What is the HCBS Settings Rule?

The Rule, issued by the Center for Medicaid Services (CMS) on March 16, 2014, defines the characteristics any setting in which HCBS waiver services are provided must exhibit.
By no later than March 17, 2023, all settings must be in compliance with the following requirements to be eligible to continue to receive federal waiver funding:

  • Ensure an individual’s right to control personal resources
  • Ensure an individual’s rights of privacy, dignity, respect, and freedom from coercion and restraint
  • Optimize an individual’s initiative, autonomy, and independence in making life choices
  • For a Provider-Owned or Controlled Residential Setting:
    • The individual has a lease or other legally enforceable agreement providing similar protections
    • The individual has privacy in their unit including lockable doors, choice of roommates and freedom to furnish or decorate the unit
    • The individual controls his/her own schedule including access to food at any time
    • The individual can have visitors at any time
    • The setting is physically accessible

ADMH is continuing to work with their providers and other stakeholders toward full implementation of other requirements of the Rule, many slowed by COVID-19’s impact on day-to-day community life and the impact on availability of direct support professionals (DSPs), vital to supporting people to live safe, healthy and fulfilling lives.

These requirements include:

  • Integrative and supportive access to the greater community
  • Opportunities provided to seek employment and work in competitive integrated settings, engage in community life
  • Ensuring the individual receives services in the community to the same degree of access as individuals not receiving Medicaid home and community-based services
  • Selection by the individual of setting options, including non-disability specific settings and an option for a private unit in a residential setting (with consideration being given to financial resources)
  • Facilitates individual choice regarding services and supports, and who provides them