AHCA reports that the Centers for Medicare and Medicaid Services (CMS) has posted new FAQs on the Home and Community-Based Services (HCBS) waiver rule implementation. CMS notes that further technical assistance is forthcoming to detail how the home and community-based settings requirement can be implemented for individuals with dementia or Alzheimer’s disease. The guidance provided some information on modifications to the HCB settings requirement, in particular acknowledging that providers serving individuals with dementia have to take into account safety concerns. It emphasizes, however, that modifications must be highly individualized and cannot be made for a class of individuals.

CMS also clarified that it will not issue pre-approval for a setting under development or new construction. According to CMS, a setting presumed to have the qualities of an institution cannot be determined to be compliant until it is operational and occupied. States may request a heightened scrutiny review of newly operational settings that will be presumed to be institutional, but CMS “strongly encourages states to limit the growth of these settings.” CMS expects that stakeholders instead create new programs that promote full community integration.