Office of Developmental Programs Home and Community Based Settings Final Rule

On January 16, 2014, the Centers for Medicare and Medicaid Services (CMS) issued a final rule for Home and Community-Based Settings (HCBS). The CMS HCBS rule became effective on March 17, 2014, and applies to the settings in which ODP waiver services are provided. Per CMS guidelines, all states must be compliant with the regulations by March 2022.

The purpose of the CMS HCBS rule is to make sure individuals receive services in settings that are integrated into the community and individuals receiving services have access to community resources equal to that of those who do not receive services. Individuals receiving services should be able to:

  • Have opportunities to seek employment and work in competitive and integrated settings.
  • Engage in community life.
  • Control personal resources.
  • Obtain services in the community.

The rule also aims to make sure individuals receiving services have free choice of where they live and what provider to choose as long as the providers is willing and qualified. The CMS HCBS Rule also ensures that each individual's rights are not restricted and clarifies that services will not be allowed in settings that have the qualities of an institution.

The rule's settings requirements apply to each of ODP's 1915(c) waivers. The four waivers offered by ODP are the Adult Autism Waiver, the Consolidated Waiver, the Person/Family Directed Support (P/FDS) Waiver, and the Community Living Waiver. To find more information on each of these waivers, please see the following:

HCBS Assessments and Reports

Heightened Scrutiny Onsite Tools

To be compliant with the Centers for Medicare and Medicaid Services (CMS) Home and Community-Based Settings (HCBS) rule, ODP must identify and complete onsite reviews of all service locations that are presumed to have the qualities of an institution. The purpose of these onsite reviews will be to determine whether each service location can overcome the institutional presumption by either showing proof that the requirements contained in the CMS HCBS rule are currently met, or by ensuring the requirements will be met within a timeframe specified by ODP (but no later than March of 2023). If ODP determines that the service location currently meets, or will meet the HCBS rule requirements within the timeframe specified by ODP, that service location’s related documentation will be submitted to CMS for heightened scrutiny. CMS will then determine whether the service location has the qualities of a home and community-based setting and does not have institutional qualities.

Service locations that do not meet the HCBS rule requirements and do not have plans to meet the requirements, will not be submitted to CMS because the service location may not receive waiver funds for services rendered after March 17, 2023. Any individuals impacted by this will be notified and given the opportunity to transition to settings that can continue to receive waiver funds due to meeting HCBS rule requirements.

The following tools will be used during the onsite visit as part of the Heightened Scrutiny process.

Residential Service Locations:

Non-Residential (Community Participation Support/Day Habilitation) Service Locations:


2015 Home and Community-Based Settings (HCBS) Waiver Specific Transition Plans

Per CMS requirements, ODP created the following document that reflects summaries of the comments received during the public comment period of December 20, 2014, through February 2, 2015, reasons why comments were not adopted, and any modifications to the transition plans based upon those comments. Multiple comments that convey the same meaning were consolidated. This document reflects comments received for all three of ODP's waivers.

CMS requires that states undergo activities to assess whether or not their waiver providers are in compliance with the rule and to incorporate continued provider compliance into their overall monitoring activities. To begin the assessment process in Pennsylvania, the Department of Human Services (Department) surveyed all providers of waiver services administered by the Office of Developmental Programs (ODP) and the Office of Long-Term Living (OLTL) to learn how services are currently being provided. Providers were instructed to complete the survey for each enrolled site location in which services are provided. For instance, if a provider has a home office (no services provided) and four locations where services are provided, four surveys would be completed. If a provider is enrolled with both ODP and OLTL to provide services in shared settings, one survey should be used to provide information for both offices. The survey was open for the period of April 2, 2015, to April 30, 2015.