In January 2014, the Centers for Medicare & Medicaid Services (CMS) finalized a landmark regulation for people with disabilities, known as the Home and Community-Based Services (HCBS) Settings Rule. For the first time, the agency established standards to define the characteristics that qualify a setting as “community-based” for the purposes of Medicaid services. HCBS include a range of services, but especially center around supports for completing activities of daily living, like eating, bathing, and moving about, along with other services needed to live in the community, like help with household chores, managing money, or supported employment. The rule aimed to distinguish clearly between funding streams for HCBS and those for institutional long-term services and supports (LTSS). The publication of the final rule marked the end-product after nearly a decade of stakeholder engagement, with multiple rounds of public comment on various proposed approaches.
