The CMS final rule related to Home- and Community-Based Services (HCBS) for Medicaid-funded long-term services and supports provided in residential and non-residential home and community-based settings (the “Community Rule”) took effect March 17, 2014. States were required to submit transition plans to CMS within one year of the effective date indicating how they would comply with the new requirements ensuring participants have access to and are integrated into the broader community. In December 2014, CMS issued guidance on how the Community Rule applies to non-residential services such as employment and day services.
Massachusetts first submitted its Statewide Transition Plan (STP) regarding residential HCBS services to CMS in a letter dated March 2, 2015, followed by an addendum that addressed non-residential services in a letter dated September 3, 2015. Prior to these submissions, the state gathered public comments on the STP and the addendum during two public comment periods, including three public forums. In total, 323 individuals or agencies submitted comments in writing, through e-mail, mail, and written testimony. Summaries of the comments received and the state’s response to these comments for all previously submitted materials are posted below.
In November 2015, the state received feedback from CMS addressing both the first STP submission and the addendum, and in response informally submitted a revised draft of the STP to CMS in February 2016. CMS provided additional, informal feedback in May 2016. The current version of the STP reflects updates responsive to all feedback and guidance received from CMS. Updates since the original 2015 submissions to CMS include several technical, structural, and formatting changes.
- The current version of the STP covers both residential and non-residential services for all three HCBS waiver-operating agencies in one comprehensive document. The comprehensive STP was compiled in response to CMS’s request that the state present a single combined document. Previously, residential and non-residential services were addressed in separate STP attachments corresponding to each HCBS waiver-operating agency: the Department of Developmental Services (DDS), the Massachusetts Rehabilitation Commission (MRC), and the Executive Office of Elder Affairs (EOEA).
- A description of EOHHS’s role in the statewide transition plan was added.
- A chart that maps each Community Rule requirement to one or more state regulations, policies, or other sub-regulatory instrument was added to the STP as Table 1.
- The results of the site-specific assessment process are combined into a single chart reflecting residential and non-residential settings in each waiver (Table 2).
- Systemic and site-specific transition steps and associated timelines for both residential and non-residential settings across the three waiver-operating agencies are combined into a single chart (Table 3).
- Links to related documents are provided in a new chart (Table 4).
- The Public Input section is updated to reflect the planned public comment period and public forum that will occur prior to final submission of the STP to CMS.
The state’s overall approach to transitioning all HCBS settings to full compliance with the Community Rule has not changed since the initial STP submissions to CMS in 2015. Therefore, substantive changes in the current version of the STP are limited to the inclusion of additional detail, updated information, and/or clarifications in the following areas.
- The systemic assessment section and the transition tasks/timeline chart (Table 3) were updated to reflect progress toward promulgation of revised regulations and issuance of new or revised policies, guidance, and other tools that will strengthen compliance by more clearly aligning state requirements with the Community Rule. Examples include
- Revisions to 115 CMR 5, 7, and 8 (DDS);
- Revisions to the licensure and certification tool for residential and non-residential settings (DDS);
- Development of a participant handbook and policy document for the ABI and MFP waivers (DDS and MRC);
- Development of guidance for providers regarding the requirements for locks and tenancy protections (DDS and MRC);
- Revisions to the HCBS Provider Policy Manual (MRC); and
- Revisions to the HCBS Program Guidelines (EOEA).
- Additional details were added regarding the “heightened scrutiny” and “participant relocation” processes, as well as the state’s plan for continued monitoring of all HCBS settings for ongoing compliance with the Community Rule. This information appears in three new sections in the STP.
- The site-specific assessment section was reorganized for clarity as follows.
- Additional details were included to describe more clearly each agency’s site-specific assessment process;
- Findings were updated; and
- Details were included to describe more clearly the remedial actions or actions related to compliance undertaken by each waiver-operating agency.
- The site-specific assessment section was updated to reflect DDS’s determination that all Community Based Day Services (CBDS) settings and group employment settings require some level of modification to fully comply with the Community Rule. Details are provided regarding the steps that DDS will undertake with each provider/setting to ensure that all settings fully comply in advance of the required full compliance date of March 2019.
Massachusetts Statewide Transition Plan for Compliance with the Home and Community-Based Services (HCBS) Community Rule
- The Massachusetts Statewide Transition Plan for Compliance with the CMS Home and Community Based Services Community Rule
IMPORTANT – as required by the new rule, Massachusetts will provide opportunities for the public to comment on the Statewide HCBS Transition Plan. Members of the public can submit their input on the Statewide HCBS Transition Plan via e-mail, regular mail, or in person at the public forum being held on August 3, 2016. Details about this event are listed below.
Public Forum Location: Worcester Public Library
3 Salem Square
Worcester, MA 01608
Date: Wednesday, August 3rd, 2016
Time: 10:00 AM – 1:00 PM
The Massachusetts Executive Office of Health and Human Services (EOHHS) will discuss and receive public comments regarding the revised Statewide HCBS Transition Plan for compliance with the 2014 federal rule for Medicaid-funded residential and non-residential home- and community-based waiver services (also known as the "Community Rule" or the "HCBS Rule").
Written comments regarding the Statewide HCBS Transition Plan may be submitted by email to: HCBSWaivers@State.MA.US
Or by mail to
HCBS Waiver Unit
1 Ashburton Place, 11th Floor
Boston, MA 02108
Printed copies of the STP are available upon request. Use the email address or mailing address above to request a hard copy of the STP and related documents. Printed copies of the STP will also be available at the public forum.
Please Note: Comments regarding the Statewide HCBS Transition Plan must be submitted by August 10, 2016.
These Program Instructions (PIs) are issued by the Office of Elder Affairs and provide required procedures, protocols, and instructions to ASAPs in their operation of the Frail Elder Waiver and do not apply to participants in any other HCBS waiver.
- Program Instruction 09-20: Service Plans
- Program Instruction 09-13: Home Care Program Service Definitions
- Program Instruction 97-31: Medicaid Waiver Manual Clarification
Prior Materials Submitted to CMS as part of Initial Statewide Transition Plan
In response to new rules issued by the Centers for Medicare and Medicaid Services (CMS) related to home and community based settings for Medicaid-funded HCBS waivers, the Commonwealth of Massachusetts submitted the materials found below. These materials include our initial Statewide HCBS Transition Plan, agency-specific Transition Plans related to waiver-operating agencies, a summary of the comments received through the public input process and the state’s responses to these comments. Massachusetts submitted these materials to CMS in a letter dated March 2, 2015.
In addition you will find further information about the new CMS rule through the links below.
Click on the links below to find additional information about the new CMS rules for HCBS waivers and Massachusetts’ response to these rules.
- Cover Letter
- Massachusetts Statewide HCBS Transition Plan
- Attachment A – The Massachusetts Department of Developmental Services Transition Plan
- Attachment B – The Massachusetts Rehabilitation Commission Transition Plan
- Attachment C – The Massachusetts Executive Office of Elder Affairs Transition Plan
- Attachment D - Responses to Comments Received on the Massachusetts Transition Plan
- Summary of Revisions made to the Statewide HCBS Transition Plan
- CMS Summary of New Federal Requirements
Addendum to the Statewide Transition Plan for Non-residential Services Compliance with the Home- and Community-Based Services (HCBS) Community Rule
Click on the links below to find the Massachusetts’ HCBS Transition Plan Addendum for non-residential services as well as agency-specific information for DDS, MRC and EOEA. Massachusetts submitted the addendum to CMS in a letter dated September 3, 2015.
- Cover Letter
- Massachusetts Statewide HCBS Transition Plan – Addendum for Non-residential Services
- Attachment A – DDS Transition Plan Addendum for Non-residential Services
- DDS Appendix A – Summary of Tasks and Timelines
- DDS Appendix B – Blueprint for Success (Employment Supports)
- DDS Appendix C – Positive Behavioral Supports Policy and Guidelines
- DDS Appendix D - Employment Progress Report file size 1MB
- DDS Appendix E Revised Guidance Criteria to Assist Providers in Compliance with HCB Setting Requirements
- DDS Appendix F - Survey of Community Based Day Services
- Attachment B – MRC Transition Plan Addendum for Non-residential Services
- Attachment C – EOEA Transition Plan Addendum for Non-residential Services
- Attachment D – Responses to Comments Received on the Addendum for Non-residential Services