The HCBS settings rule was published in 2014 by the Centers for Medicare & Medicaid Services (CMS). The federal requirements define the qualities of settings eligible for reimbursement for Medicaid home and community-based services. Under the new requirements, DHS must ensure that settings in which home and community-based services are provided meet and remain in compliance with the settings rule requirements.
Nonresidential settings subject to the home and community-based services (HCBS) settings rule:
- Adult day services settings
- Adult day care settings
- Prevocational settings
- Group supported employment settings
- Children's day services settings
(See Implementation of Federal Home and Community-Based Services Settings Rule in Wisconsin, P-02428 (PDF) for more information)
All nonresidential settings must meet conditions that ensure specific rights of people receiving home and community-based services in those settings. Settings must not isolate people from the broader community, and programs must provide opportunities for adults, children, and youth to do the following in an age and developmentally appropriate manner:
- Seek employment
- Work in competitive integrated settings
- Engage in community life
- Receive services in the community
- Interact with peers who do not have disabilities
- Participate in community events and activities
- Access and control personal resources
The Benchmark Guide for Home and Community-Based Services Settings Rule: Nonresidential Provider Settings, P-02207A (PDF) cross-references the Wisconsin Department of Health Services (DHS) compliance requirements for nonresidential provider settings with the federal settings rule. It provides justification to support the reviewing agency's determination of compliance and gives reviewers a reference of DHS benchmarks for HCBS compliance.
Additional information on the nonresidential provider review process is available in HCBS Settings Rule: Nonresidential Provider Overview (PDF).
The comprehensive assessment evaluates nonresidential provider compliance with the requirements of the federal HCBS settings rule. DHS will review provider-submitted self-assessments and will contact each nonresidential provider setting to schedule a visit. Providers are required to complete a site visit with DHS so that a compliance determination can be made. See the Implementation of Federal Home and Community-Based Services Settings Rule in Wisconsin, P-02319 (PDF) for more information.
Providers will be asked to submit documents that evidence many compliance areas. See the HCBS Evidentiary Document Checklist, F-02605 (Word) for more information.
If you cannot find the answer to your question, send us an email or call 877-498-9525.
The information provided on this page is published in accordance with 42 C.F.R. 441.301(c)(4).