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Four Briefs Examine New Home and Community-Based Services Settings Rules

National Center for Assisted Living

Barbara Coutler Edwards, Principal, Health Management Associates
Sharon Lewis, Principal, Health Management Associates
Rachel Patterson, Senior Consultant, Health Management Associates
Lilly Hummel, Senior Director, Policy and Program Integrity, American Health Care Association/National Center for Assisted Living

The federal Center for Medicaid and Medicare Services (CMS) promulgated regulations in 2014 which established standards for the settings in which Medicaid-reimbursed home and community-based services (HCBS) may be provided (42 C.F.R. § 441.301). These regulations also pertain to the settings in which individuals who receive HCBS may reside, even if the Medicaid HCBS are provided in a different setting. The federal regulations focus on community integration, individual choice and privacy, and other factors that relate to an individual’s experience of the setting as being home-like and not institution-like. These regulations set a floor for Medicaid reimbursement, but states may elect to set more stringent requirements. States have been charged with developing a transition plan to ensure that state Medicaid programs come into compliance with the new HCBS expectations by March 2022. As of November 2017, seven states (Arkansas, Delaware, Kentucky, Oklahoma, Tennessee, Washington, and the District of Columbia) have received final CMS approval of their Transition Plans.

The four briefs below examine new settings rules for HCBS:

An Effective Person-Centered Planning Process Is Key for Memory Care Units

Community Integration Options and Resident Choice Are Key in Assessment of Co-Located Assisted Living Communities and Inpatient Facilities

Ensuring Individual Choice and Privacy

Resolving Differences Between State Assisted Living Licensure Requirements and HCBS Settings Rule