State Medicaid agencies and care organizations aim to comply with rule protecting HCBS recipients’ rights
James receives home- and community-based services (HCBS) through Medicaid. He has I/DD, and he recently participated in
a survey about the HCBS Settings Rule, conducted by the
Council on Quality and Leadership. In his responses, James explained how much he values his ability to check the mail and meet with others in the neighborhood.
The Centers for Medicaid & Medicare Services (CMS) HCBS Final Settings Rule sets standards for home and community care settings.
Studies demonstrate a strong, positive correlation between adherence to the HCBS Settings Rule and program participants’ overall safety. Additionally, adherence to settings rule requirements tends to lead to reduced instances of abuse, neglect, injury, and emergency room visits for program participants living at home or in their communities.
The survey James participated in provides insights into the benefits and protections the HCBS Final Settings Rule offers many vulnerable adults. Unfortunately, not all people receiving these services are equally protected.
CMS required state Medicaid agencies and managed care organizations (MCOs) overseeing HCBS to comply with a final version of the settings rule by March 17, 2023 – actually a delayed deadline following the onset of the COVID-19 pandemic. Unfortunately, despite the extended time to comply, many state Medicaid offices and care organizations are still struggling to meet the rule’s requirements, posing a threat to the free exercise of rights, wellbeing, and personhood of people receiving HCBS services.
By the March deadline, state Medicaid offices and MCOs were meant to have established an approved system to assess care professionals’ adherence to the settings rule. The system must collect data from and monitor all groups receiving HCBS funds through Medicaid waivers, to discern their compliance—and intervene in non-compliant practices. Care organizations themselves were, likewise, meant to develop and implement processes with standard checks and balances to ensure people receiving HCBS could fully exercise their rights under the rule.
A month following the deadline, most states were
still in the transitional stage. Many states have Statewide Transition Plans (STPs) or Corrective Action Plans (CAPs) in place, or their plans are pending CMS approval. These documents reflect challenges which recur nationwide, preventing compliance, including a lack of robust data management technology to effectively monitor HCBS providers, limited available staff to enact onsite monitoring processes and interventions, and inadequate training among staff to engage in monitoring and intervention effectively. HCBS providers cite similar
staffing, training, and technical challenges as barriers to compliance.
The good news is state officials, CMS, provider organizations and advocates are committed to complying with the settings rule as soon as possible. Both CMS and disability advocacy groups provide
compliance training and
educational materials to HCBS professionals and organizations in a range of formats.
To transition effectively to full compliance with the rule, CMS encourages states, MCOs, and HCBS providers to seek technological solutions, and FEI is ready to support that effort. For instance, FEI’s
Blue Compass LTSS case management solution enables compliance with the HCBS Settings Rule’s requirement to create and abide by person-centered care plans. Moreover, the Blue Compass case management solution’s features eliminate redundancy, communication barriers, and information silos—simplifying compliance monitoring, reporting, and precise intervention processes.
