Implementation of the HCBS rule tiered standards, effective Jan. 11, 2021

Posted on January 27, 2021 by Bobbie Guidry

The Disability Division of the Minnesota Department of Human Services has announced that effective Jan. 11, 2021, there are new tiered standards for HCBS settings that provide the following services through the disability waivers (BI, CADI, CAC, DD waivers):

• Adult day services, including family adult day services
• Customized living services
• Prevocational services

“Tiered standards” mean the service/setting has a higher standard for new people authorized to receive the service. The new tiered standards meet the HCBS rule regulations more fully and support community-inclusive service models for people with disabilities.

As of Jan. 11, 2021, lead agencies and service providers must follow the tiered standards for new customized living settings and for people new to receiving adult day services, family adult day services and prevocational services.

The changes are in response to the 2014, federal Centers for Medicare & Medicaid Services (CMS) published HCBS regulations that changed the definition of home and community-based settings for the 1915(c) and 1915(i) Medicaid HCBS waivers. The definition considers a person’s experience and outcomes, in addition to a setting’s location, geography or physical characteristics.

On Feb. 12, 2019, CMS approved Minnesota’s HCBS Rule Statewide Transition Plan (PDF) to bring settings into compliance with the federal HCBS rule regulations. Minnesota’s Statewide Transition Plan includes the plan to implement higher standards for new people, or “tiered standards”, for several services. DHS submitted waiver plan amendments to CMS to implement the HCBS rule tiered standards in September 2020. CMS approved DHS’ Brain Injury (BI), Community Alternative Care (CAC), Community Access for Disability Inclusion (CADI) and Developmental Disabilities (DD) waiver amendment packages in January 2021.

Of particular interest to customized living (CL) providers that serve individuals with BI and CADI waivers, a new CL setting that enrolls and is operational on or after Jan. 11, 2021, must:

• Only serve people age 55 and older
• Comply with the setting location requirements.

A CL setting that is operational on Jan. 10, 2021, must comply with the setting location requirements and size requirements. A CL setting is not considered new if it has a change in ownership but was operational on or before Jan. 10, 2021.

Additionally, the lead agency cannot authorize CL or 24-hour CL services for people who reside in either of the following:

• A living setting adjoined to or on the same property as an institution (nursing facility, hospital, intermediate care facility for persons with developmental disabilities [ICF/DD]) or institution for mental disease (IMD) if the institution or IMD has any financial interest in the living setting.
• A living setting adjoined to or on the same property as a nursing facility, hospital, ICF/DD or IMD.

For adult day services, certain location requirements apply to new adult day settings established on or after July 1, 2019, for BI, CADI and DD waivers. The lead agency cannot authorize adult day services when the adult day setting is adjoined to or on the same property as an institution if that institution has any financial interest in the setting or services provided in the setting. For the purposes of this page, “institution” means:

• Nursing facility
• Hospital
• Intermediate care facility for persons with developmental disabilities (ICF/DD)
• Institution for mental disease (IMD).

When a single provider leases or owns more than one service setting located on the same or adjoining property, the lead agency can only authorize services in one of the settings. A service setting includes customized living services, adult day services, integrated community supports and others.

For more information, including size limits, exceptions, and provider standards, visit the full announcement: Implementation of the HCBS rule tiered standards, effective Jan. 11, 2021.