HCBS Settings Rule Deadlines are Approaching. Is Your State Ready?

After eight years and multiple delays, the Centers for Medicare & Medicaid Services (CMS) and the Biden administration are strongly committed to ensuring full compliance with the HCBS Settings Rule by March. Given the timeline outlined below, including the acknowledgement of ANCOR’s workforce concerns and the current status of statewide transition plan approvals, full compliance seems difficult at best.

• January 2014: CMS issued the HCBS settings final rule to ensure that beneficiaries of Medicaid-supported HCBS programs have full access to services in settings integrated into the community, rather than in institutional settings.
• 2019: Originally, states were given a five-year transition period — ending in 2019 — to comply with the new standards. But in 2017, the Trump administration extended the deadline by three years. Then, with the onset of the COVID-19 pandemic, officials pushed things back again to March 17, 2023.
• May 2022: In response to ANCOR’s advocacy, CMS announced the release of its slide deck detailing how states can use corrective action plans to request additional time to comply with staff-dependent provisions of the HCBS Settings Rule due to the direct care workforce crisis.
• December 1, 2022: Deadline for states to submit a corrective action plan (CAP) to CMS.
• March 17, 2023: Deadline for states to receive final approval of their statewide transition plans from CMS. Note: Only 17 states and Washington, DC, have received final approval from the federal government for their statewide transition plans, according to information posted as of Nov. 28 on medicaid.gov

As we stated in our March 14, 2022, letter to CMS:

ANCOR has been and continues to be supportive of the Settings Rule which emphasizes the critical importance of autonomy, self-determination and access to quality home and community-based services. Notably, ANCOR spearheaded a letter to Congress, signed by more than 40 national disability and aging organization, sent July 28, 2015, showing support for the Settings Rule, and urging appropriate funding and policies are in place as the rule is implemented. We remain committed to successful implementation of the Settings Rule and our shared goal of meaningful community inclusion for all.

The COVID-19 pandemic has drastically accelerated the direct care workforce crisis, forcing delays and closures of crucial home and community-based services (HCBS) due to insufficient staffing. Through no fault of providers, the direct care workforce crisis has created barriers to compliance and the resulting enforcement measures threaten access to already limited and fragile services.

ANCOR’s position has not changed, and we are committed to supporting our members to work with their states to request a CAP and to comply with the settings rule.

What Can You Do?

If your state has not submitted a CAP, we’ve learned that since the December 1 deadline is not specified in regulation, there is some wiggle room there. CMS reports that they’ve been messaging states to let them know as soon as possible if they think they’ll be requesting a CAP.

We encourage our members to continue reaching out to your states to understand final decisions on whether to request a CAP, and to provide any information from your provider perspective so that states fully understand the realities of complying with the rule – especially those that are impacted by and reliant on the workforce.

Please do not hesitate to reach out to me if you have any questions or need additional information.

Shannon McCracken is Vice President of Government Relations at ANCOR.