CEO Update: HCBS and the “Final Rule”

by Debera Taylor, CEO of NW Works, Inc.

If you follow Disability issues and policy, you may be familiar with the term Home and Community Based Services. But if you are new to the field or a more passive supporter of NW Works, you may not be familiar with Home and Community Based Services Settings Regulations and what the “Final Rule” means for NW Works and the individuals we serve. 

In the April CEO Update, I addressed the Virginia budget and how NW Works is funded. Within that article, I touched on the topic of Medicaid waiver funding briefly, as it is a primary way that NW Works is reimbursed for services provided to those we support. Home and Community Based Services (often referred to as HCBS) are person-centered opportunities provided within the individuals’ home or community settings, rather than isolated settings or institutions. HCBS aren’t exclusively for people with disabilities, but are the preferred form of services for the disability community. 

As an agency which provides Medicaid-reimbursable HCBS, NW Works must be compliant with HCBS Settings Regulations, also known as the “Final Rule”, which are federal regulations. Being non-compliant with the rule would put the organization in jeopardy of not being able to provide services. The Commonwealth of Virginia is currently in a transitional period as providers across the commonwealth adopt all of the HCBS Settings Rule by March 17 of 2023. 

Per federal regulations, all agencies providing Medicaid-reimbursable HCBS must meet the following criteria:

  • Individuals must be integrated in and supported to have full access to the greater community. 
  • Agencies must ensure an individual’s rights of privacy, dignity, respect, and freedom from coercion and restraint. 
  • The agency is selected by the individual from a variety of setting options
  • The agency supports an individual’s choice in selecting the provider and services; and 
  • The agency optimizes autonomy and independence in making life choices.

All of the above criteria must be met by NW Works and agencies like us by March 17 of 2023. (There are additional conditions that must be met by residential providers, which do not impact NW Works.) The good news is that NW Works has been working toward the above criteria over the past two years (even through COVID impacts).  We have expanded Community Engagement partnerships, increased social outings in the community, have placed more Individuals in Group and Individual Supported employment and continue to support Individuals in transition through the ProjectSearch collaboration.

What Comes Next?

If NW Works is already compliant with HCBS, then what changes?

There are a number of smaller changes that come along with the Final Rule, including around language. Currently the recommendation from the Department of Medical Assistance Services (DMAS) are that providers must use person-first language (eg. “people with disabilities”, rather than “disabled people”). Terms such as “non-verbal”, “differently abled”, “handicapped” and “challenged” are discouraged. While NW Works already uses person-first language, the Final Rule also states that possessive language is not allowed – such as terms like “client”, “participant”, “patient” or “consumer.” This does provide a shift for us, as we update our language to use the preferred “individual who receives services” rather than “client”. 

A bottom-line impact that comes with these changes is Medicaid Waiver reimbursements will not continue to fund any internal work programs that our Individuals participate in thus causing the organization to look to other funding sources and request more resources from our business partners in the form of reworking contracts and pricing. 

You may notice NW Works’ language around those we serve and the programs we offer shift a bit, as we work to meet the language requirements of the Final Rule. Additionally, you may notice a larger push for agencies like NW Works, the Department of Aging and Rehabilitative Services, and the Community Services Board to encourage individuals with disabilities to pursue competitive, integrated employment opportunities. This effort does not mean our Group Day Support and Community Engagement programs are diminishing, but that we are working to remain compliant with the overall federal guidelines for HCBS.