Overview

The Centers for Medicare and Medicaid Services (CMS) has released a final rule that defines the settings in which states can offer Medicaid Home and Community Based Services (HCBS). This website will serve as a place where you can submit comments about the rule and the way its provisions will be set up within Texas Medicaid.

Timeline

CMS initially gave states five years to put the new rule into effect. Recently, a three-year extension was granted, making the new deadline March 2022.

Stakeholder Input

HHSC is looking to get input from long-term services and supports providers, professional groups or associations, and Medicaid members and their support groups on the following:

  • Settings that need to be considered in an assessment of the existing system.
  • Suggestions on how to conduct the assessment.
  • Ideas on how to address settings that may not be compliant with the new rule.
  • Input on the best ways to make sure that the rule, as implemented in Texas, is person-centered.
  • Input on the statewide transition plan submitted to CMS.

If you'd like to send comments regarding Texas implementation of the rule, send them to: Medicaid_HCBS_Rule@hhsc.state.tx.us

Background

The purpose of the CMS rule is to make sure people get Medicaid HCBS in settings that are integrated in the community and people getting services have access to community resources equal to that of people who do not get HCBS. This means people getting services should be able to:

  • Have opportunities to seek employment and work in competitive and integrated settings.
  • Engage in community life.
  • Control personal resources.
  • Get services in the community.

The rule also aims to make sure people getting HCBS have a free choice of where they live and who provides services to them, as well as ensuring that each person's rights are not restricted.While Medicaid HCBS has never been allowed in institutional settings, the new rule clarifies that HCBS will not be allowed in settings that have the qualities of an institution.

All HCBS must be provided through a person-centered service planning process outlined in the rule.Toward that end, there can be exceptions to the settings requirements as long as they are designed to meet the goals of the individual's person-centered service plan.

The rule's settings and person-centered planning requirements apply to each of Texas' 1915(c) HCBS waivers, including day settings within the following service arrays:

  • Community Living Assistance and Support Services (CLASS)
  • Deaf-Blind with Multiple Disabilities (DBMD)
  • Home and Community-based Services (HCS)
  • Texas Home Living (TxHmL)
  • Medically Dependent Children's Program (MDCP)
  • Youth Empowerment Services (YES)

The requirements also apply to HCBS provided through the Community First Choice state plan option and the 1915(i) state plan services. According to CMS, the provisions will apply to the Texas' STAR+PLUS HCBS program within the 1115 waiver.

Transition Planning

As part of implementation, Texas was required to submit a statewide transition plan to CMS detailing the steps the state will take to come into compliance with the regulations. The transition plan must include:

  • An assessment of settings.
  • Strategies for remediation.
  • Public/stakeholder input into the assessment and remediation strategies.

Texas received initial feedback from CMS in a letter received in September 2015 (PDF).

Centers for Medicare & Medicaid Services (CMS) Feedback Summary - June 2016:

In June 2016, CMS provided feedback from their review of HHSC's statewide transition plan (STP) submission in February 2016. CMS asked for more information about remediation, assessments, and the heightened scrutiny process, along with adding more electronic links in Appendix I. These updates are mainly to clarify and strengthen these components of the STP.  The STP includes the changes planned for submission to CMS in November 2016. CMS indicated posting for public comment is not required for this update; however, the State provided the plan for a short review period. The period for public comment ended on Oct. 27, 2016.

Statewide Transition Plan Review

Comments about the transition plan may be submitted through the HCBS mailbox.

Link to the Federal Register

Links to Proposed HCBS Waiver Amendments

Links to related state agency webpages:

Links to presentation materials and webinars

Communications

Intellectual and Developmental Disability Program External Assessment

As part of the statewide project to assess compliance with the settings component of the CMS HCBS rule, the Texas Department of Aging and Disability Services (DADS) Center for Policy and Innovation (CPI) developed and distributed a self-assessment to providers of the following Home and Community-based Services (HCS) waiver services:

  • supervised living and residential support services
  • host home/companion care services
  • day habilitation
  • employment assistance
  • supported employment

Case managers and service coordinators were also assessed. The full report (PDF) shares the findings of this assessment.