DEPARTMENT OF HEALTH AND HUMAN SERVICES 
Centers for Medicare & Medicaid Services 
7500 Security Boulevard, Mail Stop S2-26-12 
Baltimore, MD 21244-1850 
 
 
CMCS Informational Bulletin 
 
 
DATE:  May 9, 2017 
 
FROM:  Brian Neale, Director 
 
SUBJECT:   Extension of Transition Period for Compliance with Home and Community-
Based Settings Criteria 
 
Health and Human Services Secretary Thomas E. Price, M.D. and Centers for Medicare & 
Medicaid Services (CMS) Administrator Seema Verma, MPH, issued a letter to the nations 
Governors on March 14, 2017, affirming the continued HHS and CMS commitment to 
partnership with states in the administration of the Medicaid program and noting key areas where 
we will improve collaboration with states and move towards more effective program 
management. One of the areas of the increased flexibility CMS intends to extend to states is in 
the provision of home and community-based services (HCBS), and this information will provide 
additional clarity on immediate steps taken to act on that commitment.  
 
Promoting community integration for older adults and people with disabilities remains a high 
priority for CMS. We acknowledge the important work underway at the state level in 
implementing the regulation that finalized criteria for home and community-based settings 
appropriate for the provision of HCBS.  State partners, stakeholders representing beneficiaries 
and their families, providers, and other community organizations have been collaborating with 
us, and with each other, to develop transition plans that would make the reforms described in the 
regulation a reality for over a million Medicaid beneficiaries receiving HCBS.  
 
Language in the preamble to the final HCBS regulations governing services provided under 
sections 1915(c), 1915(i) and 1915(k) of the Social Security Act, in a response to comments 
submitted on the regulations proposing the settings criteria, recognized that compliance with the 
new regulations would be a complex process requiring a balancing of interests. As a result, CMS 
indicated that states were permitted to propose transition plans (i.e., Statewide Transition Plans) 
encompassing up to five years after the effective date of the regulations for settings reflected in 
existing state plans and waivers to come into compliance with the regulation. 
 
In recognition of the significance of the reform efforts underway, CMS intends to continue to 
work with states on their transition plans for settings that were operating before March 17, 2014 
to enable states to achieve compliance with the settings criteria beyond 2019. Consistent with the 
preamble language, states should continue progress in assessing existing operations and 
identifying milestones for compliance that result in final Statewide Transition Plan approval by 
March 17, 2019.  However, in light of the difficult and complex nature of this task, we will 
extend the transition period for states to demonstrate compliance with the home and community-  
 
CMCS Informational Bulletin  Page 2  
 
 
based settings criteria until March 17, 2022 for settings in which a transition period applies.  We 
anticipate that this additional three years will be helpful to states to ensure compliance activities 
are collaborative, transparent and timely. 
 
CMS remains committed to providing technical assistance to states and other stakeholders in 
understanding regulatory provisions and developing implementation approaches that maximize 
the provision of Medicaid services in a manner compliant with program requirements.  
 
If you have any questions, please contact Mike Nardone, Director, Disabled and Elderly Health 
Programs Group, at 410-786-7089.