Missouri Code of State Regulations › Title 13 - DEPARTMENT OF SOCIAL SERVICES › Division 70 - MO HealthNet Division › Chapter 3 - Conditions of Provider Participation, Reimbursement, and Procedure of General Applicability › Section 13 CSR 70-3.290 - Home and Community-Based Services Waiver Setting Requirements

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule implements federal regulatory
				  requirements promulgated by the United States Department of Health and Human
				  Services, Centers for Medicare and Medicaid Services at
				  42 CFR
				  441.301(c)(4) establishing
				  the requirements that must be met for settings in which home and
				  community-based services are provided under a 1915(c) HCBS Waiver Program.
				  1915(c) Home and Community-Based Services (HCBS) Waiver Programs are programs
				  that provide home and community based services to individuals who, in the
				  absence of those services, require the level of care provided in a hospital, a
				  nursing facility, or an ICF/IID. To offer a 1915(c) HCBS Waiver Program the
				  state must submit a waiver application for approval to the Centers for Medicare
				  and Medicare Services, who, on behalf of the Secretary of Health and Human
				  Services, determines if the waiver meets the statutory and regulatory
				  requirements found in 42 CFR 441.301-441.310.
(1) Home and Community-Based Setting
				Requirements. Home and community-based settings must have all of the following
				qualities based on the needs of individuals as indicated in their
				person-centered service plans:
(A) The
				setting is integrated in and supports full access of individuals receiving
				Medicaid Home and Community-Based Services (HCBS) to the greater community,
				including providing 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 individuals
				not receiving Medicaid HCBS;
(B)
				The setting is selected by the individual from 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 individual's needs,
				preferences, and, for residential settings, resources available for room and
				board;
(C) The setting ensures the
				individual's rights of privacy, dignity, and respect, and freedom from coercion
				and restraint;
(D) The setting
				optimizes, but does not regiment, individual initiative, autonomy, and
				independence in making life choices, including but not limited to, daily
				activities, physical environment, and with whom to interact;
(E) The setting facilitates individual choice
				regarding services and supports, and who provides them; and
(F) In a provider-owned or controlled
				residential setting, in addition to the qualities at 13 CSR 70-3.290(1)(A)
				through (E), the following additional conditions must be met:
1. The unit or dwelling is a physical place
				that can be owned, rented, or occupied under a legally enforceable agreement by
				the individual receiving services, and the individual has, at a minimum, the
				same responsibilities and protections from eviction that tenants have under the
				landlord/tenant law of the State of Missouri, county, city, or other designated
				entity. For settings in which landlord/tenant laws do not apply, a lease,
				residency agreement, or other form of written agreement must be in place for
				each HCBS participant, and that document must provide protections that address
				eviction processes and appeals comparable to those provided under the
				jurisdiction's landlord tenant law;
2. Individuals have privacy in their sleeping
				or living unit including:
A. Units have
				entrance doors lockable by the individual, with only appropriate staff having
				keys to doors;
B. Individuals
				sharing units have a choice of roommates in that setting;
C. Individuals have the freedom to furnish
				and decorate their sleeping or living units within the lease or other
				agreement;
3. Individuals
				have the freedom and support to control their own schedules and activities, and
				have access to food at any time;
4.
				Individuals are able to have visitors of their choosing at any time;
5. The setting is physically accessible to
				the individual; and
6. Any
				modification of the additional conditions, under (1)(F)1. through 4. of this
				rule, must be supported by a specific assessed need and justified in the
				person-centered service plan. If any modifications are made, the following
				requirements must be documented in the person-centered service plan:
A. A specific and individualized assessed
				need;
B. Positive interventions and
				supports used prior to any modifications to the person-centered service
				plan;
C. Less intrusive methods of
				meeting the need that have been tried but did not work;
D. A clear description of the condition that
				is directly proportionate to the specific assessed need;
E. Regular collection and review of data to
				measure the ongoing effectiveness of the modification;
F. Established time limits for periodic
				reviews to determine if the modification is still necessary or can be
				terminated;
G. The informed consent
				of the individual; and
H. An
				assurance that interventions and supports will cause no harm to the
				individual.