HCBS Setting Requirement: Additional CMS Guidance

Regulation | January 22, 2017 | by Peter Notarstefano

On June 26, the Centers for Medicare and Medicaid Services (CMS) released additional Frequently Asked Questions related to home and community-based settings. This new guidance further clarifies what States will expect from home and community-based service providers located in a facility.

On June 26, 2015, the Centers for Medicare and Medicaid Services (CMS) released additional Frequently Asked Questions (FAQs) related to home and community-based settings. 

The guidance focuses on:

  • The process for states to use in overcoming the presumption that certain settings have the characteristics of an institution.
     
  • The heightened scrutiny review that CMS will give such information submitted from states.
  • State flexibility to exceed federal settings requirements.
     
  • Use of section 1915(b)(3) waiver authority, and application of the settings requirements to visitors and tenancy.

Concerning sites in a publicly-owned or privately-owned facility, the guidance said that the state can submit, and CMS will consider, documentation showing that the home and community-based (HCBS) setting is not operationally interrelated with the facility setting, such as:

 

  • Interconnectedness between the facility and the setting in question, including administrative or financial interconnectedness, does not exist or is minimal.
     
  • To the extent any facility staff are assigned occasionally or on a limited basis to support or back up the HCBS staff, the facility staff are cross-trained to meet the same qualifications as the HCBS staff.
     
  • Participants in the setting in question do not have to rely primarily on transportation or other services provided by the facility setting, to the exclusion of other options.
     
  • The proposed HCBS setting and facility have separate entrances and signage.