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HCBS Final Rule

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Home and Community-Based Services (HCBS)

In 2014, new federal rules were released by the Centers for Medicare & Medicaid Services (CMS), requiring homes and programs where Home and Community-Based Services (HCBS) are delivered to meet new “HCBS Final Rule” criteria by March 17, 2017. This was later extended through March 17, 2023. Home and Community-Based Services (HCBS) were developed to offer support to individuals in community settings, as an alternative to institutional care. The HCBS Final Rule aims for individuals to have full access to participate in their community, to exercise their choices and to have their rights protected among other things. CMS is the federal agency that provides healthcare through Medicaid (Medi-Cal) and oversees HCBS compliance of services for people with developmental disabilities in California. CMS pays for about 50% of the cost of services provided in these waiver programs. To keep receiving these federal funds, California has to follow their rules.

The regional centers and the Department of Developmental Services (DDS) have been working with service providers to implement the requirements for home and community-based settings in accordance with this HCBS Final Rule. All HCBS services must meet the requirements in the settings rule. Links to Lanterman Regional Center’s initial notification to service providers are found below.

Adult Day Program

Childrens Services

Residential Providers

Work Programs

The Statewide Transition Plan – The HCBS Rules Affect More Than Just DDS-Funded Services

The California Statewide Transition Plan (STP) outlines the steps the State will take to be in alignment with the HCBS Final Rule. These steps have included an evaluation of current services through a self-assessment, a review and sample of on-site assessments to validate the results of the self-assessment, input from individuals receiving services, and the completion of transition plans for services that are not in alignment with the Final Rule. More historical information concerning the review activities can be found by following this link.

On November 22, 2023, the DDS issued a directive to support regional centers in fully implementing the federal requirements for HCBS settings. The directive establishes 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 and outlines steps to support vendored service providers requiring additional assistance with implementation of those policies. All affected programs must be reviewed by August 31, 2024.

November 22, 2023 Directive

On January 8, 2024, the DDS issued a subsequent directive to define the data DDS requires from the regional centers for reporting for HCBS settings to the federal Centers for Medicare and Medicaid Services (CMS) and provide options on how to obtain and report the data to DDS in a timely manner.
Per the State’s approved Corrective Action Plan (CMS-CAP), DDS is required to regularly report to CMS throughout 2024 on progress with the key compliance indicators:

  1. Number of settings reviewed on-site since March 18, 2023.
  2. Number of HCBS-compliant settings upon initial on-site review.
  3. Number of settings with an HCBS-related corrective action plan (CAP) in progress.
  4. Number of settings in remediation with technical assistance.
  5. Number of HCBS-compliant settings after remediation is complete.
  6. Number of settings currently appealing the on-site HCBS review findings.
  7. Number of settings that have been issued sanctions in accordance with the December 1, 2023, directive.

Regional Center Reporting

Regional Centers shall report to DDS the required data listed above in alignment with the milestones in the CMS-CAP.  A regional center shall report this information to DDS biweekly by 5 p.m. every first and third Friday of the month.

In accordance with Welfare and Institutions Code section 4519.2(b), each regional center and DDS must post HCBS Final Rule compliance information on its website, and shall update the information no less frequently than every six months. Providers vendored after March 18, 2023, are not required to be included in this data, as regional centers have ensured policies and practices are aligned with the federal requirements at the start of service.

HCBS Final Rule Compliance Information

April 5, 2024

Service Type

Total Settings

Active Settings Reviewed

Number Compliant Upon Evaluation

Compliant After Remediation

Number Requiring Technical Assistance

Number of CAP Issued

Number of Provider Appeals

Number of Moratoriums Issued

Number of Providers Issued 50% Withold

Residential

132

71

26

11

33

1

0

0

0

Day Service

84

9

7

0

2

0

0

0

0

Employment

4

0

0

0

0

0

0

0

0

All

220

80

33

11

35

1

0

0

0

How Lanterman Regional Center supports HCBS Compliance

We are here to support our service providers in understanding HCBS and their compliance status. We will do in the following ways:

  • Provide ongoing trainings on HCBS Regulations
  • Frequently update Lanterman Regional Center Service Providers
  • Provide feedback/technical assistance for service providers regarding their HCBS compliance
  • Provide opportunities to identify barriers and formulate solutions
  • Promote Person-Centered Planning and Person Centered Thinking

Service Provider Resources

FAQ

Get Answers

Service providers must be vendored by a regional center before they can provide and be reimbursed for services. Please see our “How to Become a Service Provider” page, which provides detailed instructions.

Any change to your existing vendorization needs to be reviewed and processed by Lanterman’s Community Services Unit.

  1. Organizational changes require submission of a letter in advance of the change consistent with the parameters and process found here
  2. If you are interested in providing additional services, use the contact form to connect with one of Lanterman’s Resource Developers.

Rate setting rules are established both by the statute (Lanterman Act) and regulation (Title 17) and dictate the type of rate needed for a particular service type. Providers with negotiated/median rates or DDS set rates can adjust rates based on minimum wage ordinances, Health and Safety Waiver needs or statutory/regulatory changes. Providers with Medi-Cal set rates, can see rate changes consistent with Medi-Cal rate changes. Usual and Customary Services providers can request rate adjustments consistent with changes to their general fee schedule. Please click here for a full description of different rate types and a description of rate changes.

All service providers, whether vendored by Lanterman or another regional center that serve Lanterman individuals, must carry liability insurance and name Frank D. Lanterman Regional Center as additional insured consistent with the following insurance memo. Additionally, updated insurance certificates must be submitted to Irma Padilla at ipadilla@lanterman.org.

The DS1891 Disclosure Statement is a Department of Developmental Services (DDS) form which must be completed at the time of vendorization and subsequently every 2 years moving forward unless requested by the regional center sooner. In short, this statutory requirement (WIC Code § 4748.12) does not allow individuals or organizations convicted of fraud, abuse or neglect to be vendored. Regional centers are required to monitor vendorization requirements biennially per California Code of Regulations Title 17 § 54332(b).

Every regional center service provider has an assignment Accounting Associate who can help with all payment and billing issues. You can find your assigned Accounting Associate here and by logging into your e-billing portal.

At the time of vendorization, Community Services notifies all of service coordination staff of the newly vendored service provider. Capacity and availability can be communicated to Quality Assurance Manager Sonia Garibay at sgaribay@lanterman.org or Director of Community Services Pablo Ibañez at pibanez@lanterman.org. In turn, Community Services will notify service coordination of your services.

For school aged individuals and younger, please contact Associate Director of Client and Family Services Rose Chacana at rchacana@lanterman.org. For adults served by the regional center, please contact Associate Director of Client and Family Services, Megan Mendes, at mmendes@lanterman.org

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