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ANCOR News - 03.17.23

The Day is Here: The HCBS Settings Rule is in Effect

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Dear ANCOR members,

Today marks a significant milestone in the history of our community, as the effective date of the Home and Community Based Services (HCBS) Settings Rule.

It’s hard to capture just how much has happened in the nine years since the Obama administration finalized the HCBS Settings Rule in 2014 – or the years during which the rule was under development. The Rule requires states to ensure that people accepting services under an HCBS waiver have full access to the least restrictive community-based services possible, thereby enhancing their sense of community and their independence in day-to-day activities. Of course, it’s about more than just settings; the Rule requires that people have choices about where they live and work, but also the people with whom they interact and the extent to which their daily living services remain private.

The road to today’s compliance deadline has been long and complicated. The regulation initially gave states until 2019 to determine how they would comply, at which point the U.S. Department of Health & Human Services would begin withholding funding for programs. Before we got to that point, however, the Trump administration in May 2017 delayed the implementation by three years, postponing from 2019 until 2022, citing the “difficult and complex nature” of compliance. Of course, the COVID-19 pandemic and its impact on the workforce crisis threw a significant wrench into the implementation process, necessitating another postponing of the deadline for implementation.

ANCOR has always supported the Settings Rule and its emphasis on the critical importance of autonomy, self-determination, and access to quality home- and community-based services. We’ve learned from many ANCOR members that the rule’s expectations are achievable – they’ve been providing services in this manner for years. But they acknowledge that this fundamental shift in how to support people takes time and resources. That’s why we pushed the Centers for Medicare & Medicaid Services to clearly understand the impact of the magnitude of the workforce crisis and that successful implementation demands appropriate funding, technical assistance and guidance.

I’m proud of the advocacy of the ANCOR community from the beginning, and the tangible impact it has had. Most notably, in direct response to ANCOR’s advocacy, CMS announced a process last May to enable states to use corrective action plans to request additional time to comply with the staffing-dependent provisions of the Rule. Since then, nearly 40 states have officially sought additional time to comply with the staffing-dependent provisions while remaining committed to the Rule’s other provisions. Equally importantly, other advocates, frustrated that the rule has taken so long to be fully enforced, understand and agree with what we’ve all been saying for years: that the biggest barrier to greater community inclusion is the DSP workforce crisis.

Taken together, this means that we all still have important work to do. Nevertheless, we have accomplished so much since the Settings Rule was issued in 2014, and the road ahead for the people we support will be more inclusive and more equitable thanks to your dedication and commitment.

For that, I hope you will take a moment today to reflect on this significant achievement and the meaningful role you have played in it.

Barbara Merrill, ANCOR CEO