The Home and Community Based Settings Rule is often referred to as the “Final Rule” or “Settings Rule” and establishes new guidelines for certain types of long term services and support services for people with disabilities.

1. An Overview of the Home and
Community Based Settings Rule
(HCBS)
July, 2016

2. This rule is often referred to as the “Final Rule” or
“Settings Rule” and establishes new guidelines for certain
types of long term services and support services for
people with disabilities.
Home and Community Based
Settings (HCBS) Rule

3. Community living and participation means different things to
different people.
Promoting Community Living

4. • Control over where and with whom a person lives.
• Control over where a person works and how he or
she earns money.
• Options for what a person does during the day.
• Presence of quality relationships developed with
chosen people.
Promoting Community Living and
Participation

5. • Control over what and with whom a person does things
of personal interest.
• Health and well-being (physical and emotional).
• Control over if, where and with whom a person
worships.
• Options to explore interests and engage in learning and
personal growth.
• Ability to make informed decisions about their lives.
Promoting Community Living and
Participation

6. HCBS services must
be provided in
settings that focus on
the needs of the
individual as
identified in the
individual’s person-
centered support
plan.

7. All services funded through Medicaid HCBS
funding authorities must:
Be integrated
in and
provide full
support for
full access to
the greater
community.

8. Provide
opportunities
to seek
employment
and work in
competitive
integrated
settings.

9. Engage in
community life,
control personal
resources, and
receive
services in the
community, to
the same
degree as
individuals not
receiving HCBS.

10. Be selected by
the individual
from among
setting options
including non-
disability
specific
settings and
an option for a
private unit in
a residence.

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

12. Optimize
individual
initiative,
autonomy, and
independence in
making life
choices, including
but not limited to,
daily activities,
physical
environment, and
with whom to
interact.

13. Facilitate
individual
choice
regarding
services and
supports, and
who provides
them.

14. Provider-Owned or Controlled Residential
Setting
The unit or dwelling must be a specific physical place that can
be owned, rented or occupied under a legally enforceable
agreement by the individual receiving services.

15. Provider-Owned or Controlled Residential
Setting
Where landlord tenant
laws do not apply, the
State must ensure that a
lease, residency
agreement or other form
of written agreement will
be in place for each HCBS
participant, and that the
document provides
protections that address
eviction processes and
appeals comparable to
those provided under the
jurisdiction’s landlord
tenant law.

16. Each individual has privacy
in their sleeping or living
unit including:
■ Entrance doors can be
locked by the individual,
with only appropriate staff
having keys.
■ Individuals sharing units
have a choice of roommates
within that setting.
■ Individuals have the
freedom to furnish and
decorate their sleeping or
living units to the extent
allowed by the lease or other
agreements.

17.  Individuals have the
freedom and
support to control
their own schedules
and activities, and
have access to food
at any time.
 Individuals are able
to have visitors of
their choosing at
any time.
 The property is
physically
accessible to the
individual.

18.  The Rule defines settings that are not home and community-
based include:
 Nursing facilities
 Institutions for mental diseases
 Intermediate Care Facilities for Individuals with Intellectual
Disabilities (ICF/ID)
 Hospitals and other locations that have qualities of an
institutional setting
Settings That Are Not Considered
Community Based

19.  While the HCBS Rule became effective March 17, 2014,
states have a transition period to come into
compliance with the settings portion of the rule.
 As of January 2016, all states had submitted transition
plans, describing to CMS their strategy for complying
with the HCBS regulation within a five-year period.
 The submitted plans will require significant systems
change in some states, which could result changes in
the settings in which services are offered.
State Transition Plans

20. A foundation of the Settings Rule
is that individuals who receive
HCBS MUST have a choice in
where they live.
The HCBS Rule – Choice Is A Must

21. Scioto offers several services that can assist providers in focusing on their service mission
while allowing Scioto, as a third party, to focus on the setting issues.
How Scioto Can Assist Providers
Scioto offers:
 Third party landlord relationships with support that separate the roles of
landlord and provider.
 Opportunities for Scioto to purchase/own the property and lease it back to
the individuals though a support agreement with the organization.
 Leasing agreements with providers that offer them the ability to sublease to
the individuals which gives individuals the flexibility to move in and out of the
home.
 Long term leasing that allows for supportive housing so that individuals
receiving support are not at risk of losing their housing.

22. About Scioto Properties
 Innovation - Since its founding in 1999, Scioto Properties LLC has established
itself as the nation’s largest provider of single-family residential group homes for
individuals with developmental disabilities (DD).
 Leadership – Scioto is leading the market by supporting the movement of special
needs populations (DD, TBI/ABI, etc.) to the lower cost, higher quality,
community-based model.
 Strategy – Provide property solutions for national, regional and local Care
Providers of group home services.
 Management Team - Our leaders have more than 100 years of combined work
experience in the DD industry. Our knowledge and understanding enable us to
generate successful housing solutions for our clients and enhance the quality of
lives for individuals with DD.
1200 Homes | 38 States | 3,500 Served

23. Scioto is committed to helping transition people
with disabilities into community-based settings.

24. Download and read the Scioto White Paper
on HCBS now!

25. For more information about
HCBS Final Settings Rule
www.Medicaid.gov/HCBS

26. Scioto can help.
800-930-2892
614-889-5191
www.scioto.com