DEPARTMENT OF HEALTH & HUMAN SERVICES 
Centers for Medicare & Medicaid Services 
7500 Security Boulevard, Mail Stop S2-26-12 
Baltimore, Maryland   21244-1850 
 
 
CMCS Informational Bulletin 
 
DATE:  January 10, 2014 
 
FROM:  Cindy Mann 
Director 
 
SUBJECT:  Final Rule - CMS 2249-F  1915(i) State Plan Home and Community-Based 
Services, 5-Year Period for Waivers, Provider Payment Reassignment, Setting 
Requirements for Community First Choice, and CMS 2296-F 1915(c) Home and 
Community-Based Services Waivers 
 
 
Today the Centers for Medicare & Medicaid Services (CMS) is pleased to announce the publication 
of an important final rule about home and community-based services (HCBS) provided through 
Medicaids 1915(c) HCBS Waiver program, 1915(i) HCBS State Plan Option, and 1915(k) 
Community First Choice. The rule enhances the quality of HCBS, provides additional protections to 
HCBS program participants, and ensures that individuals receiving services through HCBS programs 
have full access to the benefits of community living.  The rule is available at 
http://www.medicaid.gov/HCBS. 
 
The final rule is a result of multiple rulemaking efforts over the last five years and consideration by 
CMS of input from thousands of stakeholders.  This robust process helped CMS ensure that the 
regulation takes into account a wide range of stakeholder perspectives and the varying experiences 
across the states.  There will be continued opportunities for stakeholder input as CMS works with 
states to implement this final rule. 
 
CMS will offer opportunities for additional information, issuing additional guidance, and providing 
assistance as states begin implementing this final rule.  We recognize that implementing this final 
rule may require states to evaluate and make adjustments in their current systems and that this 
process will take time.  The final rule provides for a process that will allow states to implement this 
rule in a manner that will support continuity of services for Medicaid participants and minimize 
disruptions in service systems during implementation.  This Informational Bulletin contains a brief 
overview of this transition process and the assistance available from CMS to assist states with the 
process. 
 
Additional Information and Forthcoming Guidance 
 
CMS is committed to ensuring that stakeholders have immediate access to information to help them 
understand the final rule. CMS has developed a website dedicated to providing information about the 
rule, available at http://www.medicaid.gov/HCBS.  On this website, stakeholders can find links to 
fact sheets, questions and answers and other related resources.  In addition, CMS will be holding a 
series of informational webinars over the next several weeks.  The dates for these webinars can be  CMCS Informational Bulletin  Page 2 
 
found on the website.  CMS has also established a mailbox at HCBS@cms.hhs.gov and encourages 
you to submit questions to the mailbox. 
 
As states begin implementation, CMS will provide additional information on a number of topics over 
the next several weeks and months. The information will be provided through additional 
Informational Bulletins and through revisions to the 1915(c) Waiver Technical Guide for regulatory 
changes for the 1915(c) HCBS Waivers, CMS will also be creating additional fact sheets and 
frequently asked questions (FAQs) to address questions from the public after they have had a chance 
to review the final rule. 
 
Transition for Implementing Home and Community-Based Settings Requirements 
 
CMS recognizes that states and providers may need time to implement the clarifying requirements 
about the characteristics of home and community-based settings. The final regulation provides for a 
transition process that will allow states to implement this rule in a manner that supports continuity of 
services for Medicaid participants and minimizes disruptions in service systems during 
implementation. New 1915(c) waivers or 1915(i) state plans must meet the new requirements to be 
approved.  For currently approved 1915(c) waivers and 1915(i) state plans, states will need to 
evaluate the settings currently in their 1915(c) waivers and 1915(i) state plan programs and, if there 
are settings that do not meet the final regulations home and community-based settings requirements, 
work with CMS to develop a plan to bring their  program into compliance.  The public will have an 
opportunity to provide input on states transition plans.  CMS expects states to transition to 
compliance in as brief a period as possible and to demonstrate substantial progress towards 
compliance during any transition period.  CMS will afford states a maximum of a one year period to 
submit a transition plan for compliance with the home and community-based settings requirements, 
and CMS may approve transition plans for a period of up to five years, as supported by individual 
states circumstances, to effectuate full compliance. 
 
States submitting a 1915(c) waiver renewal or waiver amendment within the first year of the effective 
date of the rule may need to develop a transition plan to ensure that specific waiver or state plan 
meets the settings requirements.  Within 120 days of the submission of that 1915(c) waiver renewal 
or waiver amendment, the state needs to submit a plan that lays out timeframes and benchmarks for 
developing a transition plan for all the states approved 1915(c) waiver and 1915(i) HCBS state plan 
programs.  CMS will work closely with states as they consider how to best implement these 
provisions and will be issuing sub-regulatory guidance to provide the details regarding requirements 
for transition plans. 
 
Assistance from CMS 
 
CMS is committed to assisting states in implementing these rules and is available to work closely 
with individual states at the beginning and throughout the development of their transition plans.  In 
addition, CMS is working to provide additional technical assistance resources to states and will 
provide information about these resources as soon as possible. 
 
Many states have made significant progress in recent years to increase the availability and quality of 
home and community-based services. We believe the implementation of these rules will contribute  CMCS Informational Bulletin  Page 3 
 
significantly to the quality and experience of participants in Medicaid HCBS programs and will 
further expand their opportunities for meaningful community integration in support of the goals of 
the Americans with Disabilities Act and the Supreme Courts decision in Olmstead v. L.C. 
 
We thank the many individuals and organizations who contributed input to these rules and look 
forward to the continuing dialogue with stakeholders as we work together to make them a reality.