Overview
In 2014, the Centers for Medicare and Medicaid Services (CMS) issued a federal Home and Community-Based Services (HCBS) Settings Rule that required states to review and evaluate current HCBS settings, including residential and non-residential settings where Medicaid HCBS waiver services are provided.
The rule requires that all home and community-based settings have the following qualities:
- is integrated in and supports full access to the greater community;
- is selected by the individual from among setting options;
- ensures individual rights of privacy, dignity and respect, and freedom from coercion and restraint;
- optimizes autonomy and independence in making life choices; and
- facilitates choice regarding services and who provides them.
In addition, the final rule also includes provisions for provider-owned or controlled home and community-based residential settings. The requirements include:
- The individual has a lease or other legally enforceable agreement providing similar protections;
- The individual has privacy in his/her unit including lockable doors, choice of roommate and freedom to furnish or decorate the unit;
- The individual controls his/her own schedule;
- The individual can have visitors at any time; and
- The setting is physically accessible.
The HCBS Settings Rule applies to the following Arkansas Medicaid programs and services:
- ARChoices in Homecare (ARChoices) Waiver
- Living Choices Assisted Living (LCAL) Waiver
- Community and Employment Support (CES) Waiver
- Autism Waiver
Types of residential and non-residential settings identified for HCBS settings requirements include:
- Assisted Living Facilities (Residential)
- Community Support Services Providers- CSSP (Residential)
- Provider owned or controlled apartments and group homes (Residential)
- Provider Controlled Staff Homes (Residential)
- Adult Day Care Facilities (Non-Residential)
- Adult Day Health Care Facilities (Non-Residential)
Documents & Memos
The following documents are CMS issued information regarding HCBS Settings Rules:
- 1915(i) State Plan HCBS, 5-Year Period for Waivers, Provider Payment Reassignment, Setting Requirements for Community First Choice, and 1915(c) HCBS Waives- CMS-2249-F/2296-F
- Informational Bulletin- Final Regulations for HCBS Provided Under Medicaid’s 1915(c), 1915(i), and 1915(k) Authorities
- CMS- HCBS Settings Final Rule Webinar Presentation 2014
- CMS- Final Rule Questions & Answers
- Exploratory Questions to Assist States in Assessment of Residential Settings
The following documents have been submitted to CMS:
- Arkansas State Transition Plan 2017 (Approved by CMS)
- CMS Approval Notice of Arkansas State Transition Plan
- Arkansas Approved Corrective Action Plan-CAP (Approved by CMS)
- Arkansas Approved Corrective Action Plan- CAP UPDATED (Approved by CMS)
- January 1, 2023 Requested Updates from States- Public Health Emergency Impacts
- Home and Community Based (HCBS) Settings Rule Heightened Scrutiny Review Evidentiary Summaries 2024
- Supplemental Corrections to the HCBS Settings Rule Heightened Scrutiny Review Evidentiary Summaries 2024
The following memos have been issued by DHS to Arkansas HCBS providers:
- Arkansas Home and Community Based Provider Heightened Scrutiny Evidentiary Summary Report (July 1, 2024)
- Frequently Asked Questions (FAQ) HCBS Self-Assessment Survey (December 16, 2022)
- HCBS Provider Self-Assessment Survey Required (December 12, 2022)
