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Centers for Medicare and Medicaid Home and Community Based Services Settings Final Rule

Background

On January 16, 2014, the Centers for Medicare & Medicaid Services (CMS) published a Final Rule which addresses several sections of the Social Security Act and makes changes to the  1915(c) Home and Community-Based Services (HCBS) waiver program. The Final Rule was designed to improve available HCBS programs by ensuring the quality of HCBS, providing protections to participants, enabling participants to have the same opportunity to receive services in the most integrated setting appropriate and have full access to community living opportunities.

The main focus of the HCBS Final Rule is to ensure that all Home and Community-Based (HCB) settings meet certain qualifications, including:

  • Integration in, and supports access to, the greater community, including opportunities to seek employment and work in competitive integrated settings, engage in community life, control personal resources, and receive services in the community  to the same degree of access as individuals not receiving Medicaid HCBS;
  • Selection by the individual from among all settings options that are identified and documented in the person-centered service plan and are based on the individual’s needs and preferences;
  • Ensure individual rights of privacy, dignity and respect, and freedom from coercion and restraint;
  • Optimize autonomy and independence in making life choices; and
  • Facilitate choice regarding services and who provides them.

CMS issued guidance that states currently operating HCBS programs, regardless of the federal authority under which the programs operate, must submit a Statewide Transition Plan (STP) for approval. The STP must include the state’s assessment of its regulations, standards, licensing requirements and provider requirements against the requirements in the HCBS Final Rule. The STP is also to describe the State’s ongoing strategies to accomplish compliance with all federal requirements, including timeframes and deliverables.

New Mexico provides HCBS under the following four programs:

  •          1915(c) Mi Via Waiver
  •          1915(c) Developmental Disabilities Waiver
  •          Section 1115 Centennial Care Demonstration Waiver
  •          1915(c) Medically Fragile Waiver

Each of these programs is addressed in the New Mexico STP.

Department of Health, Developmental Disabilities Supports Division: Know Your Rights Campaign

In the fall of 2016, the Department of Health (DOH), Developmental Disabilities Supports Division (DDSD) launched the “Know Your Rights” campaign to conduct educational outreach to participants, their families, providers, and other stakeholders regarding the HCBS Final Rule and Statewide Transition Plan.  To view: http://actnewmexico.org/cms-final-rule.html

The next quarterly meeting of the Primary Care Council will be held in early 2023 (date TBA). The meeting is open to the public and will be held via zoom:

https://us02web.zoom.us/j/85812829319?pwd=bTljTFVHZmRhMDZzanRnZitldGoxZz09

Meeting ID: 858 1282 9319
Passcode: 521129
One tap mobile
+13462487799,,85812829319#,,,,*521129# US (Houston)
+16694449171,,85812829319#,,,,*521129# US

Please contact Elisa Wrede, Primary Care Project Manager, with any questions: Elisa.Wrede@state.nm.us.