THE SETTINGS RULE

The Division of Services for People with Disabilities (DSPD) offers Home and Community-Based Services (HCBS) to help people with disabilities live in their own homes and communities instead of institutions. In 2014, the Centers for Medicare and Medicaid Services (CMS) announced the HCBS Final Rule, or Settings Rule. The Settings Rule is a set of rules that providers, Support Coordinators, and states must follow in regards to HCBS settings and the Person-Centered Planning (PCP) process.

All providers of day, residential, and employment services must be compliant with the Settings Rule by March 17, 2023. DSPD understands that some providers may have to change their service delivery model to meet the requirements of the Settings Rule. DSPD, along with the Department of Health (DOH) and the Office of Quality and Design (OQD) is committed to working with those providers that have changes to make.



Settings Rule Requirements
Requirements for Residential Settings
Rights Restrictions/Modifications
Heightened Scrutiny
Resources

Settings Rule Requirements


According to the Settings Rule, Home and Community-Based settings must have all of the following qualities, and such other qualities based on the needs of the individual as indicated in their Person-Centered Support Plan (PCSP):

  • Setting is integrated in and supports full access to the community
  • Is selected by the individual among setting options
  • Ensures individual rights of privacy, dignity and respect, and freedom from coercion and restraint
  • Optimizes autonomy and independence in making life choices
  • Facilitates choice regarding services and who provides them

                  In addition to the above requirements, providers that offer services (day, residential, or employment) to multiple people with disabilities in the same location must make sure services:

                  • Do not discriminate in any way
                  • Provide services in the most integrated setting
                  • Are chosen from a variety of options
                  • Provide opportunities to seek employment and work in competitive integrated settings
                  • Do not isolate individuals from the community

                  Requirements for Residential Settings



                  Provider-owned or controlled residential home and community based service settings must also ensure that the individual:

                  • Has a lease or other legally enforceable agreement providing similar protections
                  • Has privacy in their unit including lockable doors, choice of roommates, and freedom to furnish or decorate the unit
                  • Control their own schedule including access to food at any time
                  • May have visitors at any time
                  • The setting is physically accessible

                  Rights Restrictions/Modifications


                  Any modifications of the settings rule requirements must be supported by a specific assessed need and justified in the Person-Centered Support Plan (PCSP), with the following items documented in the plan:

                  1. Identify a specific and individualized assessed need
                  2. Document the positive interventions and supports used prior to any modifications to the person-centered service plan
                  3. Document less intrusive methods of meeting the need that have been tried but did not work
                  4. Include a clear description of the condition that is directly proportionate to the specific assessed need
                  5. Include regulation collection and review of data to measure the ongoing effectiveness of the modification
                  6. Include established time limits for periodic reviews to determine if the modification is still necessary or can be terminated
                  7. Include the informed consent of the individual
                  8. Include an assurance that interventions and supports will cause no harm to the individual.

                  Heightened Scrutiny


                  Heightened Scrutiny is an additional review process where the Centers for Medicare and Medicaid Services (CMS) reviews settings that have institutional qualities to ensure that those sites demonstrate that they have overcome those institutional qualities and are in compliance with all aspects of the Settings Rule. CMS will also review the state’s process for determining compliance for those sites that have institutional qualities.




                  Resources