In 2014 The Centers for Medicare and Medicaid Services (CMS) promulgated a new rule providing more clarity regarding the characteristics of Home and Community Based Services (HCBS) settings. The overall purpose of the HCBS Final Rule is to ensure that all individuals receiving long-term services and supports under the 1915(c) waiver programs have full access to the benefits of community living and the opportunity to receive services in the most integrated setting appropriate.
This rule applies to all 1915(c) waiver programs, which include both NC Innovations and TBI. The following are specific services that are required to meet these characteristics:
- Innovations, (b) (3) and TBI Waiver – Day Support
- Innovations, (b) (3) and TBI Waiver – Supported Employment
- Innovations, (b) (3) and TBI Waiver – Residential Support
- CAP/DA and TBI Waiver – Adult Day Health
For any applicable service sites yet to complete the HCBS provider self-assessment 2016 or later, the following applies:
Prior to service provision, all sites providing Residential Supports (including AFLs) and Day Supports are required to complete a provider HCBS self-assessment and have it reviewed by the applicable MCO as “Fully Integrated.”
The site validation process starts April 1, 2019 and ends March 31, 2020. ALL sites within the transition period MUST be fully integrated/fully compliant AND validated by March 31, 2020. All new sites outside of the transition period must be fully integrated/fully compliant PRIOR to providing services.
Access additional information about HCBS including training slides, orientation information, and the link to the provider self-assessment tools and companion documents. You may address any questions regarding HCBS to Alliance at [email protected]
Alliance Health encourages providers offer advanced notice of plans to move to a new location. A new self-assessment for the future address must be submitted. This practice will provide the opportunity to confirm/validate HCBS compliance at the new site location. All new sites must be HCBS compliant prior to providing any services at the site.
Since the newly submitted self-assessment falls outside of the transition period, Alliance Health will provide specific technical assistance and deadlines in order to reach full compliance within a reasonable amount of time given, should items be found not compliant.
Provider/agency should offer advanced notice to Alliance Health of plans to acquire an existing provider. A new self-assessment for acquired site location(s) must be submitted. This is required due to the potential for a change in agency policy or procedures, which could have an impact on HCBS waiver services. Since the newly submitted provider self-assessment(s) falls outside of the transition period Alliance Health will ensure the site is fully compliant within 10 business days of acquisition.
Providers found not compliant with HCBS rules and regulations may face administrative action.