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What is the Home & Community-Based Services (HCBS) Final Rule?

The Home and Community-Based Services (HCBS) Final Rule is the Federal mandate from the Centers for Medicare & Medicaid Services (CMS) that requires that all federally funded services provided to people with developmental disabilities, shall respect individual choice, promote independence, and increase access to community inclusion.

Home and Community-Based Services (HCBS) were developed to offer support to individuals in community settings, as an alternative to institutional care. In 2014, new federal rules were released by the Centers for Medicare & Medicaid Services, requiring homes and programs where HCBS are delivered to meet new criteria. The Department of Developmental Services, regional centers, and community partners are working to implement the requirements for home and community-based settings in accordance with this Final Rule.

CMS has given all states until March 17, 2023 to ensure full compliance with HCBS Final Rule.

Everyone who receives, or provides, HCBS services may be affected by the CMS Final Rule. Activities are happening now to help California meet these new requirements.

HCBS Final Rule Criteria for all service settings are as follows:

  • Integrated (inclusion): in and supports full access to the community.
  • Choice:
    • Is selected by the individual from among settings options;
    • Optimizes autonomy and independence in making life choices; and
    • Facilitates choice regarding services and who provides them.
  • Self-determination:
    • FreedomĀ to plan your life and make decisions just like people without disabilities are able to do.
    • Authority & Responsibility:Ā you make decisions in your life and to accept your valued role in the community.
    • Support:Ā you pick the people and supports that help you live, work, and play in your community.
    • Confirmation:Ā you are the most important person when making plans for your life. You are the decision-maker about your services.

Additional Requirements for provider-owned/controlled residential settings:

  • Person has anĀ admission agreement, lease, or otherĀ legally enforceable agreementĀ providing similar protections;
  • Person hasĀ privacyĀ in their room (unit):
    • Lockable doors
    • Choice of roommates
    • Freedom to furnish or decorate
  • PersonĀ controlsĀ his/her own schedule including access to food at any time;
  • Person can haveĀ visitorsĀ at any time; and
  • Setting isĀ physically accessible.

HCBS Final Rule Compliance Information for RCRC

In accordance withĀ Welfare and Institutions Code section 4519.2(b), the RCRC Home and Community-Based Services (HCBS) Final Rule compliance information as of October 1st, 2021, is availableĀ here.

This information will be updated every six months, or as provided by DDS.

Per the DDS Directives dated December 1, 2023, https://redwoodcoastrc.org/wp-content/uploads/2024/02/HCBS-Final-Rule-Monitoring-and-Corrective-Action.pdf

RCRC continues to complete on-site reviews of all HCBS settings

https://redwoodcoastrc.org/wp-content/uploads/2024/02/Enclosure.pdf

to verify their full compliance and implementation of the HCBS settings requirements by August 31, 2024.

During the on-site review RCRC must verify all relevant federal requirements are satisfied.

Adult Family Home Agencies have been assessed using the RCRC Unannounced Visit Tool

https://redwoodcoastrc.org/wp-content/uploads/2024/02/AFHA-Uannounced-Visit-Tool-Feb.-2024.pdf

Community Care Licensed Residential Facilities are being assessed using the RCRC Facility Liaison Monitoring Tool

https://redwoodcoastrc.org/wp-content/uploads/2024/02/Facility-Liaison-Unannounced-Visit-Report-Feb-2024.pdf).

If you have any questions related to the HCBS Final Rule or the data identified above, please contact:

Sierra Braggs, CMS Waiver & Employment Specialist Manager

707-445-0893 ext. 348 or by email sbraggs@redwoodcoastrc.org