Home and Community-Based Services (HCBS) are designed to enable Medicaid recipients requiring long-term services and supports to live in their own homes and communities. This approach contrasts with institutional settings, offering individuals the opportunity to remain integrated within their communities rather than in isolated environments.
The Centers for Medicare and Medicaid Services (CMS) has established the HCBS Settings Rule to further ensure that these services are delivered in settings that are truly integrated within the community. This rule mandates that HCBS settings must facilitate full access to the broader community, promoting opportunities for individuals to:
- Seek and maintain employment in competitive and integrated environments.
- Participate actively in community life.
- Manage their personal resources effectively.
- Receive services and supports within typical community settings.
This pivotal HCBS Settings Rule applies across a range of Texas Medicaid programs, including but not limited to:
- Community Living Assistance and Support Services (CLASS)
- Deaf-Blind with Multiple Disabilities (DBMD)
- Home and Community-based Services (HCS)
- Texas Home Living (TxHmL)
- Medically Dependent Children’s Program (MDCP)
- Youth Empowerment Services (YES)
- STAR+PLUS HCBS
- Community First Choice (CFC) services
- HCBS Adult Mental Health (HCBS AMH)
To ensure states comply with these federal regulations, CMS requires each state to develop and implement a Statewide Transition Plan (STP). This plan outlines the state’s strategies and activities for achieving full compliance with the HCBS Settings Rule. Settings that might be considered institution-like are subject to heightened scrutiny by CMS, requiring states to provide evidence demonstrating their community-integrated nature.
Understanding HCBS and the Settings Rule is crucial for Medicaid recipients, their families, service providers, and all stakeholders involved in long-term care. These initiatives are in place to protect the rights of individuals to receive care in the most integrated and community-inclusive settings possible.
