210 R.I. Code R. 210-RICR-50-10-1.8

Current through December 3, 2024

Section 210-RICR-50-10-1.8 - HCBS Setting Requirements

A. The federal government regulations beginning at 42 C.F.R. § 441.700 establish standards and criteria that states must follow when determining whether Medicaid coverage is available for certain HCBS services and settings. This section incorporates the federal standards and establishes the core HCBS for long-term services and supports. The federal standards and requirements for HCBS are designed to: provide states with more flexibility when using federal funds to pay for Medicaid in non-institutional-settings; and establish a set of standards for HCBS that ensures Medicaid LTSS beneficiaries will have full access to advantages of community life and health services in integrated settings. The EOHHS is committed to implementing a federally approved, stakeholder-driven transition plan that assures the State is in compliance with these requirements by the deadline for adoption in 2022. These regulations hereby adopt and incorporate 42 C.F.R. § 441.700 et seq. (2014) by reference, not including any further editions or amendments thereof and only to the extent that the provisions therein are not inconsistent with these regulations.

B. HCBS setting requirements include the following characteristics:

1. The setting is integrated in and supports full 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 applicants/beneficiaries not receiving Medicaid HCBS.

2. The setting is selected by the applicant/beneficiary from among setting options, including non-disability specific settings and an option for a private unit in a residential setting. The setting options are identified and documented in the person-centered service plan and are based on the applicant's/beneficiary's needs, preferences, and, for residential settings, resources available for room and board.

3. Ensures an applicant's/beneficiary's rights of privacy, dignity and respect, and freedom from coercion and restraint.

4. Optimizes, but does not regiment, applicant/beneficiary initiative, autonomy, and independence in making life choices, including but not limited to, daily activities, physical environment, and with whom to interact.

5. Facilitates applicant/beneficiary choice regarding services and supports, and who provides them.

6. In a provider-owned or controlled residential setting, in addition to the above qualities at paragraphs (a)(l)(i) through (v) of this section, the following additional conditions must be met:

a. The unit or dwelling is a specific physical place that can be owned, rented, or occupied under a legally enforceable agreement by the applicant/beneficiary receiving services, and the applicant/beneficiary has, at a minimum, the same responsibilities and protections from eviction that tenants have under the landlord/tenant law of the state, county, city, or other designated entity. For settings in which landlord tenant laws do not apply, the State must ensure that a lease, residency agreement or other form of written agreement will be in place for each HCBS participant and that the document provides protections that address eviction processes and appeals comparable to those provided under the jurisdiction's landlord tenant law;

b. Each applicant/beneficiary has privacy in their sleeping or living unit:

(1) Units have entrance doors lockable by the applicant/beneficiary, with only appropriate staff having keys to doors;

(2) Applicants/beneficiaries sharing units have a choice of roommates in that setting; and

(3) Applicants/beneficiaries have the freedom to furnish and decorate their sleeping or living units within the lease or other agreement.

c. Applicants/beneficiaries have the freedom and support to control their own schedules and activities, and have access to food at any time;

d. Applicants/beneficiaries are able to have visitors of their choosing at any time;

e. The setting is physically accessible to the applicant/beneficiary; and

f. Any modification of the additional conditions, under paragraphs (a)(l)(vi)(A) through (D) of this section, must be supported by a specific assessed need and justified in the person-centered service plan. The following requirements must be documented in the person-centered service 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 regular 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 applicant/beneficiary.

(8) Include an assurance that interventions and supports will cause no harm to the applicant/beneficiary.

210 R.I. Code R. 210-RICR-50-10-1.8