Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 50 - Medicaid Long-Term Services and Supports › Subchapter 10 - Home and Community Based LTSS › Part 1 - "Medicaid Long-Term Services and Supports: Home and Community-Based Services (HCBS)" (210-RICR-50-10-1) › Section 210-RICR-50-10-1.8 - HCBS Setting Requirements

Current through June 14, 2024
A. The federal
				  government regulations beginning at
				   42 C.F.R. §
											441.700  establish standards and criteria that
				  states must follow when determining whether Medicaid coverage is available for
				  certain HCBS services and settings. This section incorporates the federal
				  standards and establishes the core HCBS for long-term services and supports.
				  The federal standards and requirements for HCBS are designed to: provide states
				  with more flexibility when using federal funds to pay for Medicaid in
				  non-institutional-settings; and establish a set of standards for HCBS that
				  ensures Medicaid LTSS beneficiaries will have full access to advantages of
				  community life and health services in integrated settings. The EOHHS is
				  committed to implementing a federally approved, stakeholder-driven transition
				  plan that assures the State is in compliance with these requirements by the
				  deadline for adoption in 2022. These regulations hereby adopt and incorporate
				   42 C.F.R. §
											441.700  et seq. (2014) by reference, not
				  including any further editions or amendments thereof and only to the extent
				  that the provisions therein are not inconsistent with these
				  regulations.
B. HCBS setting
				  requirements include the following characteristics:
1. The setting is integrated in and supports
				  full access to the greater community, including 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 applicants/beneficiaries not receiving Medicaid
				  HCBS.
2. The setting is selected by
				  the applicant/beneficiary from among 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 applicant's/beneficiary's needs, preferences,
				  and, for residential settings, resources available for room and
				  board.
3. Ensures an
				  applicant's/beneficiary's rights of privacy, dignity and respect, and freedom
				  from coercion and restraint.
4.
				  Optimizes, but does not regiment, applicant/beneficiary initiative, autonomy,
				  and independence in making life choices, including but not limited to, daily
				  activities, physical environment, and with whom to interact.
5. Facilitates applicant/beneficiary choice
				  regarding services and supports, and who provides them.
6. In a provider-owned or controlled
				  residential setting, in addition to the above qualities at paragraphs (a)(l)(i)
				  through (v) of this section, the following additional conditions must be met:
a. The unit or dwelling is a specific
				  physical place that can be owned, rented, or occupied under a legally
				  enforceable agreement by the applicant/beneficiary receiving services, and the
				  applicant/beneficiary has, at a minimum, the same responsibilities and
				  protections from eviction that tenants have under the landlord/tenant law of
				  the state, county, city, or other designated entity. For settings in which
				  landlord tenant laws do not apply, the State must ensure that a lease,
				  residency agreement or other form of written agreement will be in place for
				  each HCBS participant and that the document provides protections that address
				  eviction processes and appeals comparable to those provided under the
				  jurisdiction's landlord tenant law;
b. Each applicant/beneficiary has privacy in
				  their sleeping or living unit:
(1) Units have
				  entrance doors lockable by the applicant/beneficiary, with only appropriate
				  staff having keys to doors;
(2)
				  Applicants/beneficiaries sharing units have a choice of roommates in that
				  setting; and
(3)
				  Applicants/beneficiaries have the freedom to furnish and decorate their
				  sleeping or living units within the lease or other agreement.
c. Applicants/beneficiaries have
				  the freedom and support to control their own schedules and activities, and have
				  access to food at any time;
d.
				  Applicants/beneficiaries are able to have visitors of their choosing at any
				  time;
e. The setting is physically
				  accessible to the applicant/beneficiary; and
f. Any modification of the additional
				  conditions, under paragraphs (a)(l)(vi)(A) through (D) of this section, must be
				  supported by a specific assessed need and justified in the person-centered
				  service plan. The following requirements must be documented in the
				  person-centered service plan:
(1) Identify a
				  specific and individualized assessed need.
(2) Document the positive interventions and
				  supports used prior to any modifications to the person-centered service
				  plan.
(3) Document less intrusive
				  methods of meeting the need that have been tried but did not work.
(4) Include a clear description of the
				  condition that is directly proportionate to the specific assessed
				  need.
(5) Include regular
				  collection and review of data to measure the ongoing effectiveness of the
				  modification.
(6) Include
				  established time limits for periodic reviews to determine if the modification
				  is still necessary or can be terminated.
(7) Include the informed consent of the
				  applicant/beneficiary.
(8) Include
				  an assurance that interventions and supports will cause no harm to the
				  applicant/beneficiary.