The Centers for Medicare and Medicaid Services (CMS) published regulations in the Federal Register effective March 17, 2014, which changed the definition of home and community-based services (HCBS) settings for the 1915(c) and 1915(i) Medicaid HCBS Waivers. Effective March 1, 2019, the Division of Quality Assurance (DQA), Bureau of Assisted Living will aid in HCBS compliance reviews and ongoing HCBS compliance checks for the following assisted living facilities. This includes adult family homes (AFH), community-based residential facilities (CBRF), and certified residential care apartment complexes (RCAC).
- Facilities requesting HCBS compliancy on their license or certification applications.
- Licensed facilities that currently do not have public funding as a provider group defined for their facility and who would like to serve residents receiving waiver funding.
- Licensed facilities that currently serve residents receiving waiver funding and have received the initial HCBS compliant determination from the Division of Medicaid Services.
Refer to DQA Implementation of HCBS Rule in Assisted Living Facilities, P-01826 (PDF) for detailed information.
HCBS Compliant Determination
If your facility is not currently serving waiver-funded residents and you would like to have HCBS compliance determination made, perform the following:
- Review the Medicaid HCBS information.
- Review the Wisconsin HCBS Waivers information.
- Implement the HCBS requirements as defined by Wisconsin at your facility.
- Complete and submit the HCBS Compliance Review Request, F-02138 with the required supporting documentation to your Bureau of Assisted Living Regional Office.
An HCBS compliant determination does not guarantee a contract with Wisconsin waiver agencies to provide services under Wisconsin Medicaid waiver programs: Family Care, Family Care Partnership, IRIS (Include, Respect, I Self-Direct) or Children’s Long-Term Support Waiver.
Maintaining HCBS Compliance
BAL has incorporated the HCBS settings rule into its current assisted living survey process and licensing/certification activities. During a survey, BAL will ensure the provider continues to meet the HCBS setting rule requirements.
A notice of noncompliance or notice of rescinded compliance is not an order for the setting to close.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. If you choose to do so, review the requirements on HCBS webpages and ensure all compliance requirements are met prior to resubmission of your request.
If a provider has received a previous HCBS notice of rescinded compliance and requests a compliance review, the provider will need to attest to all HCBS requirements via HCBS Compliance Review Request, F-02138 and be subject to additional inspection regarding the specific noncompliant HCBS settings rule that was previously identified. Additional inspection may include but not limited to providing documentation or evidence of compliance requirements, such as the following:
- A policy informing residents and legally responsible parties that employment paychecks and other types of income are not required to be signed over or given to the facility.
- A policy that ensures personal funds of residents are not held by the facility unless requested to do so by the resident or legally responsible party.
- A policy for residents to access their personal funds and resources to the extent of their functional capability, in a manner of their choosing, and at times agreed upon between the provider and the resident and his or her legal representative, as applicable.
- Documentation of the owner, administrator, all staff and caregivers, and any others providing care (including nurses) to the resident(s) complete new hire and annual resident rights training.
- A policy to ensure resident rights are regularly reassessed for compliance and effectiveness and amended as necessary.
- Evidence of lockable key entry doors on all resident rooms and individual keys to all residents.
- A policy ensuring staff uses facility keys to enter a resident’s room only under circumstances agreed upon with the resident.
- Lease or other written legal agreement which demonstrates residents have the freedom to furnish and decorate their sleeping or living units.
- Evidence of residents having choice of roommates.
- Evidence of individuals’ ability to have visitors of their choosing at any time in a private, unsupervised space.