Federal officials have issued long-awaited guidance to help states determine what living arrangements for people with disabilities are considered community-based rather than institutional. The new guidelines from the Centers for Medicare and Medicaid Services clarify a 2014 rule outlining criteria for programs provided through Medicaid home- and community-based services waivers.  The rule calls for home- and community-based settings to provide full access to the community as well as offer privacy, foster independence and allow people with disabilities to make their own choices about services and providers.

CMS issued guidance on the rule five years ago, but that prompted questions from some states and stakeholders. The latest information covers the “heightened scrutiny” process, a part of the rule which allows states to provide evidence to CMS demonstrating that a setting that appears to be isolated or have other institutional characteristics should in fact qualify as community-based.  CMS still defines settings as isolating and in need of further review if they offer limited opportunity to interact with the broader community. Other criteria include restricted choices for services or outside activities and locations that are “separate and apart” from the community, without opportunity for participation.   Advocates said the rule is important for providing people with disabilities choices about where and how to live.