Guidance

Request for Information – Provision of Timely and Quality Home and Community Based Services

A Request for Information was issued on November 04, 2016 to solicit public input on ways to strengthen the provision of home and community-based services. Comments are due on January 9, 2017. Stakeholders are encouraged to provide feedback on potential actions CMS could consider to enhance access to quality and safe services.

Home and Community Based Services (HCBS) Final Regulation

The final Home and Community-Based Services regulations set forth new requirements for several Medicaid authorities under which states may provide home and community-based long-term services and supports. The regulations enhance the quality of HCBS and provide additional protections to individuals that receive services under these Medicaid authorities.

• Final Regulation: 1915(i) State Plan HCBS, 5-Year Period for Waivers, Provider Payment Reassignment, Setting Requirements for Community First Choice, and 1915(c) HCBS Waivers - CMS-2249-F/CMS-2296-F
  • Informational Bulletin - Final regulations for HCBS provided under Medicaid’s 1915(c), 1915(i) and 1915(k) authorities
  • Press Release - Final regulations for HCBS provided under Medicaid’s 1915(c), 1915(i) and 1915(k) authorities
  • Fact Sheets Regarding Final Regulation CMS-2249-F/CMS-2296-F
    • 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
    • Final Rule: Questions and Answers

Settings Requirements Compliance Toolkit

CMCS is pleased to share with State Medicaid Agencies, Operating Agencies, and other stakeholders a Home and Community-Based Settings Toolkit to assist states develop Home and Community-Based 1915(c) waiver and 1915(i) SPA amendment or renewal application(s) to comply with new requirements in the recently published Home and Community Based Services' (HCBS) regulations.
The toolkit includes:

• FAQs concerning Medicaid Beneficiaries in Home and Community-Based Settings who Exhibit Unsafe Wandering or Exit-Seeking Behavior
• A summary of the regulatory requirements of fully compliant HCB settings and those settings that are excluded.
• Schematic drawings of the heightened scrutiny process as a part of the regular waiver life cycle and the HCBS 1915(c) compliance flowchart.
• Additional technical guidance on regulatory language regarding settings that isolate.
• Exploratory questions that may assist states in the assessment of: 
  • Residential Settings
  • Non-Residential Settings
• Questions and Answers Regarding Home and Community-Based Settings
• Statewide Transition Plan Toolkit for Alignment with HCB Settings Regulation Requirements Suggestions for alternative approaches and considerations for states as they prepare and submit Statewide Transition Plans for the new federal requirements for residential and non-residential home and community-based settings. The regulatory requirements can be found at 42 CFR 441.301(c)(4)(5) and 441.710(a)(1)(2).
• Frequently Asked Questions Regarding the Heightened Scrutiny Review Process and Other Home and Community-Based Settings Information
• Frequently Asked Questions on Planned Construction and Person-Centered Planning Requirements

Additional Resources

Modifications to Quality Measures and Reporting in §1915(c) Home and Community-Based Waivers

State Medicaid Director’s Letter- August 2010 – Improving Access to Home and Community-Based Services

Strengthening Program Integrity in Medicaid Personal Care Services

Home and Community Based Services (HCBS) Training Series – Webinars Presented During SOTA Calls

This site provides a link to the PowerPoints developed by CMS Contractors for webinar trainings which were presented during calls with the states. These webinars focused on a variety of HCBS topics such as Home and Community-Based settings requirements, the Heightened Scrutiny Process, Fiscal Integrity with a focus on Personal Care Services, and Conflict of Interest.