Home and Community Based Services

Medicaid home and community-based services (HCBS) provide opportunities for Medicaid recipients to receive long-term services and supports in their own home or community, rather than in an institution or isolated setting.

HCBS Settings Rule

Public Comment Period for Statewide Transition Plan

CMS requires states to submit a transition plan describing the state’s planned initiatives and activities for achieving compliance with the federal HCBS Settings Rule. HHSC has amended its initial STP based on these requirements and other guidance from CMS.

HHSC invites members of the public, including Medicaid HCBS recipients and their families, providers and other stakeholders to submit comments on the latest version of the STP. The STP and appendices are available at the following links:

Written comments, requests to review comments or both may be sent by U.S. mail, overnight mail, special delivery mail, hand delivery, fax, or email.

All comments must be received by HHSC by 11:59pm on April 4, 2022.

Instructions for submitting comments

Email: Medicaid_HCBS_Rule@hhsc.state.tx.us

U.S. Mail:
Texas Health and Human Services Commission
Attention: Rachel Neely, Office of Policy
John H. Winters Complex
701 W 51st Street
Mail Code H-600
Austin, TX 78751

Overnight mail, special delivery mail, or hand delivery:
Texas Health and Human Services Commission
Attention: Rachel Neely, Office of Policy
John H. Winters Complex
701 W 51st Street
Mail Code H-600
Austin, TX 78751

Phone number for package delivery: 512-438-4297

Fax:
Attention: Rachel Neely, Office of Policy at 512-438-5835

Overview of HCBS Settings Rule

In March 2014, the Centers for Medicare and Medicaid Services (CMS) issued the federal HCBS Settings Rule, which added requirements for settings where Medicaid HCBS are provided. CMS has given states until March 17, 2023 to bring Medicaid programs into compliance with the regulations.

The purpose of the HCBS Settings Rule is to ensure people receive Medicaid HCBS in settings that are integrated in the community. 
Medicaid HCBS settings must be integrated in and support full access to the greater community, and are required to provide opportunities to:

  • Seek employment and work in competitive, integrated settings.
  • Engage in community life.
  • Control personal resources and
  • Receive services in the community.

The HCBS Settings Rule applies to the following Texas Medicaid programs and services:

  • Community Living Assistance and Support Services (CLASS)
  • Deaf-Blind with Multiple Disabilities (DBMD)
  • Home and Community-based Services (HCS)
  • Texas Home Living (TxHmL)
  • Medically Dependent Children's Program (MDCP)
  • Youth Empowerment Services (YES)
  • STAR+PLUS HCBS
  • Community First Choice (CFC) services
  • HCBS Adult Mental Health (HCBS AMH)

Statewide Transition Plan

CMS requires all states to submit a transition plan describing their planned initiatives and activities to achieve compliance with the federal HCBS settings regulations.

Heightened Scrutiny

CMS presumes some settings have qualities that are institutional or isolating in nature. CMS requires states to submit evidence demonstrating that these settings are able to overcome this presumption.

These settings must go through a heightened scrutiny review by CMS.

Find more information about the heightened scrutiny process.

Resources

CMS Resources

Provider Communications