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Centers for Medicare and Medicaid Services Release New Regulations on Home and Community-Based Settings

March 30, 2014

On Jan. 10, the Centers for Medicare and Medicaid Services (CMS) released new regulations governing home and community-based services (HCBS) provided through state Medicaid programs. The regulations clarify that, in order to receive federal HCBS funding for services for people who are elderly and/or with disabilities, states must ensure that those services are tailored to each individual’s needs and provided in a setting that promotes community inclusion and services in the most integrated setting possible. States must ensure that HCBS recipients live in the setting of their choice, and that they have opportunities to seek employment and work in competitive integrated settings, engage in community life, and control personal resources. CMS also noted that HCBS services provided outside the home – such as supported employment services, job training or day programs – also must be provided in settings that promote community integration. CMS plans to issue additional guidance on those nonresidential settings that also qualify as “community-based” for the purposes of receiving HCBS funding. The rule went into effect on Mar. 17, 2014, and states have to submit transition plans to CMS related to how they plan to transition to services that meet the requirements laid out in the regulation.

Several tools and resources exist to help stakeholders get up to speed on the new regulations. On March 20, CMS released the Home and Community-Based Service (HCBS) 1915(c) Waiver and 1915(1) State Plan Amendment (SPA) Settings’ Requirements Compliance Toolkit. While it does not include tools for employment settings, this toolkit was developed to help stakeholders comply with the new requirements. 
The LEAD Center also co-hosted two webinars on the new regulations with the U.S. Department of Labor’s Office of Disability Employment Policy (ODEP), CMS’s Disability and Elderly Public Health Group and Employment First. Both webinars and related handouts are available in their entirety through the LEAD Center webinar archives by clicking the links below:

·         Innovative Strategies for Using Medicaid State Plan and Waiver Options to Promote Integrated Employment of People with Disabilities (Feb. 20, 2014)

·         Implications of HCBS Final Rule on Non-Residential Settings – The Impact of New HCBS Guidance on Employment & Day Services (Feb. 27, 2014)

Additional information on the new regulations is available at