A Quick Review of the Home and Community Based Settings Final Rule (HCBS) and How It Is Implemented
Staff at the Community Living Education Project (CLEP) continue to focus on and emphasize the Home and Community Based Settings Final Rule (HCBS) and the Person-Centered planning, practices and tools, that support the implementation of this vital regulation.
Need an HCBS Refresher?
The Centers for Medicare and Medicaid (CMS) issued the Final Rule in 2014. It states how Medicaid waiver supports for people with intellectual/developmental disability, Home and Community Based Services, (HCBS) are to be delivered.
It states that all services are to be integrated in the community, and support full access to the community.
Additionally,
- Service recipients have the same degree of access to the community as people not receiving Medicaid Home and Community-Based services.
- It ensures that the person’s home is selected by that individual from a choice of setting options, including non-disability specific settings and an option for a private unit in a residential setting.
- Institutions, nursing facilities, hospitals and intermediate care facilities for people with intellectual/developmental disabilities are NOT Home and Community-Based Settings.
- Opportunities must be provided to seek employment and work in competitive, integrated settings, engage and be part of community life.
- It ensures a person’s right of privacy, dignity, respect and freedom from coercion and restraint.
- HCBS ensures the person’s right to engage in community life in the most integrated setting and have control of personal resources.
HCBS optimizes individual initiative, autonomy and independence in making life choices, facilitates individual choice regarding services and supports, who provides them, and are fiscally responsible. Service costs must not exceed institutional costs.
HCBS incorporates Person-Centered planning, practices, processes and tools. The planning process is to be driven by the person and must reflect their strengths, preferences and their support, including clinical (medical and behavioral), safety and health needs. The Person-Centered planning must include the choice of Self-Directed services and choice of community residential settings.
How does this look in practice?
The CLEP team continues to use Person-Centered Thinking, Planning, Practices and Tools when working with people and families.
One tool CLEP utilizes is The One Page Profile from Helen Sanderson and Associates.
Additional tools are Charting the Life Course Nexus Tools such as the Life Trajectory from the person’s perspective and family perspective, Integrated Support Stars, Integrated Supports Split Star, to name a few. Whatever the tool, the person is at the center of the conversation, focusing on their gifts, qualities and strengths while then addressing what the person wants for their life, the supports needed, so they can live their best life.
