1. Making Sense of the Home and Community-Based Final Rule
Association of Regional Center Agencies
October 15, 2015

2. The History of Federal Funding
Medicaid began in 1965.
The federal government only paid for institutional care prior to 1981.
California began receiving funding for Home and Community-Based Services (HCBS) in 1983.
Now, federal funds pay about 40% of the cost of California’s community-based developmental services.

3. The Road to the HCBS Final Rule
The Americans with Disabilities Act (1990)
U.S. Supreme Court Olmstead decision (1999)
U.S. Department of Justice actions related to day services (post 2010)

4. HCBS Rules – What happened?
In January 2014, the Centers for Medicare and Medicaid Services (CMS) issued rules about what states must do in order to keep receiving federal funding for HCBS.
States have until March to make needed changes in order to keep receiving federal funds.
These rules do not directly impact funding for institutions.

5. HCBS Rules – Three Major Changes
All services must be provided in Home and Community-Based Settings. This is also known as “the settings rule.”
Each individual must have a person-centered plan.
States must develop transition plans for existing Waivers and State Plan Amendments.

6. The Settings Rule – What is Community?
“Community” used to mean just not institutional.
Then, “community” was a standard only applied to where people lived. There were rules about what it meant to be “homelike.”
Now, “community” means services must be integrated in and support full access to the greater community.

7. Person-Centered Planning
In Virginia individual plans must have:
Individually identified goals and preferences related to work & alternates to work, learning & other pursuits, community & interests, relationships, home, transportation & travel, money, health & safety, and the individual’s vision of a good life.

8. Perspective Makes a Difference

9. Transition Plans Each state must submit a plan that explains:
What changes are needed;
How the changes will be made;
When the changes will be made (by March 2019); and,
How the state will make sure the new federal rules keep being followed in the future.
Each HCBS program within the state also needs to submit a smaller, more specific plan.

10. Putting it all Together…
New service models, such as the Self-Determination Program, have to meet the new rules right away.
The Workforce Innovation and Opportunities Act will also change the way that employment services are funded. California’s Blueprint on Employment will do this too.