Home and Community-Based Services Waivers

Compliance Assessments for Home and Community-Based Services (HCBS) Settings Rule to Begin for Nonresidential Provider Settings

The compliance review process established by the Wisconsin Department of Health Services (DHS) will be implemented by the Public Consulting Group (PCG). PCG will begin the validation assessments effective March 6, 2019. The comprehensive assessment evaluates nonresidential provider compliance with the requirements of the federal HCBS settings rule. PCG will review provider-submitted self-assessments to make a preliminary determination of compliance. Each nonresidential provider setting will be contacted in advance by PCG to schedule a site visit. Initial site visits will take place between March 2019 and March 2020. See Implementation of Federal Home and Community-Based Services Settings Rule in Wisconsin, P-02319 (PDF) for more information.

The Benchmark Guide for Home and Community-Based Services Settings Rule: Nonresidential Provider Settings, P-02207A (PDF) cross-references DHS compliance requirements for nonresidential provider settings with the federal settings rule. It provides justification to support a reviewing agency's determination of compliance and gives reviewers a reference of state benchmarks for HCBS compliance.

The rule applies to all nonresidential waiver services. However, the nonresidential settings most affected by the rule are:

  • Adult day service settings
  • Adult day care settings
  • Children’s day services settings
  • Prevocational settings
  • Group supported employment settings

 

This webpage shares key information related to the Centers for Medicare & Medicaid Services (CMS) final rule for Medicaid home and community-based services waivers.

Background

Home and community-based services waivers provide opportunities for Medicaid beneficiaries to receive services in their own home or community rather than in institutions or other isolated settings.

CMS requires all states that operate home and community-based services waivers to comply with a federal settings rule. The purpose of the settings rule is to ensure that people receiving services through home and community-based waiver programs have access to the benefits of community living and are able to receive services in the most integrated settings.

The home and community-based settings rule applies to the following Medicaid waiver programs:

  • Family Care and Family Care Partnership
  • IRIS (Include, Respect, I Self-Direct)
  • Children’s Long-Term Support Waiver

More information about the federal rule and settings requirements can be found on CMS' website.

Compliance in Wisconsin

Under the new requirements, the Wisconsin Department of Health Services (DHS) must ensure that settings in which home and community-based services are provided meet and remain in compliance with the settings rule requirements.

DHS is continuing to determine compliance of residential and nonresidential settings so that providers that are compliant can be assured they meet the requirements, and providers that do not meet compliance, have time to remediate any deficiency. DHS intends to enforce compliance by March 17, 2019, for adult residential settings.

Adult residential settings subject to the rule:

  • Licensed community-based residential facilities
  • Licensed 3-4 bed adult family homes
  • Certified 1-2 bed adult family homes
  • Certified residential care apartment complexes

The nonresidential settings process is on a separate timeline. Adult nonresidential settings subject to the rule:

  • Adult day care
  • Day habilitation service settings
  • Group-supported employment settings (enclaves, work crews)
  • Prevocational services

Learn more about Wisconsin's compliance review process (PDF)

Frequently Asked Questions

FAQs About the Home and Community-Based Settings Rule

Statewide Transition Plan

The home and community-based settings rule required all states to develop a transition plan for obtaining compliance. DHS developed a statewide transition plan to address how it intended to reach and ensure ongoing compliance with the settings rule. DHS submitted the plan to CMS on June 30, 2017. The plan included DHS responses to comments received during the March 1-April 3, 2017, public review period. CMS provided initial approval of Wisconsin's statewide transition plan on July 14, 2017.

Wisconsin Statewide Transition Plan for Compliance with the Medicaid Home and Community-Based Setting Requirement, P-01839 (PDF)

Contact Information

If you cannot find the answer to your question, send us an email or call 877-498-9525.

Last Revised: October 17, 2019