CMS (Centers for Medicare & Medicaid Services) changed its home and community-based services (HCBS) settings rule, effective March 17, 2014. This includes 1915(c) and 1915(i) Medicaid HCBS waiver requirements. These waivers allow people on Medicaid to get services in their home or community.
Waiver changes apply to the following facilities:
- Adult family homes
- Community-based residential facilities
- Certified residential care apartment complexes
The Wisconsin Division of Quality Assurance (DQA) and Bureau of Assisted Living can help facilities understand and follow these new rules. This includes facilities that:
- Want their license to show they meet HCBS waiver requirements.
- Serve, or would like to serve, residents receiving HCBS waiver services.
- Already meet HCBS requirements.
Refer to DQA Implementation of HCBS Rule in Assisted Living Facilities, P-01826 (PDF) for more information.
Meeting HCBS requirements
Facilities must meet certain requirements to serve HCBS waiver residents. This is called being HCBS compliant. To make sure they meet these requirements, facilities must complete a compliance review.
To find out if your facility meets HCBS rules, you should:
- Review Medicaid HCBS information.
- Review the Wisconsin HCBS Waivers information.
- Implement Wisconsin HCBS requirements at your facility.
- Complete the HCBS Compliance Review Request, F-02138. Submit the form to your Bureau of Assisted Living Regional Office.
Facilities that meet all HCBS rules and are determined to be HCBS compliant have the ability to provide services under the following Medicaid waiver programs:
- Family Care
- Family Care Partnership
- IRIS (Include, Respect, I Self-Direct)
- Children's Long Term Support Waiver
An HCBS compliant determination doesn't guarantee a contract to provide services.
Following HCBS requirements
The Bureau of Assisted Living has added the HCBS setting rule requirements to its Assisted Living Survey. They regularly survey facilities that serve HCBS residents. The goal is to make sure facilities follow HCBS requirements. Facilities that aren't following HCBS requirements are given one of two notices:
- Notice of noncompliance. This means a facility is not following HCBS requirements.
- Notice of rescinded compliance. This applies to facilities that met HCBS requirements in the past, but are no longer following HCBS requirements.
The Bureau of Assisted Living informs waiver agencies when a facility receives either notice.
These notices do not mean a facility must close. Notices of this type mean the setting will not be reimbursed for services to Medicaid waiver participants. The waiver agencies responsible for any affected member(s) or participant(s) will be informed of the action(s) required and will contact the setting to address the next steps. The provider may choose to resubmit a request for a compliance determination. The goal is to make sure they are following HCBS requirements.
Compliance review request
To request a compliance review, facilities should:
- Re-review HCBS requirements.
- Complete the HCBS Compliance Review Request form, F-02138.
- Submit the form to request a new compliance review.
Facilities may be asked to show:
- A policy for telling residents and their representatives:
- Residents don't need to give their income to the facility.
- Facilities don't hold a resident's personal funds without consent.
- Residents can access their personal funds when they choose. Certain restrictions may apply.
- Proof that all staff complete resident rights training.
- A policy for protecting resident rights that is regularly reassessed and amended as necessary.
- Policies protecting resident's right to control their own rooms. This includes:
- Allowing residents to have locks and keys for their doors.
- Prohibiting staff from entering a locked resident room without consent.
- Allowing residents to decorate their rooms.
- Allowing residents to choose their roommates.
- Allowing residents to have visitors when they choose.