**HCBS enables individuals with disabilities to live and receive services in integrated community settings, promoting independence and choice. These services provide alternatives to institutional care, ensuring individuals can remain in their homes and communities while receiving necessary support.

HCBS Final Rule

In 2014, the Centers for Medicare & Medicaid Services (CMS) introduced the HCBS Final Rule to enhance service quality and ensure individuals have full access to community living. The rule sets standards that require HCBS settings to be more person-centered, giving individuals greater control over their lives, services, and daily activities. The Department of Developmental Services (DDS) and its partners have been working toward compliance, with full implementation required by March 17, 2023. The Statewide Transition Plan (STP) includes provider self-assessments, virtual assessments, training, and compliance funding.

Affected Services

HCBS Final Rule applies to both residential and non-residential services, including:

*Source: DDS Directive dated 12/1/2023

HCBS Setting Requirements

All settings must meet #1-5 and #10:

1. The setting is integrated in and supports full access of individuals receiving Medicaid HCBS to the greater community, including opportunities to seek employment and work in competitive integrated settings, engage in community life, control personal resources, and receive services in the community, to the same degree of access as individuals not receiving Medicaid HCBS.

2. The setting is selected by the individual from among setting options, including non-disability specific settings and an option for a private unit in a residential setting. The setting options are identified and documented in the person-centered service plan and are based on the individual’s needs, preferences, and, for residential settings, resources available for room and board.

3. Ensures an individual’s rights of privacy, dignity and respect, and freedom from coercion and restraint.

4. Optimizes, but does not regiment, individual initiative, autonomy, and independence in making life choices, including but not limited to, daily activities, physical environment, and with whom to interact.

5. Facilitates individual choice regarding services and supports, and who provides them. In provider-owned or controlled residential settings:

Only Residential Settings must meet 6-9:

6. The unit or dwelling is a specific physical place that can be owned, rented, or occupied under a legally enforceable agreement by the individual receiving services, and the individual has, at a minimum, the same responsibilities and protections from eviction that tenants have under the landlord/tenant law of the state, county, city, or other designated entity.

7. Each individual has privacy in their sleeping or living unit (units have entrance doors lockable by the individual, with only appropriate staff having keys to doors; individuals sharing units have a choice of roommates in that setting; and Individuals have the freedom to furnish and decorate their sleeping or living units within the lease or other agreement).

8. Individuals have the freedom and support to control their own schedules and activities, and have access to food at any time.

9. Individuals are able to have visitors of their choosing at any time.

10. The setting is physically accessible to the individual.

Modification Requirements

Any modification of the additional requirements applying to provider-owned or controlled residential settings (requirements #6 through #9) must be supported by a specific assessed need and justified in the person-centered service plan.

The following requirements must be documented in the person-centered service plan:

· Identify a specific and individualized assessed need.

· Document the positive interventions and supports used prior to any modifications to the person-centered service plan.

· Document less intrusive methods of meeting the need that have been tried but did not work.

· Include a clear description of the condition that is directly proportionate to the specific assessed need.

For residential settings, specifically, individuals receiving services must have:

· Include regular collection and review of data to measure the ongoing effectiveness of the modification.

· Include established time limits for periodic reviews to determine if the modification is still necessary or can be terminated.

· Include the informed consent of the individual.

· Include an assurance that interventions and supports will cause no harm to the Individual.

Please find a printable copy of the requirements here: Final Rule Requirements

Compliance Monitoring

DDS and Regional centers are overseeing HCBS compliance through:

• On-Site Reviews: Conducted by regional centers to verify compliance
• Validation and Site Assessments: Used to confirm providers meet Final Rule standards.
• Provider Support: Training, technical assistance, and remediation plans.

Completion of the Statewide Transition Plan Monitoring 2024

As part of the final phase of the Statewide Transition Plan, the Department of Developmental Services directive issued 12/1/2023 which provided regional center guidance for monitoring and corrective action to complete the verification full compliance and implementation of the HCBS Setting requirements by August 31,2024.

DDS, Kern regional center, service providers and individuals served, all diligently collaborated to verify HCBS compliance. This effort included interviews with individuals served, documentation review of program designs and policies which were verified by onsite assessments for every service provider and setting under HCBS’s Final Rule. Kern Regional Center HCBS Monitoring team utilized the DDS Public Consulting monitoring tools for 2024. These tools may be found on the DDS website and below for reference. 

2024 DDS PCG Monitoring Tools

• Non-Residential Provider – Validation Compliance (Enclosure 2a)
• Residential Provider – Validation Compliance (Enclosure 2b)
• Non-Residential Site Assessment (VSA Non-Residential Provider Questions)
• Residential Site Assessment (VSA Residential Provider Questions)

On November 22, 2023, the Department issued a establishing a monitoring timeline for completion of required on-site reviews to confirm that all HCBS settings are implementing policies in compliance with HCBS settings requirements by September 31, 2024. The following data is the result of those efforts.

• Statewide HCBS Final Rule Compliance Report – October 4, 2024

Ongoing Monitoring for 2025

It should be highlighted that compliance is not a one-time assessment but an ongoing process that reflects a cultural shift toward continuously improving individuals’ quality of life and upholding full access of community living, person centered services and ensuring individuals have greater control over their lives, services and daily activities. Kern Regional Center has gathered input from individuals served, regional center staff, service providers and from the HCBS Community of Practice hosted by Bakersfield ARC, and will be utilizing a revised monitoring tool and consumer interview to determine continued HCBS Compliance for 2025. This tool can be found below.

Providers required to complete site monitoring visits will receive scheduling notices from their Community Service Specialist. The monitoring tool will outline any necessary recommendations and remediation steps, ensuring that services evolve to meet the needs of individuals served. Providers will receive technical support and guidance to align with HCBS requirements and foster sustainable person-centered practices. If providers are unable to reaffirm compliance with the HCBS settings rule, Kern regional center will work with the provider in a Corrective Action Plan, as detailed DDS Directive issued 12/1/2023.

· 2025 HCBS Monitoring Tool

· 2025 HCBS Consumer Interview

Have questions or need support?

• Who can I contact for assistance? For any questions regarding HCBS compliance, monitoring, or support, please reach out to the KRC’s HCBS Program Evaluator at Leslie.mosqueda@Kernrc.org or (661) 852-3227.
• What support is available? KRC offers a wide range of technical assistance, training, and guidance to help providers align with HCBS requirements and foster person-centered practices. If you need further assistance, please contact your Community Service Specialist or attend upcoming informational webinars.

Additional Key Resources and Supports for Providers

Under the Fiscal Years (FY) 2022-23 and 2023-24 the enacted budget included $15 million to assist providers in complying with the HCBS Final Rule, and to support broader work in each community which promotes and sustains ongoing compliance. The Department of Developmental disabilities allocated funds between the 21 regional centers across California. Several local services have joined in partnership with Kern Regional Center to be a resource for service providers and individuals served to establish the following supports in the community.

Newsletter and Community of Practice

Bakersfield ARC crafts a monthly newsletter, webinar training and hosts a Community of Practice meetings monthly for residential and non residential service providers and their direct support professionals to learn more about HCBS and have a place to voice questions among other providers. To get on their newsletter and access their Training and Community of Practice please email Irene Arellano iarellano@bakersfieldarc.org or call (661) 834-2272 x 4201.

Individual Peer Mentor 

Bakersfield ARC has a peer mentor who is available to visit residential services or day programs to provide training, share experiences with services, advocacy discussions, and a wealth of information to individuals served, direct support professionals, and service providers. If you are interested, please contact Irene Arellano, iarellano@bakersfieldarc.org or call (661) 834-2272 x 4201.

Need training to be self-paced for Administrators, Directors or Direct Support Professionals (DSPs)?

Bakersfield ARC has developed a self-paced 31-module HCBS focused training plan through RELIAS that will allow trainees to earn CEUs approved through Kern Regional Center. If you are interested in taking advantage of this opportunity email Valerie Gomez at vgomez@bakersfieldarc.org or Irene Arellano at iarellano@bakersfieldarc.org . Limited slots are available on a first come first serve basis. Relias is a leading provider of workforce education and empowering organizations and their staff with integrated tools and best-in-class learning content. Each module provides practices that support community integration, individual rights, and individual choice, emphasizing a holistic approach to service delivery. A committed and engaged workforce is essential to the quality of care and overall success of each organization. By having ongoing training and developing the skills of your staff, you position your agency for success and ultimately improve the quality of care for those you serve.

To access all archived Trainings please visit Bakersfield ARC website https://www.bakersfieldarc.org/

Person Centered Training

Valley Achievement Center is collaborating with Kern Regional Center’s Person Centered trainers in the Learning Community to offer person centered training to service coordinators, DSPs, service providers and community members. Classes fill up fast! Please check out KRC’s person centered practices webpage for the latest training calendar. Person Centered Practices | Kern Regional Center

G.R.O.W. Peer-led Initiative

Valley Achievement Center is planning soon 2025 to coordinate a startup of a peer led group called G.R.O.W. Guidance, Rights, Opportunities, and Well-Being, for individuals who are served by the regional center to come together to discuss and promote rights, education, community engagement and leadership development. If you’re interested or know of individuals who are interested in participating, please contact Kurtis Parker, at kparker@autism-vac.org

Assessments and Technical assistance

Positive Purpose Consulting offers training and support with HCBS assessments and technical assistance for providers. For Information, please contact Sabrina Morrow at sabrina@positivepurpose.net or 1 661-717-8249.

HCBS, Employment and Community informational Trainings

Positive Purpose and Bakersfield ARC have both held engaging perspective shift trainings with Dr. Tom Pomeranz at Kern Regional Center, these recorded sessions can be found on YouTube by following the link provided here. Dr Pomeranz: HCBS – Session 1

Positive Purpose will be holding Employment Training and Community informational presentation series soon early spring and summer 2025. For Information, please contact Sabrina Morrow at sabrina@positivepurpose.net or 1 661-717-8249.

Additional HCBS Resources

Through the use of HCBS Compliance Funding, the Peer Partnership Funding project was formed as a collaboration of service providers with Tri-Counties Regional Center (TCRC) to create an HCBS Workbook titled, Living Well In My Community- A Guide to HCBS Standards and Person-Centered Practices.  This workbook was created to help people with disabilities and service providers better understand the rights and roles for living well in the community.  This can be found on the TCRC web site in three languages and is available for sharing and downloading. TCRC has also created a series of animated HCBS videos as an educational resource for individuals, families, and service providers. These videos can be found on TCRC’s YouTube page.

If you are Interested in learning more about funding to support compliance with the home and community based service final rule please contact Leslie.mosqueda@kernrc.org or visit:

https://www.dds.ca.gov/initiatives/cms-hcbs-regulations/hcbs-compliance-funding/

Resources

CMS HCBS Information

CMS Heightened Scrutiny Guidance

California Statewide Transition Plan

Provider Compliance Guidance

DDS HCBS Training & Information

DDS HCBS Webinar: Strategies for Providing Services in Alignment With the Final Rule

The 2020 enacted budget contains $15 million to fund changes that are necessary for providers to come into compliance with the HCBS rules by March 2023. For more information visit the Department of Developmental Disabilities website in link below.