CMS Final Rule on HCBS

On January 10, 2014, the Centers for Medicare and Medicaid Services (“CMS”) issued a final rule regarding home and community based services (“HCBS”) (“Final Rule”).   

Specifically, the Final Rule discusses HCBS under §1915(i) of the Social Security Act (“the Act”), and describes the Medicaid optional state plan benefit to furnish HCBS and draw federal matching funds, without the State having to obtain a waiver.   Also significant, the Final Rule defines community-based settings as locations where individuals have full access to greater community, opportunities to seek employment and control personal resources, along with additional rights. Individuals must have privacy in their sleeping or living quarters, units that have lockable entrance doors and the choice of whether to have a roommate, among others.  However, the Final Rule disqualifies homes that are deemed too close to a nursing home, because the home is likely to be operated in a similar manner to the nursing home (the home is located in a building that is also a publicly or privately operated facility that provides inpatient institutional treatment, or in a building on the grounds of, or immediately adjacent to a setting that has the effect of isolating individuals)

The Final Rule also:

                   Provides a 5-year demonstration project/waiver for States that provide medical assistance for individuals dually eligible for Medicaid and Medicare benefits. 
                   Provides payment reassignment provisions because State Medicaid programs are often the primary or only payment for HCBS providers.
                  Amends Medicaid regulations to provide HCBS requirements for the Community First Choice State plan option (under §1915(k) of the Act)
                   Provides a few other changes to waivers under §1915(c) of the Act.

·                  Allows States to combine the existing three waiver targeting groups identified in 42 CFR §441.301
·                  Implements requirements regarding person-centered services plans
·                  Clarifies timing of State amendments to current HCBS waiver programs and services rates
·                   Provides additional strategies to ensure state compliance with §1915(c) of the Act
·                   Establishes HCBS requirements and provides a transition/phase-in period for current §1915(c) waivers to demonstrate compliance.

For questions regarding this Final Rule of HCBS, please contact Meghan McNab at or Kristen Gentry at