The Centers for Medicare & Medicaid Services (CMS) requires states to conduct validated site-specific assessments of provider-owned or controlled settings, to ensure each setting meets all requirements of the federal HCBS Settings Rule by the final compliance deadline of March 17, 2023.
HHSC is conducting site-specific assessments of provider-owned or controlled settings in its Medicaid HCBS programs, which are:
- In the Home and Community-based Services (HCS) program:
- Three-person residences
- Four-person residences
- Host home/companion care (HH/CC)
- In the Deaf Blind with Multiple Disabilities (DBMD) program:
- Licensed assisted living
- In the STAR+PLUS HCBS program:
- Assisted living facilities
- Adult foster care
HHSC’s existing provider monitoring processes for the HCS program determine compliance with all HCBS Settings Rule requirements except:
- Residential agreement (42 CFR §441.301(c)(4)(vi)(A))
- Bedroom door locks (42 CFR §441.301(c)(4)(vi)(B)(1))
- Access to food at any time (42 CFR §441.301(c)(4)(vi)(C))
HHSC is conducting an assessment of HCS three-person residences, four-person residences, and provider-owned or controlled HH/CC settings to determine compliance with the three bulleted criteria only.
If the assessment determines that an HCS residential setting does not comply with the federal HCBS Settings Rule, HHSC will provide information to the provider about remediation steps that must be taken to comply.
Additional information about the assessment process is in HHSC Information Letter 2022-49, Assessment of 3-Person Residences, 4-Person Residences, and Host Home/Companion Care (HH/CC) Settings for Compliance with Federal Home and Community Based Services (HCBS) Settings Rule [PDF].
HHSC is assessing licensed assisted living settings in the DBMD program for compliance with all requirements of the HCBS Settings Rule. HHSC provider monitoring staff will conduct on-site visits to these settings to assess for compliance with all of the HCBS settings criteria. Assessors will observe the setting, interview the provider, and interview the individual(s) who reside at the setting.
If the assessment determines that a licensed assisted living setting does not comply with the federal HCBS Settings Rule, HHSC will provide information to the provider about remediation steps that must be taken to comply.
STAR+PLUS HCBS Program
HHSC is assessing assisted living facility settings and adult foster care settings for compliance with all criteria of the HCBS Settings Rule.
Assisted living facility settings have been assessed by HHSC and STAR+PLUS managed care organizations (MCOs). All assisted living facilities in STAR+PLUS HCBS have been submitted to CMS for heightened scrutiny review. Read additional information about the assessment process and heightened scrutiny submission.
The state will assess adult foster care settings providers for compliance with all of the HCBS Settings Rule requirements. The assessment process includes the following steps:
- Adult foster care providers complete and submit a provider self-assessment form to HHSC.
- HHSC staff reviews the self-assessment and conduct a virtual visit or desk review of the setting.
- During a virtual visit, the provider is asked to give a virtual tour of the setting that includes viewing the kitchen area for any physical obstructions that could limit access to food and viewing bedroom doors to verify the presence of a lock.
More information about the assessment process for adult foster care is available in the following webinar recording:
- HCBS Settings Requirements for Adult Foster Care Providers Webinar
Previous Surveys of Medicaid HCBS Residential Providers
In 2016, HHSC completed a survey of a sample of residential providers in waiver programs to determine where systemic remediation was needed. The document below is a copy of that survey which is being provided for informational purposes only.