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Home and Community Based Services Settings Final Rule

The Department’s heightened scrutiny determinations are currently open for public comment. Please refer to the Heightened Scrutiny section of this page.

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, non-institutional 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 statewide compliance with the Settings Final Rule by three years, to March 2022. In July 2020, CMS issued a State Medicaid Director Letter extending the transition period by another year, to March 2023. Providers need to demonstrate compliance well before the end of the transition period in order to allow time for individuals at noncompliant settings to transition to other settings or funding sources.

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

 

Settings Final Rule and Related CMS Guidance

Settings Final Rule

CMS Guidance Materials

CMS Training Materials

Heightened Scrutiny Settings
Public comment opportunity

The Department’s heightened scrutiny determinations are currently open for public comment. The 30-day public comment period runs from June 10, 2021 through July 10, 2021. The Department intends to submit the determinations to CMS after it has reviewed and addressed the comments received during the public comment period. CMS will make final determinations regarding these settings.

 

Documents for review

HS-001

HS-018

HS-036

HS-002

HS-019

HS-037

HS-003

HS-020

HS-038

HS-004

HS-021

HS-039

HS-005

HS-022

HS-040

HS-006

HS-023

HS-041

HS-007

HS-024

HS-042

HS-008

HS-025

HS-043

HS-009

HS-026

HS-044

HS-010

HS-027

HS-045

HS-011

HS-028

HS-046

HS-012

HS-029

HS-047

HS-013

HS-030

HS-048

HS-014

HS-031

HS-049

HS-015

HS-032

HS-050

HS-016

HS-033

HS-051

HS-017

HS-034

HS-052
 

HS-035

  

The Department has on file folders of supporting evidence (PTPs and documents attached to PTPs). Members of the public wishing to review any folder should reach out to the Department using one of the contact methods listed below and provide their name, their email address, and the setting(s) of interest (identified by the HS-series number(s) in the list of settings and, if known, the provider name and setting address). If you need hard copies of these materials, please let us know.

Town Hall Meetings

The Department will host public town hall meetings to allow interested stakeholders to comment on the Department’s determinations relating to settings subject to heightened scrutiny. Interested stakeholders may include individuals receiving services at these settings; their family members, friends, and advocates; advocacy organizations; providers that own or operate the settings; and others. All are welcome. It is not necessary to have a direct personal connection to a provider or setting to comment on it. If a commenter has such a connection, it is not necessary to disclose it. All public comments received by the Department through this process are subject to the Colorado Open Records Act and may be disclosed. Citizens are encouraged to bear that in mind when giving personal information in a public comment.

Meeting 1: Settings subject to heightened scrutiny based on their location (settings HS-001 through HS-015 and HS-017)

  • June 28, 2021 from 1 - 2 p.m.

  • Join Meeting Online 
  • Or call in toll-free at 866-619-5581, conference ID 921264045#
Meeting 2: Settings subject to heightened scrutiny based on their potential to isolate, first half (settings HS-018 through HS-035)
  • June 29, 2021 from 12 - 1 p.m.
  • Join Meeting Online 
  • Or call in toll-free at 866-619-5581, conference ID 749414827#
Meeting 3: Settings subject to heightened scrutiny based on their potential to isolate, second half (settings HS-016 and HS-036 through HS-052)
  • June 30, 2021 from 1 - 2 p.m.
  • Join Meeting Online
  • Or call in toll-free at 866-619-5581, conference ID 997310448#

Priority during each meeting will be given to comments on the specific settings identified above for that meeting. If time allows, comments will be taken on settings scheduled to be discussed at other meetings, to accommodate people unable to attend those meetings.

The Department commits to incorporating comments, concerns, and suggestions when and wherever possible. This includes comments provided orally or via chat boxes during the town hall meetings, as well as any written email or hard copy submissions. The Department will summarize comments and its responses on the relevant summary sheet, which after any necessary revisions will be submitted to CMS. The Department will post updated summary sheets on this website after the public comment period ends.

Reasonable accommodations will be provided upon request for persons with disabilities. Auxiliary aids and services for individuals with disabilities and language services for individuals whose first language is not English may be provided upon request. Please notify John Barry at 303-866-3173 or John.R.Barry@state.co.us or the 504/ADA Coordinator at hcpf504ada@state.co.us at least one week prior to the meeting to make arrangements.

To request a paper or electronic copy of the materials listed above, and/or to provide public comment by July 10, 2021:

Please reach out to us via:

  • Phone: 303.866.6314 
  • Email: hcpf_STP.PublicComment@state.co.us
  • U.S. Mail: Department of Health Care Policy & Financing, 1570 Grant Street, Denver, CO 80203, ATTN: Statewide Transition Plan Team
  • Fax: 303.866.4411, ATTN: Statewide Transition Plan Team
  • Meeting: by speaking or using the chat box during the public town hall meetings, as identified above
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.

Prior versions of the Statewide Transition Plan:

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

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: HCPF_STP.PublicComment@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

The Department’s heightened scrutiny determinations are currently open for public comment. Please refer to the Heightened Scrutiny section of this page.

The Department is hosted a series of open meetings in summer-fall 2020 to continue the development of the Draft Rule that will codify within Colorado regulations the requirements of the Settings Final Rule and an informed consent template with guidance for providers and case managers. For more information, please review this Informational Memo.

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.

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

Rights Modification Stakeholder Workgroup Meetings

As announced in Informational Memo IM 19-050, the Department hosted a Rights Modification Stakeholder Workgroup to develop proposed materials regarding the rights modification process. The workgroup met five times between December 2019 and June 2020.

Initial 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.

Waiver-Related Meetings

  • Adult Day Services Stakeholder Workgroup - For stakeholders interested in Adult Day Services. Meetings are scheduled as needed.
  • 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.
  • Alternative Care Facilities (ACF) Stakeholder Workgroup - For stakeholders interested in ACF services. Meetings are scheduled as needed.
  • 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 first Thursday of the month.
  • Community Centered Board (CCB) Chief Financial Officer Meeting - Meetings are held quarterly (February, May, August, November) on the third Wednesday of the month.
  • 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.
  • 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.

Other Meetings

  • Medicaid Provider Rate Review Advisory Committee (MPRRAC) Meeting- This committee reviews Medicaid rates on a five-year cycle.
  • 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

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

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.

Archived Links

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.

Training Materials Presented by the Department

Additional Departmental Guidance

Operational Memo 21-032 - Informed Consent Template for Rights Modifications - March 17, 2021

Operational Memo 20-103 - Rights Modifications Documentation - December 21, 2020

Informational Memo 20-34 - HCBS Settings Final Rule - Milestone Update 3 - September 1, 2020

Informational Memo 20-034 - HCBS Settings Final Rule - Meetings to Develop Rule and Related Materials - August 3, 2020

Informational Memo 20-025 - HCBS Settings Final Rule - PTP Training Announcement #3 - June 16, 2020

Informational Memo 20-007 - HCBS Settings Final Rule - Updated Milestones - February 3, 2020 *

  • HCBS Settings Final Rule Colorado Milestones Update II - February 3, 2020 *

Operational Memo 19-029 - HCBS Settings Final Rule - Rights Modification Updates - July 8, 2019

Operational Memo 19-024 - HCBS Settings Final Rule - Intensive Supervision - June 4, 2019

Informational Memo 19-050 - HCBS Settings Final Rule - Rights Modification Workgroup - August 27, 2019

Informational Memo 19-029 - HCBS Settings Final Rule Announcement of FAQ Part IV - April 10, 2019

Operational Memo - 19-009 - HCBS Settings Final Rule - PTP Process - March 21, 2019

Informational Memo 18-059 - HCBS Settings Final Rule - Rights Modification Training Announcement - December 26, 2018

Informational Memo 18-045 - HCBS Settings Final Rule - PTP Training Announcement #2 - November 27, 2018

Policy Memo 18-004 - HCBS Settings Rule Announcement of Settings Final Rule FAQ, Part III - November 15, 2018

Informational Memo 18-028 - HCBS Settings Final Rule - PTP Training Announcement #1 - August 29, 2018

Communication Brief - Responses to FAQs on HCBS Settings Requirements, Part II - June 22, 2018*

HCBS Settings Requirements Guidance Call Recording - April 5, 2018

HCBS Settings Requirements Guidance Call Transcript - April 5, 2018

Communication Brief - Follow-up Conference Call Regarding Responses to FAQ son HCBS Settings Requirements - March 22, 2018*

Communication Brief - Responses to Frequently Asked Questions (FAQs) on HCBS Settings Requirements (Part One) - January 31, 2018*

Communication Brief - Department Responses to June 2016 Public Comments on HCBS Statewide Plan and Systemic Assessment Crosswalk - November 9, 2017*

Communication Brief - Compliance Requirement for New Settings under the Home and Community Based Services (HCBS) Settings Final Rule - November 9, 2017*

Communication Brief - Individual/Family/Advocate (IFA) Survey Report, Results to Date, and Revised Survey - August 30, 2017*

Communication Brief - Department Adjusts Timelines for Statewide Transition Plans - June 1, 2017 *

Fact Sheet for Individuals and Families - August 2015

Fact Sheet for Providers - August 2015

* To request a copy of materials that are no longer available online, please contact HCPF_STP.PublicComment@state.co.us

Contact Us

HCPF_STP.PublicComment@state.co.us