Use this page to find national-level advocacy resources on Home and Community-Based Services (HCBS) and the Centers for Medicare and Medicaid Services (CMS) final rule regarding HCBS in the Medicaid program.
CMS Correspondence to States
- Update- Extension of Transition Period for Compliance with Home and Community Based Settings Criteria. Please note this extension is provided for compliance of settings, which is now extended to March 2022. The deadline for final statewide transition plan approval is still March 2019.
- Summary of CMIA Letters to States: This document lists any changes states have to make to the STP and deadlines for public comment prior to resubmitting the revised STP.
Guidance from CMS:
- Guidance regarding HCBS Planned Construction of Presumed Institutional Settings
- Guidance concerning Medicaid Beneficiaries in HCBS who Exhibit Unsafe Wandering or Exit-Seeking Behavior
- Guidance on the implementation of the Community First Choice State Plan Option
HCBS Settings Rule 3-Part Toolkit:
The national HCBS Advocacy Coalition worked together to create this new toolkit that provides advocates with detailed information about the new rule and action steps to fully participate in its implementation. The toolkit contains three documents:
- HCBS Settings Rule – What You Should Know
- HCBS Settings Rule – Settings Presumed to be Institution & the Heightened Scrutiny Process
- HCBS Settings Rules – How to Advocate for Truly Integrated Community Settings (Full and Abridged)
Implement and Advocate
- National Core Indicators: Evidence for New HCBS Requirements and Revised HCBS Assurances by the
Human Services Research Institute – This guide crosswalks the HCBS rules and NCI data to show how states can use NCI data to show compliance with the rule.
- New Opportunities for Individuals with Disabilities to Expect Better Quality Services and Outcomes by Collaboration to Promote Self-Determination – This issue brief places the new HCBS rule in historical context of the evolution of home and community-based services and offers a vision for how the new rule can improve HCBS.
- Letter from APSE to CMS identifying a number of observations and recommendations to consider as states return the next round of statewide transition plans to CMS for your review (October, 2015)
- ASAN Toolkit and Webinar Series on Improving HCBS by the Autistic Self-Advocacy Network published this toolkit for advocates, families, and administrators on how to ensure that people with disabilities receive Medicaid-funded HCBS in integrated settings that offer full access to the community.
- CQL Toolkit for States – CMS Crosswalk by the Council on Quality and Leadership – This toolkit provides states with information on how to use CQL quality measurement tools and data elements to comply with the new HCBS settings rule and Revised HCBS Quality Assurances.
- State Transition Plans: Four Tips for Consumer Advocates by the National Senior Citizens Law Center – Building on themes seen in the first round of transition plans, this guide provides quick tips on reviewing state transition plans for compliance with the HCBS rule.
- Just Like Home: An Advocate’s Guide for State Transitions Under the New Medicaid HCBS Rules by the National Senior Citizen’s Law Center – This guide provides government officials and stakeholders with multiple aspects of the new regulations, including determining which settings are disqualified for HCBS, and enforcing consumer protections.
- Service & Setting Assessment Worksheet for Advocates by the DD Network Partners includes the regulatory language and CMS guidance in an easy-to-use format to help advocates think about the HCBS settings in their state and help their state make accurate and comprehensive assessments.
- National Advocacy on Transition Plans – Several national advocacy groups are requesting that CMS take action to ensure proper implementation of the HCBS regulations, including issues of substantive transition plans, the Community First Choice Option (1915k), and consumer protections in settings with residents regardless of payment source.
Understand the Rule
- Webinar: Overview of HCBS Settings Rule by National Council on Aging, October 2015
- Getting the Community Life You Want by the The Boggs Center on Developmental Disabilities.
As a person who receives services funded by Medicaid, some changes in federal policy give you new opportunities to have the kind of community services you want. This guide breaks down the changes to help you understand them. Additional resources
- Joint Statement Regarding Continuity of Services During Implementation of the HCBS Rule
Disability advocacy groups joined the American Network of Community Options & Resources and National Association of State Directors of Developmental Disabilities Services released this joint statement intended to address confusion about the implementation timeline of the rule. The statement makes clear that states have until March of 2019 to come into compliance with the rule and that no services should be abruptly discontinued immediately.
- Q & A: Medicaid Home and Community-Based Waivers by Autism Speaks.
This question-and-answer format document explains the basics of the rule, what it changes, what it doesn’t change, how to learn more and how to get involved.
- Webinar: Implementation of the Home and Community-Based Services Settings Rule by Friday Morning Collaborative. This webinar provided information about the rule and provided tools and resources for state advocates to assist with implementation. Presenters included representatives from the Centers for Medicare and Medicaid Services, Administration for Community Living, National Senior Citizen’s Law Center, and Association of University Centers on Disabilities.
- Webinar: New CMS Regulation on HCBS Settings: Implications for Employment Services by LEAD Center and Autistic Self-Advocacy Network. In the aftermath of CMS’ recent regulation regarding settings for Home and Community Based Services, states and stakeholders are now considering how to transition their service-provision systems into compliance with the new CMS requirements for greater integration. This new regulation may have a profound impact on employment services.
- Presentation: Overview of the New HCBS Rules by the National Association of State Directors of Developmental Disabilities Services. Robin Cooper of the National Association of State Directors of Developmental Disabilities Services (NASDDDS) gave this presentation about the rules for NASDDDS members. Slides from the presentation are also available here: NASDDDS_HCBS_Rules_Overview.
- Health Advocate: Home and Community Based Settings – A Primer by the National Health Law Program
This issue of Health Advocate from the National Health Law Program provides an overview of Medicaid HCBS and explains the basics of how the new rule applies.
- Q&A Home and Community-Based Services Final Rules by the National Health Law Program
A Question and Answer document from the National Health Law Program on the new rules.
- Issue Brief: CMS Final Rule on HCBS Settings Rule by the Association of University Centers on Disabilities
This issue brief provides an overview of the requirements in the new rule.
- The 2014 Federal HCBS Regulation: What You Need to Know by the The Arc
This issue of National Policy Matters from The Arc provides an overview of the rules and current home and community-based services context.
Other HCBS Resources
- Role of the DD Network in Advancing Community Integration by Association of University Centers on Disabilities. This toolkit describes the current work of the AUCD network to promote community integration and how the DD network partners – University Centers for Excellence in Developmental Disabilities, Developmental Disabilities Councils, and Protection & Advocacy Systems – work together to promote community integration and quality home and community-based services.