Home and Community-Based Programs Rule Change Overview

​​​​​​​​​​​​​​​​The Centers for Medicare and Medicaid Services (CMS) issued a Home and Community-Based Services (HCBS) final rule on January 16, 2014, which came into effect on March 17, 2014. The new rule applies to both residential and non-residential settings and changes the standards by which states are allowed to pay for HCBS. Highlights of the new rule include the following:
  1. Ensuring that individuals have been given choices regarding their setting options.
  2. Guaranteeing individuals’ rights of privacy, dignity, respect, and freedom from coercion and restraint.
  3. Optimizing autonomy and independence in making life choices.
  4. Facilitating choice in services and those who provide it.


Community Settings Regulation Compliance 

Statewide Transition Plan for Compliance with Home and Community-Based Settings Requirements (Final Rule)​

Review of Senior Center Plus Sites and Determination: No Sites Submitted to CMS for Heightened Scrutiny Review 

The Maryland Department of Health has reviewed the  Senior Center Plus sites in the state and has found that currently all of the sites are community based and meet the criteria of the Community Settings regulations. The Maryland Department of Health invites public comment on the Senior Center Plus providers. A public comment period will be open from May 25, 2018 to June 25, 2018. Once the public comment period is complete, this information and the comments will be submitted to CMS for review. Please send all comments to mdh.hcbssetting@maryland.gov or Rebecca Oliver, Health Policy Analyst Advanced, Room 134, 201 W Preston St, Baltimore, MD 21201.

Community Settings Regulation Compliance

List of Adult Medical Day Care Sites to be Submitted CMS for Heightened Scrutiny Review

The following Medical Adult Daycare (MADC) sites were identified as falling under the heightened scrutiny (HS) designation due to the reasons listed. A public comment period was implemented from May 25- June 25, 2018.
Please note that although the public comment period prior to the submission of the list to CMS has ended, MDH will accept comments about this list and providers at all times and include them in future updates of the STP and to CMS. Please email mdh.hcbssetting@maryland.gov and include “Public Comment-HS” in the subject line.
Sites That are Heightened Scrutiny (HS)CountyAddressReason for HS/nearly HS
Arc of Washington County MDCC Washington 838 Florida Ave Day Hab on site
Delmarva Daybreak Hurlock Dorchester 6210 Shiloh Church/Hurlock Rd Day Hab on site
Diakon ADS @ Ravenwood Washington 1109 Luther Dr ALF within 1/4mile
Evergreen Medical Adult Day Svcs Allegany 1 Baltimore St ALF on site
Gallager Adult Medical Day Baltimore Co 2520 Pot Spring Rd Day Hab on site
Helping Hands - Capitol Heights Prince Georges 5400 Norfield Rd ALF within 1/4mile
Human Development Council-Frederick Frederick 5430 Mt. Zion Rd Day Hab on site
Joyful Adult Medical Day Care Ctr. Baltimore City 6650 Belair Rd ALF on site
Keswick Adult Services Baltimore City 700 W 40th St Nursing home on site
New Life AMDC Baltimore Co 7600 Clay's Lane, Ste. #C ALF within 1/4mile
Sagepoint Adult Day Services Charles 10200 La Plata Rd ALF within 1/4mile
Stella Maris ADC Center Baltimore Co 2300 Dulaney Valley Rd Nursing home on site
The League for People w Disabilities Baltimore City 1111 E Cold Spring Lane Day Hab on site
Washington HDC-ADC Washington 433 Brewer Ave Day Hab on site
We Care Adult Services Prince Georges 1717 Largo Rd ALF on site
Winter Growth-Howard Howard 5460 Ruth Keeton Way ALF on site
Winter Growth-Montgomery Montgomery 18110 Prince Philip Dr ALF within 1/4mile

Additional Resources

The following links describe HCBS programs in more detail:
Links to informational webinars are below:
Content Type
Folder: 2017 Community Settings Meeting Minutes
4/18/2017 3:22 PMFolder
Folder: A - Transition Advisory Team Meetings
6/11/2015 1:41 PMFolder
Folder: Appendices 1-14
5/10/2017 9:07 AMFolder
Folder: Appendices A-M
5/10/2017 9:08 AMFolder
Folder: B - HCBS Final Rule Transition Plan Comments
9/6/2016 10:21 AMFolder
Folder: C - Draft Transition Plan
6/24/2015 1:25 PMFolder
Folder: D - Introductory Final Rule Discussion
6/11/2015 2:05 PMFolder
Folder: DDA
4/18/2017 3:20 PMFolder
Folder: E - Preliminary Survey Information
6/11/2015 2:08 PMFolder
Freedom of Choice Form 11.15.pdf
7/14/2017 3:13 PMDocument
Folder: May 19, 2017 Webinar Follow-Up
5/25/2017 8:46 AMFolder
MD Initial Approval Letter.pdf
8/2/2017 3:00 PMDocument
MD State Transition Plan 7.26.17.pdf
7/26/2017 2:17 PMDocument
MDCTransmittalNo.86_Freedom of Choice.pdf
7/14/2017 3:13 PMDocument
Medicaid HCBS Codebook and Analysis Scheme.xls
1/27/2017 9:41 AMDocument
Memo Brain Injury Providers Community Settings 0417.pdf
4/24/2017 4:07 PMDocument
Folder: Provider Transformation
4/27/2017 8:37 AMFolder
Sample CSQ Current.pdf
7/5/2017 1:32 PMDocument
Folder: Stakeholder Notes
9/20/2016 11:16 AMFolder
State Transition Plan August 2016.pdf
7/21/2017 1:13 PMDocument
Folder: Workgroups
4/25/2017 4:36 PMFolder
Rebecca Oliver, MPA, JD
Health Policy Analyst Advanced
Office of Health Services
Maryland Department of Health and Mental Hygiene