Making Community Living a Reality for More Americans

In 2009, the HHS Community Living Initiative (CLI) was launched (as part of the Affordable Care Act) to develop and implement innovative strategies to increase opportunities for Americans with disabilities and older adults to “enjoy meaningful community living.” To that end, the Centers for Medicare & Medicaid Services (CMS) recently issued a final rule that ensures that Medicaid home and community-based services (HCBS) programs provide full access to the benefits of community living. “People with disabilities and older adults have a right to live, work, and participate in the greater community. The HHS, through its Community Living Initiative, has been expanding and improving the community services necessary to make this a reality,” said HHS Secretary Kathleen Sebelius. The final rule was developed from discussions with stakeholders, states, and federal partners about the qualities of community-based settings that distinguish them from institutional settings.

The CMS says it is moving away from defining HCBS settings by “what they are not” and toward defining them by the nature and quality of individuals’ experiences. That includes establishing a more outcome-oriented definition of HCBS settings, according to the HHS.

The CLI supports inclusive, sustainable, and transparent programs. The rule specifies that service planning for participants in certain Medicaid HCBS programs must be developed through a “person-centered” process that addresses health and long-term services and support needs in a “manner that reflects individual preferences and goals.” For example, it requires that all HCBS settings are integrated into and support full access to the greater community, that the patient is allowed to choose from among setting options, and that it optimizes autonomy and independence in making life choices.

The final rule includes a transitional period for states to ensure their programs meet the HCBS settings requirements. Technical assistance will also be available for states. For more information regarding HCBS available under Medicaid, visit http://www.medicaid.gov/HCBS. For more information regarding the CLI, visit http://www.hhs.gov/od/community.