HCBS Settings Rule: Compliance for Nonresidential Services Providers

The home and community-based services (HCBS) settings rule was published in 2014 by the Centers for Medicare & Medicaid Services (CMS). The federal requirements define the qualities of settings eligible for reimbursement for Medicaid HCBS. Under the requirements, DHS must ensure that settings where HCBS are provided meet and stay in compliance with the settings rule requirements.

Nonresidential settings subject to the HCBS settings rule:

• Adult day services settings
• Adult day care centers (See the Adult Day Care Centers webpage for more information)
• Prevocational settings
• Group supported employment settings
• Children's day services settings (See Implementation of Federal Home and Community-Based Services Settings Rule in Wisconsin, P-02428 (PDF) for more information.)

All nonresidential settings ensure specific HCBS rights of individuals who get HCBS in those settings. These individuals have the right to:

• Experience full access to the community. This includes chances to seek employment and work in integrated settings, take part in community life, control personal resources, and get services in the community. They get access to the same degree as people not getting Medicaid HCBS.
• Decide where they receive services. Options include non-disability-specific locations. Their long-term care person-centered service and support plan provides options based on their needs, preferences, and resources.
• Be treated with dignity and respect. They also have the right to privacy and freedom from coercion and restraint.
• Live with independence. They are encouraged to make their own choices about life, daily activities, friendships, and the places they visit.
• Choose services and supports. They also choose who provides them.

Settings must meet these rules to be considered compliant. Only then can they provide services under the following Medicaid waiver programs:

• Family Care
• Family Care Partnership
• IRIS (Include, Respect, I Self-Direct)
• Children's Long Term Support Waiver

An HCBS compliant determination does not guarantee a contract to provide services.

Providers can review compliance requirements with the federal settings rule for specific nonresidential settings.

• HCBS Settings Rule Benchmarks: Adult Day Service Settings, P-03481 (PDF)
• HCBS Settings Rule Benchmarks: Children’s Long Term Day Service Settings, P-03481a (PDF)
• HCBS Settings Rule Benchmarks: Prevocational Settings, P-03481b (PDF)
• HCBS Settings Rule Benchmarks: Group Supported Employment Settings, P-03481c (PDF)

Heightened scrutiny

A nonresidential setting can get paid by Medicaid if it is a home and community-based setting. The federal HCBS settings rule sets guidelines. Guidelines say a setting is not home and community-based if it:

• Is located in a publicly or privately owned facility providing inpatient treatment (including hospitals and skilled nursing facilities).
• Is on the grounds of, or next to, a public inpatient institution (including hospitals and skilled nursing facilities). Public means government owned or controlled.
• Keeps people away from the broader community of people who do not get Medicaid HCBS waiver services.

When a provider requests to receive Medicaid funding, and if any of these are true, the setting needs a heightened scrutiny review and needs to meet the additional Home and Community-Based Setting Rule Benchmarks: Heightened Scrutiny for Nonresidential Providers and 1-2 Bed Adult Family Homes, P-03629 (PDF) to see if it is home and community-based.

Learn more and review compliance requirements on the HCBS Settings Rule: Heighted Scrutiny webpage.

Nonresidential provider settings: compliance status

Find a list of nonresidential settings that have been found compliant with the HCBS settings rule on the HCBS Nonresidential Settings Compliance List (Excel). Each setting is assessed for HCBS compliance every three years, and the list of compliant settings is updated at least every six months.

Contact information

To request a copy of the evidentiary document checklist and submission instructions for adult day settings, prevocational settings, group supported employment settings, and children’s day services settings, email DHSHCBSReview@dhs.wisconsin.gov or call 608-261-6393.