Home and Community Based Services Settings Final Rule

In 2014, the federal Centers for Medicare & Medicaid Services (CMS) published a rule requiring Home- and Community-Based Services (HCBS) to be provided in settings that meet certain criteria. The criteria ensure that HCBS participants have access to the benefits of community living and live and receive services in integrated, noninstitutional settings.

The rule went into effect in March 2014, and states originally had five years - until March 2019 - to ensure that their HCBS settings were compliant with the rule. In May 2017, CMS issued an Informational Bulletin extending the transition period for compliance with the Settings Final Rule by three years, to March 2022. In light of this bulletin, the Colorado Department of Health Care Policy and Financing (HCPF or "the Department") has adjusted the statewide compliance deadline by two years, from March 2019 to March 2021.

The following documents and information relate to Colorado's implementation of the Settings Final Rule.

Settings Final Rule and Related CMS Guidance

Colorado Statewide Transition Plan for Implementation of Settings Final Rule

Colorado Statewide Transition Plan (STP.4)

The Department has developed a Statewide Transition Plan (STP) for bringing Colorado’s home-and-community-based services into compliance with the Settings Final Rule. The STP outlines the Department’s process and timelines for working with interested parties to implement requirements of the rule for all home-and-community-based services.

Current version of the STP is STP.4 - December 2016

Prior versions of the Statewide Transition Plan:

Waiver-specific transition plans are included in Colorado's affected HCBS waivers.

View Current Colorado Waivers - CMS Website
View Proposed Waiver Amendments and Renewals - Department Website

Systemic Assessment Crosswalk

Under the STP, the Department has conducted a comprehensive review of the kinds of settings in which home-and-community-based services are provided in Colorado and the state statutes, regulations, and waivers that govern the provision of home-and-community-based services in these settings. The results of this systemic review and the Department’s plan for proposing changes to relevant authorities are set forth in a crosswalk.

Current version of Crosswalk - December 2016

Prior versions of the Crosswalk:

Individual/Family/Advocate (IFA) Survey

The Department is conducting a voluntary survey for individuals receiving home-and-community-based services, as well as their family members and advocates, to provide input on the settings where they live and/or receive such services. The Department will keep the IFA Survey open for individuals and their families/advocates to take as often as they like, through at least the end of the transition period.

Participate in IFA Survey - Updated March 2018

Language	Online Survey	Paper Survey
English	Online Survey - For individuals, family, friends, and advocates Complete and submit using your computer or electronic device	Paper Survey for Individuals Paper Survey for Family and Friends Paper Survey for Advocates Complete and submit using paper and US Mail - see instructions below for sending
Spanish (Español)	Online Survey - For individuals, family, friends, and advocates Completar y enviar utilizando su computadora o dispositivo electrónico	Paper Survey for Individuals - (encuesta para personas que reciben servicios) Paper Survey for Family and Friends - (encuesta para familiares y amigos de personas que reciben servicios) Paper Survey for Advocates - (encuesta para abogados que representan a personas que reciben servicios) Complete y envíe utilizando papel y correo de los Estados Unidos - vea las instrucciones a continuación para enviar
Russian (русский)	Online Survey - For individuals, family, friends, and advocates Заполните и отправьте с помощью своего компьютера или электронного устройства	Paper Survey for Individuals - (Опрос для представителей лиц, получающих услуги по программе Medicaid) Paper Survey for Family and Friends - (Опрос для представителей лиц, получающих услsуги по программе Medicaid) Paper Survey for Advocates - (Опрос для представителей лиц, получающих услуги по программе Medicaid) Заполните и отправьте с помощью бумаги и почты США - см. Инструкции ниже для отправки

To request that a hard copy of the survey be mailed to you, and/or to submit a completed hard-copy survey, contact:

Email: Lori.Thompson@state.co.us or Kyra.Acuna@state.co.us
Mail/In Person: 1570 Grant Street, Denver, CO 80203, Attention: Statewide Transition Plan Team
Fax: 303-866-3991, Attention: Statewide Transition Plan Team
Phone: Lori Thompson, 303-866-5142 or Kyra Acuna, 303-866-5666

Results of IFA Survey - August 2017 - analysis of results from first two years of the survey

Stakeholder Engagement

To receive communications regarding implementation of the HCBS Settings Final rule, please visit the Department's distribution lists sign-up page.

Check the box(es) for the Intellectual and Developmental Disability Stakeholders list and/or the Long-Term Services & Supports Stakeholders list
Add your contact information and click Sign-Up

During each public comment period, the Department receives valuable feedback from stakeholders.

Responses to comments on STP.4 and second version of the systemic assessment crosswalk - pending
Detailed responses to comments on STP.3 and first version of systemic assessment crosswalk - November 2017
Responses to comments on STP.3 and first version of the systemic assessment crosswalk
Responses to comments on STP.2
Responses to comments on STP.1

The Department has received relevant questions and comments and/or expects to receive relevant questions and comments at the following meetings:

Waiver-Related Meetings

Adult Day Services Stakeholder Workgroup - For stakeholders interested in Adult Day Services. Meetings are scheduled as needed.
- Contact: Kyra.Acuna@state.co.us, HCBS Adult Waiver Specialist
  303-866-5666
Advocates' Communication Meeting - for stakeholders interested in the Department's work involving people with intellectual and developmental disabilities. Meetings are held quarterly (January, April, July and October) on the fourth Friday of the month.
- Contact: John.R.Barry@state.co.us, Stakeholder Relations Manager
  303-866-3173
Alternative Care Facilities (ACF) Stakeholder Workgroup - For stakeholders interested in ACF services. Meetings are scheduled as needed.
- Contact: Cassandra.Keller@state.co.us, HCBS Waiver and Benefits Administrator
  303-866-5181
Brain Injury (BI) Waiver Stakeholder Workgroup - For stakeholders interested in the BI waiver. Meetings are held quarterly (March, June, September, December) on the second Wednesday of the month.
- Contact: Diane.Byrne@state.co.us, Brain Injury Waiver Administrator
  303-866-4030
Case Management Agency (CMA) Quarterly Administrators' Meeting - for CMA administrators, directors and supervisors to receive updates and information from the Department. Meetings are held quarterly (February, May, August, November) on the fourth Thursday of the month.
- Contact: Brittani.Trujillo@state.co.us, Entry Point and Case Management Section Manager
  303-866-5567
Community Centered Board (CCB) Chief Financial Officer Meeting - Meetings are held quarterly (February, May, August, November) on the third Wednesday of the month.
- Contact: Amanda.Allen@state.co.us, Financial Compliance Unit Supervisor
  303-866-5668
Children's Habilitation Residential Program (CHRP) Waiver Communications - Department staff are coordinating with the Colorado Department of Human Services (CDHS) to communicate about Settings Final Rule implementation with county liaisons, case management staff, and providers involved in the CHRP waiver.
- Contact: Nancy.Harris1@state.co.us, HCBS-CHRP Waiver Administrator
  303-866-3278
Program Approved Service Agency (PASA) Meeting - For providers of services under the Persons with Developmental Disabilities (DD) waiver, Supported Living Services (SLS) waiver and Children's Extensive Support (CES) waiver. Meetings are held quarterly (January, April, July, October) on the fourth Wednesday of the month.
- Contact: Adam.Tucker@state.co.us, HCBS Benefit Specialist
  303-866-5472

HCBS Settings Stakeholder Workgroup Meetings

Meetings of the HCBS Settings Residential and Non-Residential Stakeholder Workgroups - These workgroups met from November 2015 through March 2016. They discussed concerns, best practices, and other issues for implementing the Settings Final Rule. The workgroups focused on expanding community integration opportunities, informed choice, and participant rights.

Stakeholder Workgroup Participant Lists - November 2015

Residential Workgroup Meeting Notes

Non-Residential Workgroup Meeting Notes

Other Meetings

Medicaid Provider Rate Review Advisory Committee (MPRRAC) Meeting - This committee reviews Medicaid rates on a five-year cycle.
- Contact: Eloiss.Hulsbrink@state.co.us, Rate Review Stakeholder Relations Specialist
  303-866-6214
Department staff have also attended meetings hosted by other organizations, such as Alliance Colorado (an association of CCBs and provider agencies serving individuals with intellectual and developmental disabilities) and the Colorado Assisted Living Association, to present information and answer questions regarding the Settings Final Rule.

Correspondence between the Department and CMS

Statewide Transition Plan Quarterly Update to CMS - Quarter ending March 31, 2019

Statewide Transition Plan Quarterly Update to CMS - Quarter ending December 31, 2018

Statewide Transition Plan Quarterly Update to CMS - Quarter ending September 30, 2018

Statewide Transition Plan Quarterly Update to CMS - Quarter ending June 30, 2018

Colorado Milestone Update - April 2018

Statewide Transition Plan Quarterly Update to CMS - Quarter ending March 31, 2018

CMS Requested Changes for Final Approval of Statewide Transition Plan - February 20, 2018

Statewide Transition Plan Quarterly Update to CMS - Quarter ending December 31, 2017

Colorado Statewide Transition Plan Initial Approval from CMS - November 2017

Colorado Milestone Template - October 2017

Statewide Transition Plan Quarterly Update to CMS - Quarter ending September 30, 2017

Colorado Milestone Template Draft from CMS - July 2017

Statewide Transition Plan Quarterly Update to CMS - Quarter ending June 30, 2017

Statewide Transition Plan Quarterly Update to CMS - Quarter ending March 31, 2017

CMS’s response to STP.4, the revised crosswalk, and related materials - February 9, 2017

Statewide Transition Plan Quarterly Update to CMS - Quarter ending December 31, 2016

Department's submission of STP.4, revised crosswalk, and related materials to CMS - December 16, 2016

Quarterly Update to CMS - Quarter ending September 30, 2016

CMS's response to STP.3, crosswalk, and related materials - August 30, 2016

List of Requested Technical Changes
Spot-check of Crosswalk
Sample Crosswalks - Iowa, Kentucky, Ohio

Department's submission of STP.3, initial crosswalk, and related materials to CMS - June 30, 2016

For earlier correspondence, please contact the Department.

Site-Specific Assessments

Provider Transition Plans (PTPs)

The PTP is completed by the provider to assess its compliance with the HCBS Settings Final Rule, assess the potential application of heightened scrutiny, and set out a remedial action plan and timeline. When submitting its PTP, the provider attaches relevant evidence (e.g., leases, photographs). The completed PTP and attached evidentiary materials are subject to review and approval by the Department.

Adult Residential PTP - G-Suite Template - December 2018
HCBS Settings Final Rule Provider Transition Plan (PTP) User Manual - November 2018

Archived Links

Adult Residential PTP - SharePoint Template - August 2017
Adult Residential PTP Template - November 2016
Non-Residential PTP Template - November 2016
Children's Residential PTP Template - November 2016

Provider Self-Assessment Survey Results (Provider Scorecards)

The Department conducted a two-stage provider survey to assess settings where waiver participants live and/or receive home- and community-based services. The results of the provider self-assessment surveys are summarized in the scorecards below, which were updated in February/March 2016.