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Guidance To Support Implementation Of The HCBS Settings Rule

Through collaboration with the Community Living Policy Center, the HCBS Advocacy Coalition has published a white paper and detailed matrix to support states’ monitoring of efforts to implement the Medicaid Home and Community-Based Services (HCBS) Settings Rule. CQL | The Council on Quality and Leadership is a member of the HCBS Advocacy Coalition Outcomes Workgroup, which is a workgroup of national subject matter experts created to develop recommended outcomes and related metrics surrounding the HCBS Settings Rule.

The HCBS Settings Rule provides guidance and requirements that people receiving supports have full access to the benefits of community living, be integrated in their communities, exercise rights, make choices, select the services they use, and direct who provides those services. The Centers for Medicare & Medicaid Services (CMS) has established requirements for entities to carry out the rule and for states to demonstrate compliance with its associated regulations.

The white paper details five major areas that are crucial for the successful implementation of the HCBS Settings Rule, along with summarized recommendations about outcomes that are relevant to those five areas:

  1. Community access and integration
  2. Residential options
  3. Day options (Competitive Integrated Employment (CIE) focus)
  4. Individual control in settings/individual rights
  5. Self-determination (person-centered planning and self-direction)

In addition to the white paper, the HCBS Advocacy Coalition produced a comprehensive matrix that lists specific measurements and sources to track and assess the outcomes. The five major areas are evaluated at the individual participant, provider, and state/systemic levels. The matrix incorporates multiple nationally-recognized measurement tools, including CQL’s Personal Outcome Measures® and Basic Assurances®.

For the development of the white paper and matrix, the HCBS Advocacy Coalition brought together a working group of national subject matter experts on quality measures and available data sets. The expert members of the working group include: the Community Living Policy Center, National Association of State Directors of Developmental Disabilities Services (NASDDDS), Human Services Research Institute (HSRI), CQL | The Council on Quality and Leadership, Coleman Institute for Cognitive Disabilities at University of Colorado, and Institute for Community Inclusion at UMass Boston, and the Institute for Community Integration at the University of Minnesota. Representatives from the HCBS Advocacy Coalition include the Center for Public Representation, Autistic Self Advocacy Network, and National Health Law Program, participate in the working group.


Since 1969, CQL | The Council on Quality and Leadership has been a leader in working with human service organizations and systems to continuously define, measure, and improve quality of life and quality of services for youth, adults, and older adults with intellectual and developmental disabilities, and psychiatric disabilities. CQL offers accreditation, training, certification, research, and consultation services to agencies that share our vision of dignity, opportunity, and community for all people.