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Requirements for Home and Community-Based Settings

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Overview of the Federal Requirements for Home and Community-Based Settings

Print this page and upload it with your HCBS Setting Requirement Form

On March 17, 2014, the Centers for Medicaid and Medicare Services (CMS) issued its final rule regarding settings for home and community-based services (HCBS) offered through the Assisted Living Waiver and the PASSPORT Waiver. For those settings that are presumed to be institutional, the state may submit evidence to CMS demonstrating the setting does not have the qualities of an institution. Accordingly, to ensure the Heightened Scrutiny process is integrated into the Ohio Department of Aging (ODA) workflow to become a certified ODA provider, ODA will adopt this process for reviewing new provider applications (see Heightened Scrutiny Workflow attachment).

Overview of the Federal Requirements for Home and Community-Based Settings

Regulatory Standards - HCBS settings must have all of the following qualities, based on the needs of individuals as indicated in their person-centered service plans:

  • The setting is integrated in and supports full access of individuals receiving Medicaid HCBS to the greater community, including opportunities to seek employment and work in competitive, integrated settings, engage in community life, control personal resources, and receive services in the community, to the same degree of access as individuals not receiving Medicaid HCBS.
  • The setting is selected by the individual from among setting options including non-disability-specific settings and an option for a private unit in a residential setting. The setting options are identified and documented in the person-centered service plan and are based on the individual's needs, preferences, and, for residential settings, resources available for room and board.
  • Ensures an individual's rights of privacy, dignity and respect, and freedom from coercion and restraint.
  • Optimizes, but does not regiment, individual initiative, autonomy, and independence in making life choices, including but not limited to, daily activities, physical environment, and with whom to interact.
  • Facilitates individual choice regarding services and supports, and who provides them.

In a provider-owned or controlled residential setting, in addition to the qualities specified above, the following conditions must also be met:

  • The unit or dwelling is a specific physical place that can be owned, rented, or occupied under a legally enforceable agreement by the individual receiving services, and the individual has, at a minimum, the same responsibilities and protections from eviction that tenants have under the landlord/tenant law of the State, county, city, or other designated entity.
  • Each individual has privacy in their sleeping or living unit:
    • Units have entrance doors lockable by the individual, with only appropriate staff having keys to doors.
    • Individuals sharing units have a choice of roommates in that setting.
    • Individuals have the freedom to furnish and decorate their sleeping or living units within the lease or other agreement.
  • Individuals have the freedom and support to control their own schedules and activities, and have access to food at any time.
  • Individuals are able to have visitors of their choosing at any time.
  • The setting is physically accessible to the individual.