(c), 1915(i), and 1915(k). Click here to read the Final Rule or find more information here.

Information from CMS

CMS has released several fact sheets on the final rule, which can be viewed here:

• Overview of Regulation
• 1915(c):  Changes to HCBS Waiver Program
• 1915(i):  Key Provisions for HCBS State Plan Option
• Summary of Key Provisions of the HCBS Settings Final Rule
• HCBS Final Rule Webinar Presentation Download - Recording and Slides
• Final Rule:  Questions and Answers
• Settings Requirements Compliance Toolkit - Click on the drop down menu to view the toolkit. The toolkit includes a summary of the regulations, schematic drawings of the heightened scrutiny process, HCBS 1915(c) compliance flowchart,  technical guidance on regulatory language, questions and answers regarding home and community-based settings, HCBS FAQs on Planned Construction and Person-Centered Planning Requirements
• Informational Bulletin
• Press Release

Updated Guidance on Home and Community-Based Services Regulation (March 2019)
The Centers for Medicare & Medicaid Services (CMS) has issued updated guidance to State Medicaid Directors on implementing activities associated with the home and community-based services (HCBS) regulation. This guidance, issued as a set of frequently asked questions (FAQs), provides clarification on the “heightened scrutiny” process, which allows states to provide evidence to CMS demonstrating that a setting does not have the qualities of an institution, but does have the qualities of a home and community-based setting. See more information on the Medicaid.gov HCBS Guidance Page.

FAQs Concerning Medicaid Beneficiaries in Home and Community-Based Settings who Exhibit Unsafe Wandering or Exit-Seeking Behavior (December 2016)
The Centers for Medicare & Medicaid Services (CMS) released FAQs concerning Medicaid Beneficiaries in Home and Community-Based Settings who Exhibit Unsafe Wandering or Exit-Seeking Behavior.  These FAQs give states and stakeholders guidance on how to protect individual choice and adhere to the requirements of person-centered planning for those individuals with dementia and who exhibit unsafe wandering and exit-seeking behaviors. In the FAQs, CMS highlights that "person-centered planning, staff training and care delivery are core components of provider operations to meet HCBS requirements while responding to unsafe wandering or exit-seeking behavior in an individualized manner." 

CMS Announces Extension for States Under Medicaid Home- and Community-Based Settings Rule
The Centers for Medicare & Medicaid Services (CMS) has announced a five-year extension for state Medicaid programs to meet the Home- and Community-Based (HCBS) settings requirements for settings operating before March 17, 2017. States now have until March 17, 2022, to demonstrate compliance for the final rule. See the announcement from CMS here. This extension is in response to states' request for more time to demonstrate compliance with the regulatory requirements and ensure compliance activities are collaborative, transparent, and timely. For more information, please visit here. 

Additional Information

Key State Policy Choices About Medicaid Home and Community-Based Services (April 2019)
Kaiser Family Foundation

Key Questions About Medicaid Home and Community-Based Services Waiver Waiting Lists (April 2019)
Kaiser Family Foundation

State Transition Plans for New Medicaid HCBS Regulations: Four Tips for Consumer Advocates

New Medicaid Home and Community-Based Services Rules - SLTCO Dialogue (May 28, 2014)
This webinar discussed the new Medicaid Home and Community-Based Services Rules that went into effect March 17, 2014, which for the first time set standards to ensure Medicaid HCBS is provided in the most integrated community setting and require person-centered care.  Eric Carlson with the National Senior Citizens Law Center and Robyn Grant with the Consumer Voice gave a quick overview of the new rules and how they will impact consumers, and Becky Kurtz with AoA at ACL and Elizabeth Priaulx with the National Disability Rights Network shared the federal perspective and new resources. Recording. Advocacy Checklist and Resources for Impacting State Compliance with Medicaid Home and Community Based Services Settings Rule