Home and Community-Based Services Settings Rule

The Centers for Medicare & Medicaid Services (CMS) released final rules in January 2014 regarding the settings of Home and Community-Based Services (HCBS). These rules require HCBS settings to provide opportunities for participants to engage in community life, have access to the community, control their personal resources, and seek employment and work in competitive settings. The purpose of these rules is to enhance the quality of HCBS, provide additional protections to HCBS program participants, and ensure that individuals receiving services through HCBS programs have full access to the benefits of community living. With strong advocacy from stakeholders, these rules hold the potential to transform systems to support real inclusion and integration -- people living in their own homes and working in typical workplaces with real pay -- and to move away from models that congregate people together in residential and day programs where they have little autonomy, choice, and interaction with the broader community. 

Significant aspects of the HCBS Settings Rules include:

  • Ensuring that HCBS settings provide people with disabilities access to the broader community and facilitate relationships with people without disabilities (other than paid providers and staff).
  • Ensuring that HCBS settings provide people with disabilities control over daily life decisions like what to eat, when to go to sleep, and who can visit; with opportunities for competitive integrated employment; and with choices about what services they receive and who provides them.
  • Assist states with coming into compliance with the obligation under the Americans with Disabilities Act and the Supreme Court’s decision in Olmstead v. L.C. to provide services in the most integrated setting.

Under these new rules, each state must submit a plan to CMS to implement the new requirements through a transition process that “supports continuity of services for Medicaid participants and minimizes disruptions in service systems during implementation.” States have up to five years (until March 2019) to come into compliance with the rules and must develop a transition plan describing how they will come into compliance, seek public input on the plan, and submit it to CMS for approval. It is critical that stakeholders and consumers in each state become involved in their state’s process, particularly when states seek public input on proposed plans.

 The Bazelon Center is working with a coalition of national disability organizations to help educate and provide advocacy tools to disability advocates, track states’ transition plans and implementation, and advocate for strong implementation of the rules with federal agencies. 

 Resources about the HCBS Settings:

 The Bazelon Center’s advocacy is funded in part by the generosity of the Ruderman Family Foundation. 

Guided by our Jewish values, the Ruderman Family Foundation believes that inclusion and understanding of all people is essential to a fair and flourishing community. Our mission is to support effective programs, innovative partnerships and a dynamic approach to philanthropy in the following areas: advocating for and advancing the inclusion of people with disabilities throughout the Jewish community; fostering a more nuanced understanding of the American Jewish community among Israeli leaders; and modeling the practice of strategic philanthropy worldwide. 

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