Home and Community Based Settings (HCBS) Rules
The purpose of the HCBS Rules is to ensure individuals receiving HCBS are integrated into their communities and have full access to the benefits of community living.
These new requirements, from the Centers for Medicare and Medicaid Services (CMS), impact individuals receiving services in residential and non-residential settings such as assisted living facilities, group homes, adult day health, day treatment and training, center-based employment programs, etc.
All service settings must come into compliance by March 17, 2023.
For more information on the HCBS Rules and the requirements for State Medicaid programs, please visit the CMS Website.
In 2015, AHCCCS began working with a wide range of stakeholders representing the long-term care community to assess the State’s compliance with the HCBS Rules and identify further opportunities to enhance member integration experience and outcomes by building off Arizona’s long-standing history of the provision of Home and Community Based Services. AHCCCS submitted Arizona’s Systemic Assessment and Transition Plan to CMS in October 2015. Subsequently, a number of iterations of the Transition Plan have been updated and informed by stakeholder input with AHCCCS receiving final approval of the Arizona Transition Plan on January 20, 2023.
As we continue to move forward, it’s important to ensure members are served by applying the guiding principles of the ALTCS program including, but not limited to, member-centered case management practices, person-centered planning that safeguards against unjustified restrictions, and stakeholder collaboration. It is equally important that we continue to monitor for HCBS Rules compliance and work together to make sure that members experience the changes brought about by the HCBS Rules in their day-to-day lives.
- AHCCCS April 2023 Communication to Stakeholders
- HCBS Rules Transition Plan Addendum - Final Approval Received - January 2023
- April 2023 - Updated HCBS Transition Plan Timeline and Progress Report
- HCBS Rules Assessment and Transition Plan - Initial Approval Received - February 2019
- HCBS Rules Assessment and Transition Plan - Accessible Version
Centers for Medicare and Medicaid Services (CMS) Monitoring
In January 2023, CMS’ approval of the Transition Plan solely addressed the State’s compliance with applicable Medicaid authorities and the State’s process for assessing setting compliance, including settings that meet the criteria for Heightened Scrutiny. CMS’ review of settings submitted for Heightened Scrutiny and subsequent determinations are separate and distinct from final approval of the Transition Plan. If States want to preserve settings that are presumed institutional in nature and the State asserts the setting complies with the HCBS Rules, the States must submit evidence to CMS to make a final determination. CMS determines whether the evidence supports that the setting is or can become compliant with the HCBS Rules. Since the March 17, 2023 deadline has passed and CMS has not yet requested evidentiary documentation packages for a sampling of settings meeting Heightened Scrutiny, a Corrective Action Plan (CAP) is warranted to afford CMS more time to review the State’s assessment documentation and either affirm the State’s findings or require remediation for identified settings. The CAP allows for a 12-month remediation period should CMS have any findings when they complete their review. Links to AHCCCS’ CAP proposal and CMS’ response are provided immediately below.
MCO Oversight of Providers
The HCBS Rules Assessment Tool Suite (see section entitled “Provider Tools”) has been formally incorporated into the ongoing quality monitoring process and tools required by the Managed Care Organizations (MCOs) for HCBS settings. The HCBS Assessment tool suite will remain the standard of compliance for HCBS settings moving forward. It is also important to note that MCOs will be required to assess HCBS Rules compliance during the initial credentialing process to ensure new providers coming into the network are compliant prior to the onset of service delivery.
These sessions will assist providers to assess, plan and align your practices with the rules so that you are prepared for the MCO’s quality monitoring visit to evaluate compliance with the HCBS Rules and, most importantly, create a more satisfying member experience.
HCBS Rules Overview
This session described the HCBS Rules, including specific person-centered practices for provider compliance and outlined the quality monitoring process.
Downloadable (non-AV) version of the training slides: HCBS Rules Overview Training Slides
Provider Self-Assessment Tool Training
This session was previously recorded in 2020.
The Provider Self-Assessment Tool is a required component of the MCO’s quality monitoring visits. This tool has been designed for providers to assess the alignment of your current practices in residential, employment and day program settings with the person-centered practices required under the HCBS Rules. The session objectives included familiarizing participants with the tools and their intended use and trained participants on how to complete a self-assessment.
Downloadable (non-AV) version of the training slides: Provider Self-Assessment Tool Training Slides
HCBS Rules Assessments Reimagined in a COVID-19 World
This session was recorded in March 2021.
The session is designed to provide a refresher on the HCBS Rules and to orient providers to changes in the quality monitoring process and tools used to assess compliance.
The session objectives included the following:
- 1. Provide an overview of the HCBS Rules and what they look like on a day-to-day basis,
- 2. Provide an orientation to the provider-self assessment including examples of documentation sources or evidence of compliance,
- 3. Outline the changes to the provider assessments for compliance as a result of COVID-19,
- 4. Provide an orientation to the new COVID-19 Transition Plan component of the provider self-assessments, and
- 5. Present a timeline for provider compliance and health plan quality monitoring visits to assess compliance including what providers can expect when they receive a notice about the health plan’s assessment.
To access the recorded training session, see below:
Downloadable (non-AV) version of the training slides: HCBS Rules Assessments Reimagined in a COVID-19 World Training Slides
Implementation in Employment, Residential and Program Settings
Part four consists of four setting specific tracks representing each unique setting type that utilize a peer-to-peer, provider-to-provider approach to share and discuss specific person-centered practices that align with the HCBS Rules. The session objectives included an over of HCBS Rules in practice and an overview of the quality monitoring assessment process.
DDD Day programs
- DDD Employment programs. To access the recorded training session, see below:
DDD Employment programs
- Adult Day Health Facilities. To access the recorded training session, see below:
Adult Day Health
- Assisted Living Facilities. To access the recorded training session, see below:
Assisted Living Facilities
- DDD Group Homes and Developmental Homes. To access the recorded training session, see below:
DDD Group Homes
The provider self-assessment tools are part of HCBS assessment tool suite that your health plan will use to assess compliance with the HCBS Rules The tools are being provided to assist HCBS Settings in preparing for the HCBS assessment that will be conducted by the health plan. Please do not submit these tools to AHCCCS. Your health plan will contact you when they are ready to complete your assessment with additional guidance and directions.
Please note, there are two tool suites available. One tool suite includes the COVID-19 Transition Plan for those providers who are still changing their service delivery to mitigate COVID-19 risk and one tool suite for those providers who have been able to resume the provision of services without COVID specific restrictions. Your Health Plan will help you choose the right tool suite option for you when they contact you to complete the assessment.
The HCBS assessment tool suite includes:
- Provider self-assessment - Purpose is to gather information directly from the provider on the extent to which the provider may or may not be currently applying practices consistent with the HCBS Rules. It is important to note, the provider self-assessment includes both the documented self-assessment from the provider perspective and documentation of the health plan’s validations of the provider’s self-assessment after a joint review of the self-assessment with the provider.
- Companion Guide – Purpose is to provide more detailed direction to assist the provider in completing the self-assessment.
- Observation tool - Purpose is to gather information by observing the location, environment and community engagement of the provider to identify characteristics that may or not be consistent with the HCBS Rules. The observation tool also includes community interviews directly from community members, who have an association with the provider, to gather information about the provider’s level of interaction with members receiving services and strategies the provider employs to maximize community engagement.
- Member Survey - Purpose is to gather information directly from the members (or their representatives) regarding the member experience with the provider which may or may not be consistent with the HCBS Rules.
HCBS Assessment Tools
- Companion Guide including COVID-19 Transition Plan Items
- Companion Guide
- Day Program
- Employment Program
- DES/DDD Residential Self-Assessment
- E/PD Residential Self-Assessment
AHCCCS asks community members to play an integral role in ongoing monitoring of compliance. Anyone can report a concern about a specific setting’s ability to comply with the HCBS Rules. Submit concerns on the Report Concerns About the Quality of Care Received web page. The information will be used to inform the health plans’ assessment of the setting’s compliance with the HCBS Rules.
AHCCCS has created a email notification list to communicate updates on recent developments for the HCBS Rules. AHCCCS encourages anyone interested in this initiative to sign up to receive communication. To subscribe, click on the sign up button below:
Persons with a disability may request a reasonable accommodation, such as large print, by contacting email@example.com. Requests should be made as early as possible to allow time to arrange the accommodation.