CMS Issues Guidance on Non-Residential Settings for Home and Community-Based Services
On December 15, the Centers for Medicare and Medicaid Services issued updated guidance on the effect of new home and community-based services (HCBS) regulations on non-residential settings. The new rule, which took effect in March 2014, prohibits states from using federal Medicaid HCBS funds to pay for services in settings that are segregated or provide insufficient access to the community. The new rule stated that its requirements applied not only to settings where individuals lived, but also to the settings in which they spend their day.
The new guidance sets forth numerous aspects of a non-residential placement that may make it eligible or ineligible for HCBS funding. For example, services intended to promote access to competitive, integrated employment must be provided in a setting that is actually conducive to achieving that goal. A provider’s actual history of successfully supporting individuals in acquiring and maintaining competitive, integrated employment will be relevant. States should also inquire as to whether non-residential service providers provide individuals with adequate information about opportunities for competitive, integrated employment, whether individuals have the opportunity to manage their own money, and as to whether individuals have consistent interactions with nondisabled co-workers or customers. Individuals should be offered a choice of settings, including non-disability-specific settings, such as competitive integrated employment.