Current through Bulletin 2024-06, March 15, 2024
(1) An HCBS
setting must be integrated and support community access to services that
include opportunities for an individual to:
(a) seek employment and to work in
competitive integrated settings;
(b) engage in aspects of community
life;
(c) control personal
resources; and
(d) receive
community services with the same degree of access afforded to individuals who
do not receive HCBS.
(2)
An individual shall select the setting from among setting options that include
non-disability specific settings and an option for a private unit in a
residential setting.
(3) Setting
options are identified and documented in the person-centered service plan based
on the following:
(a) Individual need and
preference; and
(b) Resources
available for room and board in residential settings.
(4) An HCBS setting must ensure the
following:
(a) Individual rights of
privacy;
(b) Dignity and respect;
and
(c) Freedom from coercion and
restraint.
(5) An HCBS
setting must optimize, but not regiment, individual initiative, autonomy, and
independence through life choices that include daily activities, physical
environment, and personal interaction.
(6) An HCBS setting must facilitate
individual choice in relation to services and support.
(7) In addition to the qualities described in
42 CFR
441.301(c)(4)(i) through
(v), a provider-owned or controlled
residential setting must meet the following conditions:
(a) The unit or dwelling must be owned,
rented, or occupied under a legally enforceable agreement by an individual who
receives HCBS;
(b) An individual
must possess the same responsibilities and protections from eviction that
tenants have under the landlord and tenant law of the state, county, city, or
other designated entity; and
(c)
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 is in
place for each HCBS participant, and that the document provides protections
which address eviction processes and appeals comparable to those provided under
the landlord tenant law within the jurisdiction.
(8) An HCBS setting must afford privacy to
each individual in a sleeping or living unit and the following provisions shall
apply:
(a) Units must have lockable entrance
doors and only authorized staff may possess the keys;
(b) An individual who shares a unit may have
a choice of roommates in that setting;
(c) An individual may furnish and decorate
his sleeping or living unit within the lease or other agreement;
(d) An individual may control his own
schedule and activities, and access food at any time;
(e) An individual may have his choice of
visitors at any time;
(f) An
individual must be able to physically access the setting;
(g) Any modification of the additional
conditions, under
42 CFR
441.301(c)(4)(vi)(A) through
(D), must be supported by a specific assessed
need and justified in the person-centered service plan. HCBS providers shall
document that the plan meets the following requirements:
(i) The plan identifies a specific and
individualized assessed need;
(ii)
The plan documents the positive interventions and supports used before any
modifications to the person-centered service plan;
(iii) The plan documents less intrusive, but
unsuccessful methods of meeting an individual need;
(iv) The plan includes a clear description of
the condition that is directly proportionate to the specific assessed
need;
(v) The plan includes a
regular collection and review of data to measure the ongoing effectiveness of
the modification;
(vi) The plan
includes established time limits for periodic reviews to determine whether the
modification is still necessary or may be terminated;
(vii) The plan includes the informed consent
of the individual; and
(viii) The
plan includes an assurance that interventions and supports will cause no
individual harm.