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Home and Community Based Settings Negotiated Rulemaking

Medicaid Home and Community Based Services (HCBS) settings will soon have new requirements to meet in order to continue to serve Medicaid participants funded with HCBS dollars. The regulations were passed by the Centers for Medicare and Medicaid Services (CMS) and are now law. They affect certified family home providers, residential assisted living facilities, residential habilitation agencies, and those providing services to Medicaid participants in adult day health centers, developmental disability agencies, support brokers and targeted service coordinators.

Idaho Medicaid will be promulgating rule changes in order to move our HCBS system into full compliance with these new regulations. Please watch this page for further announcements on the rule promulgation process.

Home and Community Based Settings: Final Rule, Community Settings

The Department of Health and Human Services’ Centers for Medicare and Medicaid Services (CMS) published regulations in the Federal Register on January 16, 2014, which became effective on March 17, 2014, implementing new requirements for Medicaid’s 1915(c), 1915(i), and 1915(k) Home and Community-Based Services (HCBS) waivers. The purpose of the regulation is to ensure that individuals receive Medicaid HCBS in settings that are integrated in and support full access to the greater community and that the individual’s role in service planning is optimized. This includes opportunities to seek employment and work in competitive and integrated settings, engage in community life, control personal resources, and receive services in the community to the same degree as individuals who do not receive HCBS.

CMS expects all states to develop a HCBS transition plan that provides an assessment of potential gaps in compliance with the new regulation, as well as strategies and timelines for becoming compliant with the rule’s requirements. CMS further requires that states seek input from the public in the development of this transition plan.

Idaho has completed its’ initial submission of the state plan to CMS. This plan sets forth the actions Idaho will take to operate all applicable HCBS programs in compliance with the final rules. It is Idaho’s effort to comply/demonstrate compliance with the regulations around Home and Community Based (HCB) setting requirements. 

Transitition Plan

Idaho's Statewide Transition Plan Update 2015

The comment period for the Transition Plan closed on February 22.  Comments were gathered and changes made to the plan where appropriate.  All of the comments from this comment period as well as from the comment period last fall were added to the plan along with the state’s responses.  The plan was submitted to CMS on Friday, March 13th.  A copy of the updated plan has now been posted to this webpage, please see link on right hand side of the page under: What’s New

Here is an outline of the activities planned next for the state:

March - April 2015 
  • Continued meetings with provider groups to discuss setting requirements and to develop standards for congregate/group settings
  • Plan developer/support broker outreach
  • If a non-residential service setting meets the qualities of a setting determined by CMS to be institutional, decision to refute that claim or not to be made. If so then evidence will be gathered to support the claim and submitted to CMS
  • Approval of plan to assess and monitor the non-residential HCBS service settings
  • Work to determine how to clearly define" the same degree of access as individuals not receiving Medicaid HCBS"
  • Work to determine how to best serve the intense needs population currently receiving residential habilitation services
  • Decision on options for serving children who may be residing in an institutional setting but who are also receiving HCBS services
 April - May 2015
  • Addition of the outcome of all the above activities into the Transition Plan
  • Modifications to the Transition Plan based on CMS feedback once received from them
 May 2015
  • The third and final version of the plan will be posted for public comments for 30 days (dependent upon timing of feedback from CMS)
 June - July 2015
  • Comments on the Transition Plan will be gathered, appropriate changes made to the plan, and the plan will then be resubmitted to CMS for approval
 June 2015
  • Negotiated rulemaking to incorporate all needed rule changes to support the HCBS requirements
 October 2015
  • Publication of proposed rules
  • Public hearing for comments on the proposed rules
 January - February 2016
  • Legislative review of rules
 July 2016
  • Rules approved by legislature go into effect
January - September 2016
  • Provider toolkit developed and shared
  • Provider trainings
January 2017
  • Assessment of settings for rule compliance begins, expected to take one year

Ask The Program

We are interested in receiving your comments, recommendations, and questions as we work to move to full compliance with the new HCBS setting requirements. The State’s Transition Plan is posted here under What’s New.  If you have any questions or comments about the plan or the new requirements (see Final Regulation under Resources) please send us an email and we will get back to you as soon as possible.

Email the program