HCBS Final Settings Rule

 
4
Medicaid Related Assistance
Developmental Disabilities
 
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What you need to know

​​The HCBS Final Settings Rule is federal regulation promulgated in 2014 aimed at improving Home and Community-Based Services by:

  • Enhancing quality of services and person-centered planning
  • Adding protections for participants in waiver services
  • Increasing participant integration in their communities
  • Ensuring settings where services are delivered do not have institutional features​

Nebraska's Compliance


​​​Provider Compliance Tools ​

AD/TBI Self-Assessment Links and Guidance

AD and TBI Providers will have an assessment completed by their Resource Development worker when then enroll as a new provider and during their annual review. AD and TBI Providers may complete the heightened scrutiny worksheet as requested by DDD.

DD Self-Assessment Links and Guidance

When a DD provider opens a new residential service setting, the provider must complete a self-assessment at least 15 business days before opening. Residential settings include group homes, centers for the developmentally disabled (CDDs), host homes, and shared living homes. 

When a DD provider opens a new non-residential site, the provider must notify DDD Provider Relations at DHHS.DDProviderRelations@nebraska.gov so an assessment can be completed at least 15 business days before opening. Non-residential settings include workshops, hubs, enclaves, and other locations where day services occur.​

Heightened Scrutiny Information

​For settings presumed to have institutional qualities, CMS requires an assessment process called “heightened scrutiny." Identified settings are required to undergo an additional review by state staff and may be included in a sample reviewed by CMS.

​Settings subject to heightened scrutiny are any settings that meet one or more of the following criteria: 

  • Settings in a publicly owned or privately operated facility providing inpatient institutional treatment
  • Settings on the grounds of or adjacent to a public or private institutional facility
  • Settings with the effect of isolating people receiving waiver services  from the broader community

Any setting meeting one or more of the heightened scrutiny criteria must submit a heightened scrutiny packet to assist DDD in determining their compliance with the rule.


Resources and Training​​

CMS Final Setting Rule Guidance

Training Videos from The Council on Quality and Leadership (CQL) 

CQL developed videos to explain the CMS Final Settings Rule. 

Training for Direct Support Professionals - January 2025

Learn about the Final Settings Rule and how it applies to providers.

  • ​Training for Direct Support Professionals (DSPs): Understanding the HCBS Final Rule​

Plain Language Edition of the HCBS Settings Rule


Questions can be emailed to DHHS.DDProviderRelations@nebraska.gov​.