What Difference Will the HCBS Final Rule Make? [PDF]

John O’Brien

2020 – March

Organizations funded by HCBS Waivers can’t ignore the Final Rule–states must assure CMS of compliance in order to use waiver funds. The difference the rule will make in the experience of people who rely on long-term support depends on how organizations choose to receive the provisions that define eligible settings and require person centered planning. The Rule will make

a bigger difference to people assisted by organizations that actively pursue opportunities to develop capabilities that promote the Rule’s purpose than it will to organizations that see little distance between their current reality and theRule’s purpose and so have no reason to invest in deeper change.

CMS intends these regulations to assist states to meet their obligations under the ADA and the US Supreme Court’s Olmstead decision. It aims to move CMS toward defining home and community based settings by the nature and quality of individual’s experiences.2 These two items identify some of the experiences the Rule intends to increase:

A Home & Community Based setting is integrated in & supports full access of individuals receiving Medicaid HCBS to the greater commu- nity,including opportunities to seek employment & work in competitive integrated settings,engage in community life,control personal resourc- es, & receive services in the community, to the same degree of access as individuals not receiving Medicaid HCBS. §441.301 (4)(i)

Facilitates individual choice regarding services and supports, and who provides them. §441.301 (4)(v)