CMS Rule on Home and Community Based Waiver Services

Centers for Medicare and Medicaid Services (CMS) New Rule on Home and Community Based (WAIVER) Services (HCBS)

On January 16, 2014 the Centers for Medicare and Medicaid Services issued final regulations governing various aspects of Medicaid-funded home and community-based services.  The new Rule states that all individuals receiving HCBS have the right to receive services in non-disability specific settings.  The new rule has enormous potential for reshaping the way in which future Medicaid-funded HCB services and supports are delivered.

The State has submitted a transition plan to be incompliance with the rule by March 17, 2019 to CMS.  The state is waiting for approval of its transition plan from CMS.

The rule specifies that all HCBS/Waiver settings (residential and daytime program settings) must meet the qualifications outlined below.

The setting must:

  • be integrated in and support full access to the surrounding community;
  • selected by the individual from among available options;
  • ensure individual rights of privacy, dignity and respect and freedom from coercion and restraints;
  • optimize autonomy and independence in making life choices; and
  • facilitate choice regarding services and the individuals/entity providing them.

There are requirements governing provider-owned or controlled HCBS settings.

In such settings:

  • Participants must have privacy in their units, including lockable doors, choice of roommates and freedom to furnish or decorate the unit;
  • The individual must control his/her schedule, including access to food at all times;
  • The individual has the right to have visitors at any time; and
  • The setting must be physically accessible.

The new regulations identify settings that are presumed not to meet the requirements:

  • A publicly or privately operated facility that provides inpatient institutional treatment
  • Settings in a building on the grounds of, or adjacent to, a public institution
  • Settings with the effect of isolating individuals from the broader community

If you have questions about settings meeting the new regulations or want more information you may contact: