CMS also announced the proposed State Plan Home and Community-Based Services (HCBS) rule which includes the revised definition of “home and community” setting. The State Plan HCBS proposed rule gives states guidance about how to amend their state Medicaid plans to make home and community-based services available without having to design waivers. State plan home and community-based services will be available to individuals with significant needs who will not have to meet institutional level of care. If a state chooses the option, services must be available to anyone who meets eligibility standards; waiting lists are not permitted.
CMS’s proposed definition of home and community setting lists qualities that settings should have, such as:
“The setting is integrated in, and facilitates the individual’s full access to, the greater community including opportunities to seek employment and work in competitive integrated settings, engage in community life, control personal resources, and receive services in the community, like individuals without disabilities. . . “
The proposed rule lists specific facilities that would not be considered home and community-based settings, such as intermediate care facilities for individuals with intellectual and developmental disabilities.
CMS will rely on the proposed setting definition as it reviews new 1915(k) CFC options and will expect states to comply with the setting requirements. If there are changes to the definition when the rule is finalized, CMS will give states a transition period, at a minimum of one year, to make any needed changes.
The Arc will review the revised definition of home and community setting and make comments if necessary. It is anticipated that the proposed rule will appear in the Federal Register on May 3. The comment period will close 30 days later.