What is the HCBS Final Rule?

The Centers for Medicare and Medicaid Services (CMS) established the final Home and Community-Based Services (HCBS) regulations in January 2014 affecting services within each state provided through Medicaid. The whole purpose of doing so is to create new requirements that support the following:

  • an enhancement in the quality of HCBS programs
  • adding protection for individuals receiving services
  • ensuring individuals receiving services and supports through Medicaid’s HCBS programs have full access to the benefits of community living and are able to receive services in the most integrated setting.

Due to COVID-19, CMS has recently updated the Final Rule and has allowed states an additional year to demonstrate compliance, through March 17, 2023. Here are the 10 Federal Requirements that make up the HCBS Final Rule: https://www.dds.ca.gov/wp-content/uploads/2020/09/CADDSHCBSProviderSelfAssessment.pdf

As a service provider, how am I affected?

  • HCBS are long-term services and supports provided in-home and community-based settings, as recognized under the federal Medicaid (Medi-Cal) Program. DDS hasa curated list of service codesthat they are categorizing as needing to be in compliance. To continue receiving federal funds from CMS, home and community-based settings must comply with the HCBS Final Rule
  • According to the most recent directive, the California Department of Developmental Services (CA DDS) has charged Regional Centers to do onsite evaluations of how well providers are implementing the HCBS Final Rule.

How do Person-Centered Practices align with this?

A huge component of the HCBS Final Rule is utilizing a person-centered approach to the way services are provided. RCEB and other community partners are currently offering training in Person-Centered Thinking (PCT), which can be found here.

Where is RCEB as it relates to being in full compliance with the Final Rule?

At this time, CMS has approved California’s Corrective Action Plan. Following DDS’ November 22, 2024 Directive, RCEB has partnered with Toolworks to provide HCBS onsite evaluations for all qualifying service providers by August 31, 2024. A recording of the training is embedded below.

Additionally, the following service codes will also be evaluated:

Child Day Care Facility (851), Enhanced Behavioral Support Home (901) and Community Crisis Home (903)

These are the resources that will be helpful in preparing for the onsite evaluation:

HCBS Provider Training

Individual Interview Questions Non-Residential

Checklist Tool for NonResidential

Individual Interview Questions- Residential

Checklist Tool for Residential

Ways To Show Compliance

Where can I learn more?

For more information, please contact RCEB’s HCBS Inbox: