On Friday, January 10th, the Centers for Medicaid and Medicare Services (CMS) issued new regulations on Home and Community Based Services (HCBS) [1915(c) and 1915(i)]. TASH commends CMS for establishing a regulatory framework that is clear, progressive, and elevates individual choice and dignity of Waiver participants. These regulations are intended to provide Waiver participants full access to community living in the most integrated settings. Furthermore, the rule defines key characteristics of HCBS settings.
CMS considered the input of more than 2,000 stakeholders while developing this new rule. In its comments, TASH supported a revised definition of “home”, but emphasized that waiver participants have to be supported to understand that options exist beyond accepting open “slots” in houses and with people with whom they do not wish to live. Two elements were defined as critical for a definition of “home”
Waiver participants must be able to choose the location of their home without any interference, and without pressure to lease or buy from a service provider, or third party aligned with a service provider; and,
Waiver participants must have the final, absolute right to choose who, if anyone, shares their home. This final point would also be extended to anyone wishing to enter that person’s home to provide supports.
CMS responded favorably, with requirements for key characteristics of HCBS settings (see https://medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Long-Term-Services-and-Support/Home-and-Community-Based-Services/Downloads/HCBS-setting-fact-sheet.pdf). These characteristics emphasize choice, autonomy, and privacy. The rule goes a step further: if states wish to seek an exception to these requirements, they must solicit public comments. The rules call for compliance by requiring that states develop a transition plan based on a self assessment. Advocates will have an important role in holding states accountable for living up to these requirements.
Adults with developmental disabilities have long sought greater autonomy – the freedom to exercise control over their resources, their supports, and most importantly where they live and work. The concepts of self-determination, self-direction, person-centered supports (and other similar descriptors) remain an empty promise if people do not have a place that looks like, feels like, and is their own. TASH commends CMS for providing a regulatory framework that emphasizes autonomy and choice and lays the groundwork for increased access to community living in settings that get closer to what can credibly be considered “home”.