CQL | The Council on Quality and Leadership

HCBS Settings Rule: Approaching The Original Deadline

Posted 3/15/19
By Mary Kay Rizzolo | CQL President and CEO
mkrizzolo@thecouncil.org

In January 2014, The Centers for Medicare & Medicaid Services (CMS) released a new rule that would impact Home and Community Based Services (HCBS) Settings, with direct and significant implications for people receiving supports, human service providers, families, state agencies, and other stakeholders. This rule provides guidance and requirements for human service providers that people receiving supports have full access to the benefits of community living, be integrated in their communities, exercise rights, make choices, select the services they use, and direct who provides those services.

This rule went into effect on March 17, 2014 and was initially established with a 5-year transition period – with an original deadline of March 17, 2019 - for entities to carry out the requirements of the rule and for states to demonstrate compliance with its associated regulations. In May 2017, a three year extension was issued by CMS beyond that initial 5-year period, so that the new compliance deadline is March 17, 2022. In making this decision for an extension, CMS indicated that it was due to the “difficult and complex nature of this task (achieving compliance)”.

The new deadline is now just 3 years away, yet there still remains uncertainty about what the HCBS Settings Rule is, why it’s important, and how it impacts people’s lives. To help stakeholders navigate these complex issues, we’re put together the following article to call attention to lapses in knowledge about the rule, while sharing tools and resources to bridge these gaps.

 

Wide Disparities In HCBS Settings Rule Knowledge

By Carli Friedman | CQL Director of Research
cfriedman@thecouncil.org

As Mary Kay referenced the rule is technical and lengthy, and therefore inaccessible to a lot of key stakeholders, such as people with disabilities, families, and support staff. We recently conducted a study to explore settings rule knowledge disparities of stakeholders, including people with intellectual and developmental disabilities (IDD), their families, and providers. To do so, surveys about settings rule knowledge were completed by 70 people with IDD, family members, and providers were analyzed to determine trends and differences across groups.

Findings revealed large differences across the three stakeholder groups in terms of knowledge on thirteen different metrics (see figure). Providers in the disability industry had the highest knowledge score, getting 87% of the questions correct. Family members and people with disabilities however scored much lower – 42% and 35% respectively. In fact, it was not uncommon for people with disabilities to have never heard of the HCBS settings rule in the first place. Moreover, people with IDD in group homes were less likely to have knowledge of the settings rule than other settings, which is particularly problematic given the rules are most likely to impact them.

 

SETTINGS RULE % CORRECT BY STAKEHOLDER GROUP (N = 70)

Differences among stakeholder groups regarding HCBS-related knowledge

PWD = People with disabilities 

 

Resources to Reduce Those Disparities

By Katherine Dunbar | Vice President of Accreditation
kdunbar@thecouncil.org

Over the last few years, CQL has been partnering with the Illinois Council on Developmental Disabilities and other advocacy groups to help educate people about the rule by providing numerous resources, guides, videos, trainings, and more. This collaboration has resulted in the HCBS - Advocates Creating Transformation (HCBS-ACT) program.

HCBS Informational Videos

A great place to start in becoming educated about the rule and its impact is a series of videos that were produced by CQL| The Council on Quality and Leadership and funded by the Illinois Council on Developmental Disabilities. These videos share information about the rule and the implications for people supported and provider organizations.

HCBS OVERVIEW

Watch an overview video about the Home and Community Based Settings Services rule and its various components.

WHAT DOES THE RULE GUARANTEE?

View information about how the rule will promote choices, independence, and community for people receiving supports.

HCBS PROVIDER REQUIREMENTS FOR RESIDENTIAL SETTINGS

Find out about the various requirements placed on providers involving residential settings.

RIGHTS RESTRICTIONS & MODIFICATIONS

Learn about the impact of the HCBS Settings Rule on rights restrictions and modifications for people. 

EXPLORING ASPECTS OF HCBS

Self-advocates talk about various aspects of the HCBS Settings Rule and share why those areas are important to them and their quality of life.

 

Free HCBS Resources

Along with the embedded videos above, the following resource provide awareness of and guidance for the HCBS Settings Rule. They are targeted towards both people receiving services and those who provide them with desired supports. These guides were developed in coordination with the Illinois Council on Developmental Disabilities and the Elizabeth M. Boggs Center on Developmental Disabilities.

HCBS Guide: Supporting The Right To A Community Life

Supporting The Right
To A Community Life

This free resource prepares you to assist those you support to advocate for the community lives they want and share their experiences.

Download

HCBS Guide: Your Right To A Community Life

Your Right
To A Community Life

This free resource prepares you to assist those you support to advocate for the community lives they want and share their experiences.

Download

 

CQL’s Toolkit For States

This Toolkit for States provides detailed information, across populations, of quality measurement to comply with reporting requirements to CMS about the HCBS Settings Rule and associated quality assurances. It crosswalks CQL quality measurement tools and data elements, to demonstrate compliance.

CQL Toolkit For States


Specifically, this toolkit addresses:

  • New Home and Community-Based Setting Requirements
  • Additional Requirements for Provider Owned/Controlled Residential Settings
  • New Person-Centered Service Plan Process Requirements
  • New Person-Centered Service Plan Documentation Requirements
  • Revised CMS Quality Assurances & Sub-Assurances

 

 

Need Additional Support?

For self-advocacy groups, provider organizations, state agencies, and other stakeholders who desire customized consultation surrounding the HCBS Settings Rule, CQL does offer in-person training to improve understanding of the regulations and resulting compliance issue. You can Contact CQL to discuss this further, and find out how we can provide tailored training to your unique needs.

 

 

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