CMS HCBS Rules
On January 16, 2014, the Centers for Medicare and Medicaid Services (CMS) released final rule regarding requirements for home and community based services (HCBS) operated under section 1915 of the Social Security Act. The rules establish requirements for both residential and non-residential settings. The purpose of the rule is to ensure that individuals receiving HCBS are integrated into their communities and have full access to the benefits of community living. The rule does not address services that are provided in a member’s home such as attendant care, personal care, homemaker and habilitation services.
CMS is requiring compliance for all State Long Term Care home and community based settings including programs operated under section 1115 of the Act. Arizona operates its Medicaid program under an 1115 Waiver authority. To that end, AHCCCS has established a plan to comply with the rule on a timeline consistent with its 1115 Waiver renewal submission (effective October 2016).
In Arizona, these requirements impact Arizona Long Term Care Services (ALTCS) program members receiving services in the following settings:
- Assisted Living Facilities
- Group Homes
- Adult and Child Development Homes
- Behavioral Health Residential Facilities
- Adult Day Health Programs
- Day Treatment and Training Programs
- Center-Based Employment Programs
- Group-Supported Employment Program
For more information on the Home and Community-Based Setting Rules and the requirements for State Medicaid Programs, please visit Home and Community Based Services
Arizona’s Systemic Assessment and Transition Plan
After consideration of public comment, AHCCCS submitted its final Systemic Assessment and Transition Plan (linked below) to CMS for approval on September 30, 2015. AHCCCS will have 5 years to come into compliance with the rules under the Transition Plan. During the 5-year transition period, AHCCCS will work with a variety of stakeholders to implement the plan. Additionally, AHCCCS will work collaboratively with the contracted health plans to ensure providers are adequately oriented and trained on their respective roles and responsibilities in ensuring members have full access to the benefits of community living.
Public Comment Period on Arizona’s Systemic Assessment and Transition Plan (August 1 – 31, 2015)
During the public comment period, AHCCCS hosted a round of statewide community forums to walk through the draft assessment findings and draft transition plan and take public comment. Stakeholders also submitted comments directly to AHCCCS during this period. AHCCCS reviewed and considered all public comment received.
CMS Correspondance with AHCCCS
Heightened Scrutiny (October 1, 2016 – December 31, 2016)
As a result of the systemic assessment and feedback provided through the August 2015, public comment period for the HCBS Rules Assessment and Transition Plan, several sub-setting types were identified as potentially having the characteristics of an institution. After reviewing the public feedback, it was determined that two sub-setting types would require Heightened Scrutiny.
- Assisted Living Facilities, Memory Care Units and Communities
- Farmstead Communities
Heightened Scrutiny is a CMS process for states to use to preserve settings that are presumed to have institutional qualities and presumed not be compliant with HCBS Rules. If States want to preserve settings that are presumed institutional in nature, states must collect information and submit evidence to CMS to make a determination. CMS determines whether or not the evidence supports that the setting is or can become compliant with the HCBS Rules within the allotted transition period. If CMS determines the setting does not and cannot meet compliance standards with the HCBS Rules, Medicaid funds cannot be used to fund the provision of services in Memory Care Units/Communities and/or Farmstead Communities.
AHCCCS worked in partnership with a multi-stakeholder and multi-disciplinary workgroup to create the process and tools that will be utilized to collect information and submit evidence to CMS to make a determination. Prior to submitting the report in March of 2017 of the information collected, AHCCCS will undertake a public comment solicitation process in February 2017.
- Assessment Team Training Presentation
- Assessment Team Training Webinar
- Facility Orientation Presentation
- Facility Orientation Webinar
- Facility Self-Assessment Tool
- Member Interviews and File Review Tool
- Observation and Community Interviews Tool
To submit comments to AHCCCS regarding the State’s compliance with the HCBS or request a hard copy of documents linked on the website:
- Email: HCBS@azahcccs.gov
- Mail: AHCCCS
c/o Office of Intergovernmental Relations
801 E. Jefferson Street, Mail Drop 4200
Phoenix, Arizona 85034
AHCCCS has created a listserv to communicate updates on recent developments on the State’s compliance with the HCBS Rules. AHCCCS encourages anyone who is interested in the initiative to sign up to receive the regular communication. To subscribe, follow the instructions below:
- Go to the website http://listserv.azahcccs.gov
- Locate and click on the "AHCCCS-HCBS-L" list name
- Locate on the right hand column and click on the "Join or Leave AHCCCS-HCBS-L"
- Follow the instructions to subscribe