CMS New Home and Community-Based Services Rule

The Centers for Medicare and Medicaid Services' (CMS) recently released guidance is part of a larger effort within the federal government to align policies to support integration into the community.  In 1999, the U.S. Supreme Court ruled that states must provide individuals living in state institutions with opportunities to live in the most integrated setting possible in the community, via the Olmstead mandate.  Read CSH's paper on Supportive Housing and Olmstead. 

In recent years, enforcement of the Olmstead mandate has increased, highlighting the fact that an array of federal programs have varying and sometimes inconsistent support of community-based versus institutional settings; therefore the vision of Olmstead would not be realized until federal agencies improved how their policies aligned with the mandate. Last year, the Department of Housing and Urban Development (HUD) released guidance regarding HUD programs and their compliance with Olmstead.  And for the last 4 years, CMS has been working to improve the Home and Community-Based Services (HCBS) services Medicaid reimburses. The goal was to ensure that Medicaid only supports services that are community-based and delivered at the choice of the patient.

CSH is pleased that the final rule for HCBS focuses on the tenant’s experience and the outcomes providers meet. Highlighted here are the qualifications that all HCBS settings must now meet:

  1. The setting is integrated in and supports full access to the greater community;
  2. Is selected by the individuals from among setting options;
  3. Ensures individual rights of privacy, dignity and respect, and freedom from coercion and restraint;
  4. Optimizes autonomy and independence in making life choices; and
  5. Facilitates choice regarding services and who provides them

In addition, provider-owned housing must also:

  1. Allow individuals to hold their own lease or other legally enforceable agreement providing similar protections;
  2. Provide individual privacy with lockable units, choice of roommates, and freedom to furnish/decorate;
  3. Allow individuals to control their own schedule including access to food at anytime;
  4. Permit visitors at anytime; and
  5. Be physically accessible.

Settings that provide on-site inpatient treatment on the grounds of or near a public institution are explicitly not allowed.  However, CMS does have discretion to make individual judgments on appropriate settings any state proposes.  The entire final rule and associated fact sheets is available here. 

This final rule is only a first step; implementation comes next. The final rule outlines a transition process for states to meet these new requirements; states have one year to submit a transition plan that must be implemented within a 5 year timeline.  Looking ahead, supportive housing providers should  engage with their state Medicaid agencies as they develop these transition plans and further define the housing options available to people with disabilities who need service supports.

On Thursday, February 27 at 2pm ET, CSH will host a webinar to highlight key components of the rule – watch your inbox for more details and registration information.

We look forward to working with CMS, other federal partners, and national, state and local stakeholders to ensure that people with disabilities have the choice and opportunity to live integrated in communities across the country.


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