In 2014, the federal Centers for Medicare & Medicaid Services (CMS) published regulations in the Federal Register that changed the definition of home and community-based settings for the 1915(c) and 1915(i) Medicaid HCBS waivers. The new definition considers a person’s experience and outcomes in addition to a setting’s location, geography or physical characteristics. CMS has given states until March 2023 (see update under the News tab) to bring their systems into compliance with the new HCBS settings requirements. View the Home and Community-Based Services Rule Overview video for more information.
March 2022: DHS has received summary feedback from CMS on evidentiary packages that were submitted and randomly selected as part of the heightened scrutiny process. However, we have not received setting-specific feedback to share with affected settings at this time. We will work with providers on any actions identified by CMS through the heightened scrutiny process as we receive information.
March 2020-March 2022: The heightened scrutiny preparation/submission process was put on hold because of the COVID 19 pandemic. However, during this time DHS and our contractor continued to provide targeted support to providers to change practices to comply with the rule and/or improve practices.
February 2019-January 2020: DHS solicited public comment for a total of 184 settings. As of January 2020, evidentiary packages for 130 settings were submitted to CMS for heightened scrutiny review.
The process to submit public comments and copies of evidentiary packages for review are on the HCBS settings heightened-scrutiny process webpage. Batch 5 evidentiary packages are now posted for public comment (on the Public comment tab). Public comment schedule:
Batch 1: Public comment period held from Feb. 6 to March 7, 2019
Batch 2: Public comment period held from April 30 to June 9, 2019
Batch 3: Public comment period held from Aug. 5 to Sept. 4, 2019
Batch 4: Public comment period held from Dec. 2, 2019, to Jan. 2, 2020
Batch 5: Public comment period open from April 29 to May 30, 2022.
CMS extends timelines for regulation of HCBS settings
As states respond to the COVID-19 public health emergency, it is clear that COVID-19’s impact requires changes to ongoing efforts to comply with the home and community-based settings (HCBS) settings criteria.
On July 14, 2020, the federal Centers for Medicare & Medicaid Services (CMS) released guidance (in a letter [PDF]) announcing an extension to the implementation of the HCBS regulation timelines. In this letter, CMS extended the deadline for states to bring their systems into compliance with the HCBS settings requirements by a year (from March 17, 2022, to March 17, 2023).
We administered a provider attestation to assess compliance for 100% of provider-owned or -controlled settings.
Providers self-reported either full compliance with HCBS requirements or not yet in full compliance with one or more HCBS requirements.
We required all settings to submit supporting documentation as evidence of compliance. Supporting documentation included provider policies and procedure manuals, staff training documentation, activity program calendars, resident handbooks, leases or other setting-specific information.
We provided technical assistance, instructional guidance, resources and one-to-one outreach to settings that reported they are not yet in full compliance with one or more HCBS requirements.
We conducted desk audits for 100% of the 5,991 provider-submitted supporting documentation to validate setting compliance.
We provided “compliance plans” for all settings that were determined “not yet compliant,” re-reviewed supporting documentation, provided a significant amount of technical assistance (email and phone calls) and developed assurance statements.Top 3 areas of noncompliance:
We developed provider tools and resources, improved licensing policy templates and forms and developed provider expectation guidance to help providers with their transition to compliance.
We responded to nearly 7,000 requests for technical assistance via phone and through our dedicated email box.
We conducted monthly targeted outreach to providers.
99% of settings are complaint with the HCBS settings requirements.
We will make it a priority to revalidate the 1% of settings that remain noncompliant through provider enrollment.
The HCBS provider toolkit contains frequently asked questions, guidance and examples of provider practices that support choice and autonomy for people who receive HCBS. We encourage providers to use this toolkit to help them generate ideas on how we can all better serve older adults and people with disabilities.
The CMS website contains more information about the CMS rule and requirements. The guidance documents are located within the “Settings Requirements Compliance Toolkit” section of the webpage.
HCBS Advocacy is a platform for the aging and disability communities to post information, and state and national resources regarding the new HCBS settings rule. The right-hand column of this webpage contains a helpful three-part toolkit on the rule.
Mail Minnesota Department of Human Services, Disability Services Division, Attention: HCBS Rule Transition Plan, P.O. Box 64967, St. Paul, MN 55164-0967
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