In March 2019, the CMS (Centers for Medicare & Medicaid Services) issued updated guidance on implementation of the 2014 Home and Community Based Services (HCBS) regulation. The HCBS regulation impacts older adults and individuals with disabilities eligible for Medicaid HCBS. CMS convened a working group of states to provide feedback on the original regulation. The new CMS guidance is an updated set of frequently asked questions (FAQs) to streamline and clarify the “heightened scrutiny” process and provide flexibility for states to be able to serve their residents more effectively.

Some of the highlights of the new CMS guidance include: 

CMS New Guidance March 2019

  • The new guidance is outcome-oriented and focuses on the settings facilitation of community engagement as described in one’s person-centered plan.
  • The role of an individual’s person-centered plan is paramount in guiding services, their home preferences, and access to the greater community. Make sure yours meets the federal requirements using this HCBS Final Rule Person-Centered plan checklist. 
  • Settings described in previous guidance are no longer presumed institutional nor isolating and will no longer be forced to go through heightened scrutiny if the state determines the setting is compliant with the HCBS Final Rule.
  • Settings previously submitted for heightened scrutiny may no longer need to go through the heightened scrutiny process if the state determines it is compliant or can become compliant by July 2020
  • Consumer-controlled settings are presumed compliant.

What can you do?

Take Action after CMS New Guidance March 2019

  • Reach out and thank the policymakers. The importance of making our collective voice heard should not be underestimated. 
  • Make sure your Person-Centered Plan meets federal requirements if you plan to use HCBS waiver funding. You can also visit the Autism Housing Network Resource Directory and use the ‘Topic’ filter on the right to find ‘Person-Centered Planning’ tools and materials.
  • There is another piece of CMS guidance that needs attention. Guidance on the planned construction of future housing solutions emphasizes that the Medicaid authority cannot give pre-approval that residents will be able to use their waivers before the housing is constructed and or operational.  Join our advocacy wing, the Coalition for Community Choice, for updates and future action alerts (I promise we won’t swamp your inbox!)

The impact of this change cannot be understated. Homes of people who have disabilities stigmatized in the previous guidance were going to be unnecessarily scrutinized, an expensive process that could have instilled confusion, fear, and anxiety in residents. Now, people’s homes will not be forced by CMS to go under investigation and they can live without fear of removal from their home.

What’s next?

Now more than ever before we know that our voice is stronger when we come together. Please join us as an advocate or a donor as we prove that we CAN make a difference and have a variety of housing options to find the best fit for every individual.

About the Author

Wajia Qasimi