ID/DD Services

IDD Home and Community Based Services (HCBS)

HCBS Final Rule

In 2014, the Center for Medicaid and Medicare Services (CMS) published a final rule regarding requirements for Home and Community Based Services (HCBS). The purpose of the Final Rule requirements is to ensure that people receiving all services through HCBS programs (such as the ID/DD Waiver and IDD Community Support Program) are integrated into their communities and have full access to the benefits of community living.

HCBS Final Rule requires all settings must:

Be integrated in and facilitate full access to the greater community
Optimize autonomy and independence in making life choices
Be chosen by the individual from among residential and day options, including non-disability specific settings
Ensure the right to privacy, dignity, respect and freedom from coercion and restraint
Provide an opportunity to seek competitive employment

The HCBS Final Rule also included additional requirements for provider owned or controlled residential settings. These requirements include that the individual:

Has a lease or other legally enforceable agreement providing similar protections
Has privacy in their living unit including lockable doors, choice of roommates, and freedom to furnish or decorate the unit
Has control over his/her own schedule including access to food at any time
Can have visitors at any time
Has physical access to the setting

States were required to submit a State Transition Plan outlining how the State will assure compliance with the HCBS Final Rule by March, 2023. DMH in coordination with the Division of Medicaid has conducted assessments of all site-based services (Day Services Adult, Prevocational Services, Community Respite) and provider owned or controlled residential settings (Supervised Living, Shared Supported Living, Supported Living). Following assessment, each setting was determined to be in one of four categories according to their compliance with the HCBS Final Rule:

Compliant with the HCBS Final Rule
Needs modifications – setting can become compliant with modifications
Cannot meet HCBS requirements
Heightened Scrutiny – setting can become compliant through remediation by a heightened scrutiny process to assure each setting does not have characteristics of an institution and has the quality of HCBS settings. The following settings are presumed to be institutional:
- HCBS services are provided in public or private owned facility – ICF/IID, inpatient facility for people with SMI, hospital, or nursing home
- HCBS services are provided adjacent to public or private owned facility – ICF/IID, inpatient facility for people with SMI, hospital or nursing home
- Setting has the effect of isolating individuals from the broader community

Final Rule – Medicaid Home and Community Based Services

Home and Community-Based Services Final Rule Flyer

HCBS Final Rule Assessment Tool – Day Program Settings

HCBS Final Rule Assessment Tool – Residential Settings

Summary of Final Rule Assessments – ID/DD Waiver

Summary of Final Rule Assessments – 1915i

HCBS Training Documents

2018 MS AAIDD Final Rule Seminar PowerPoint

HCBS Compliance Monitoring

Balancing Choice and Risk

Home and Community Based Services Final Rule Finding in Mississippi

This webinar (recorded on 4.24.19) discusses the general Home and Community Based Services Final Rule Assessment findings in Mississippi. Intellectual and Developmental Disability Providers were required to participate in the webinar in order to understand the Mississippi Department of Mental Health’s interpretation of key issues in the HCBS Final Rule and the remediation process required for providers to show full compliance. This is the 1st in a series of 4 webinars.

Home and Community Based Services Final Rule Webinar 2

This is the second of four webinars concerning the Home and Community Based Services Final Rule. One of the major components of the Final Rule is the importance of protecting individual rights. Site assessments conducted last fall helped to identify some common areas of noncompliance with the Final Rule. One of those areas was the need for direct support staff to have a better understanding of individual rights and how to support people in making informed choices. The Mississippi Department of Mental Health requires providers to discuss rights with persons at least annually. The assessment revealed a need for direct support staff to have a better understanding of individual rights. Direct support staff are the people that spend the majority of the time with the people we serve – where they live, work and/or spend their day. Support needs to move away from traditional ideas of caregiving that see persons with disabilities as passive recipients. Instead support should be based on persons having choice and control over their lives and supporting each to have the life they desire.

Home and Community Based Services Final Rule Webinar 3