HCBS Settings Rule

In January 2014, the Centers for Medicare & Medicaid Services (CMS) announced new rules for the nature of residential and day service settings funded through Medicaid as part of Home and Community Based Services (HCBS). The final rules require that all HCBS settings must:

  • Be integrated in and facilitate full access to the greater community
  • Optimize autonomy and independence in making life choices
  • Be chosen by the individual from among residential and day options, including non-disability specific settings
  • Ensure the right to privacy, dignity, respect and freedom from coercion and restraint
  • Provide an opportunity to seek competitive employment
  • Provide individuals an option to choose a private unit in a residential setting
  • Facilitate choice of services and who provides them

National Organizations Release Toolkit to Help Stakeholders Advocate for Strong Implementation of HCBS Settings Rule:

January 25, 2016: The Bazelon Center, together with other disability and aging advocacy groups, issued a toolkit to help advocates push for strong implementation of the new Home and Community Based Services (HCBS) Settings Rules in their states.  The new HCBS Settings Rules require all settings funded by Medicaid HCBS programs to, among other things, provide opportunities for participants to be integrated in and engage in community life, have access to the community, control their personal resources, and seek employment and work in competitive settings.  States have up until March 2019 to transition their HCBS programs into full compliance with the new settings requirements.

The extent to which these new rules are a catalyst for positive change in states’ service systems will depend on the strength of each state’s transition plan, as well as the ability of stakeholders and advocates to influence the plan and monitor its implementation.  All states have already submitted to CMS their initial transition plans, and CMS has provided feedback to states about needed improvements and next steps for amending and implementing their transition plans.  The next several months are an important time to become involved because this is when important decisions at the state level will be made and the parameters of state plans will be set. CMS has indicated that they are looking closely at public comments – advocates’ voices matter!

This new toolkit provides advocates with detailed information about the HCBS Settings Rule and provides action steps for advocates to impact implementation of the new rules in their states.  The toolkit contains three documents:  (1) The Medicaid Home and Community-Based Services Settings Rules: What You Should Know; (2) Home and Community-Based Services Regulations Q&A: Settings Presumed to be Institution & the Heightened Scrutiny Process, and (3) The Home and Community-Based Settings Rules: How to Advocate for Truly Integrated Community Settings (unabridged and abridged).

The Bazelon Center developed this toolkit together with a coalition of other disability and aging advocates working together for strong implementation of the HCBS Settings Rule – the American Network of Community Options and Resources, Association of People Supporting Employment First, Association of University Centers on Disabilities, Autistic Self Advocacy Network, Coalition to Promote Self-Determination, Justice in Aging (formerly National Senior Citizens Law Center), Human Services Research Institute, National Association of Councils on Developmental Disabilities, National Consumer Voice for Quality Long Term Care, National Council on Independent Living, National Disability Rights Network, National Down Syndrome Congress, National Health Law Program, TASH, and The Arc of the United States.

To learn more about the HCBS rules, see http://bit.ly/BazelonHCBSrules and www.HCBSadvocacy.org, a website with up-to-date information about the rules and states’ implementation maintained by several member organizations in the coalition.