What are Home and Community-Based Setting Requirements?
The Centers for Medicare & Medicaid Services (CMS) published a final rule to enhance the quality of Home and Community-Based Services (HCBS) and to provide protections for participants. The rule, or “setting requirements” makes sure individuals receiving HCBS have full access to the benefits of community living and have the opportunity to receive services in the most integrated and still appropriate type of setting.
Missouri, like other states, is in a transition period, during which the state agencies will assess the HCBS programs, and the rules and regulations that govern the programs, to ensure services will be delivered in settings that meet the new requirements.
The Missouri Medicaid Audit and Compliance Unit (MMAC) is participating in the state’s transition plan and transition activities in the following ways:
- MMAC conducted on-site visits of all the Adult Day Care and AIDS Waiver locations, and completed HCBS surveys with those providers. You can access the report here.
- MMAC will include the HCBS surveys in future pre-enrollment site visits and provider revalidation site-visits, for all HCBS providers. This means MMAC personnel will go over the survey with you and give you the opportunity to ask questions and discover where you may need to make improvements in order to be compliant in the future when these requirements take effect. The state is expected to promulgate rules that will require providers to be compliant with the new setting requirements.
- MMAC will include the survey in future audits and investigations of HCBS providers to ensure we continue to monitor the locations for the new setting requirements as well. Auditors will provide you with the survey and go over it with you. Investigators may be on-site in consumers’ and participants’ homes and will verify the services are being delivered in the most integrated and still appropriate setting.
- MMAC will also provide education and information about the new setting requirements to all HCBS providers at Provider Update Training and Designated Manager Training.
MMAC is not citing any errors or violations at this time. This is a transition time. MMAC will give information about the new setting requirements and how to achieve compliance. In the future, MMAC will inform providers about any new regulatory language that will require them to become compliant or face possible sanctions.
MMAC is also giving providers the opportunity to complete an annual self-assessment. In the future, MMAC will inform providers about any new regulatory language that will require them to complete the annual self-assessment or face possible sanctions. Click here for the Annual Self-Assessment.
What else do providers need to know?
See below for links to the full content of the final rule, including all the requirements. Some highlights:
- Home and Community-Based settings will be expected to be integrated in the community, and support access to the greater community.
- The HCBS setting should also provide opportunities to seek employment and work in competitive integrated settings, engage in community life, and control personal resources.
- The HCBS setting should ensure the participant’s or consumer’s rights of privacy, dignity, respect, and freedom from coercion and restraint.
- Participants and consumers should be able to have visitors at any time.
- The setting should be physically accessible to the participants and consumers.
Click here to see a PowerPoint presentation of the final rule and the new requirements.
Click here to be directed to the MO HealthNet Division’s webpage where you can access the state’s Transition Plan, Transition Plan Summary, and Settings Analysis (see Alerts and Notifications).
Click here to see more information about Home & Community Based Services, including the final rule, and questions and answers at Medicaid.gov.