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HCBS Transition Plans: Additional Updates And Concerns

December 15, 2015

As the states continue to release home and community-based services (HCBS) transition plans, it has become clear that each state interprets the HCBS regulations in a different manner. Some of these interpretations classify a certain type of setting as meeting the requirements, while other interpretations classify the same setting as not meeting the requirements.

For example, in Wisconsin’s transition plan, all group supported employment services are presumed eligible for HCBS funding. By contrast, the state of Maine presumes that all non-individualized, group supported employment settings are presumptively ineligible for HCBS funding. Tennessee’s transition plan, which became available this month, states that settings will be assessed based upon the qualities of the setting and whether it supports individuals receiving HCBS in the broader community. Tennessee explains that they will use a thorough, multi-step analysis that will examine, among other things, the number of individuals participating in facility-only services versus those participating in services in the community, the number of people in each setting who are participating in competitive integrated employment, and a review of both person-centered plans in use by each agency and assessments by individuals of the facility’s services. All new supported employment and integrated day services in Tennessee must at least include the exploration of both volunteer and community activities, and supported employment. They must also provide the individual with access to activities that reflect their interests and life goals. Integrated day services must provide the individual with access to the broader community and must maximize the individual’s autonomy and independence.

CMS may need to update its guidance in light of the very different ways that the states are interpreting the regulations. For further information: