Home & Community Based Services
Home and community-based services (HCBS) provide opportunities for Medicaid beneficiaries to receive services in their own home or community. These programs serve a variety of targeted populations groups, such as people with mental illnesses, intellectual or developmental disabilities, and/or physical disabilities.
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
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:
- 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:
- 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).
- HCBS Basic Element Review Tool for Statewide Transition Plans and HCBS Content Review Tool for Statewide Transition Plans
- Frequently Asked Questions Regarding the Heightened Scrutiny Review Process and Other Home and Community-Based Settings Information
State Medicaid Director’s Letter- August 2010 – Improving Access to Home and Community-Based Services
HCBS first became available in 1983 when Congress added section 1915(c) to the Social Security Act, giving States the option to receive a waiver of Medicaid rules governing institutional care. In 2005, HCBS became a formal Medicaid State plan option. Several States include HCBS services in their Medicaid State plans. 47 States and DC are operating at least one 1915(c) waiver.
State Medicaid agencies have several HCBS options:
- 1915 (c) Home and Community-Based Waivers
- 1915(i) State Plan Home and Community-Based Services
- 1915(j) Self-Directed Personal Assistance Services Under State Plan
- 1915(k) Community First Choice
CMS works with States to assure and improve quality in Medicaid HCBS waiver programs. See page on quality monitoring of HCBS waivers for more information
CMS has developed the following reports that highlight promising practices in home and community-based services offered by States to enable persons of any age who have a long-term illness or disability to live in the most integrated community setting appropriate to their individual support requirements and preferences.
State Transition Plans
The final HCBS regulation published January 26, 2014, requires states operating a section 1915(c) waiver or a section 1915(i) state plan benefit (that was in effect on or before March 17, 2014) to submit a statewide transition plan addressing compliance with the regulation. More information about this plan is available in the Statewide Transition Plan Toolkit for Alignment with HCBS Settings Regulation Requirements.
In an effort to keep stakeholders apprised of the status of HCBS Statewide Transition Plans (STP), the following documents will be posted on the Statewide Transition Plans page, as they become available or are sent to states:
- Proposed Plan URL: The URL link to the STP the state submitted to CMS.
- Public Comment: The communication CMS sends to the state regarding concerns with public notice, public input or the summary of the public comment requirements of the regulations.
- CMIA: Clarifications and/or Modifications required for Initial Approval: The communication CMS sends to the state notifying the state that public comment, input and summary requirements are met, but CMS has identified issues that must be resolved in the STP prior to initial approval.
- Initial Approval with Milestones and a Resubmission Date: The communication CMS sends to the state notifying the state that public comment, input and summary requirements are met, the STP is sufficient, but systemic and/or site-specific assessments are not yet completed. The response to the state will vary dependent on whether the state has or has not identified settings that are presumed to have institutional characteristics and any information the state may wish CMS to consider under the heightened scrutiny process.
- Final Approval: The communication CMS sends to the state notifying the state that public comment, input and summary requirements are met, the STP has provided all necessary information including but not limited to; systemic assessment, site specific assessment, settings presumed to have institutional characteristics, information regarding heightened scrutiny or the state’s decision to let the presumption stand, and clear remedial steps with milestones are delineated.
- Approved Plan: The CMS approved STP is posted on the Statewide Transition Plans page.