CMS Issues Final Guidance Documents for Medicaid Home and Community-based Services

Shelley Sabo in NYSCAL Priority Alert

Final guidance documents on the Centers for Medicare & Medicaid Services’ (CMS’) Medicaid home and community-based services (HCBS) settings final rule were issued earlier this week by the agency. Released simultaneously, the two documents can be found at:

The first document is an optional tool that states can use, as they implement the rule, to assess whether “the characteristics of Medicaid Home and Community-based Services, as required by regulation” are present. The questions in the document are “suggested,” but not required to be used by states according to CMS. The questions can be found at:

The second document consists of a Q&A about the final rule and includes common questions and answers about the following topics related to states’ development of their transition plans: public notice and comments, residential HCB settings, non-residential HCB settings, and HCB setting restrictions.

The document also provides additional guidance on key provisions such roommate choice, the provision of keys to residents and staff, “locked doors or doors with alarms for individuals who are incapable of protecting themselves unsupervised in the community and/or who have documented histories of wandering,” co-located buildings, and resident leases.

This new guidance appears to allow for some flexibility in implementation, but CMS also says that state officials can put more restrictive guidance in place in making HCBS determinations.  The Q&A guidance can be found at: