Policy & Evidence Expectation: No policy expectations. If a photo or google image does not provide evidence of compliance, then an on-site or equivalent virtual visit from the HS team will be needed.

Examples of institutions include but are not limited to; hospitals, nursing facilities, ICFs, institutions for mental diseases etc.

CMS/Final Rule: A building is institutional if it keeps people with disabilities away from, or segregated from, the larger community and people without disabilities. If the setting is located in a building that is also a publicly or privately operate facility that provides inpatient institutional treatment.

Policy & Evidence Expectation: No policy expectations. If a photo or google image does not provide evidence of compliance, then an on-site or equivalent virtual visit from the HS team will be needed.

Examples of institutions include but are not limited to; hospitals, nursing facilities, ICFs, institutions for mental diseases etc.

CMS/Final Rule Guidance:  A setting can be isolating if it is located in a building on the grounds of, or immediately adjacent to a public institution.

Policy & Evidence Expectation: Preferred evidence is a Policy(s)/Procedure(s) indicating persons-served are not isolated solely due to their disabilities and persons-served have the same access to the greater community, services and supports as those who do not have disabilities. This is ultimately not a question of whether there is a gate in the front of the setting, but whether the setting is isolating.  An image showing there is no gate could be acceptable but policy documentation indicating there is no isolation is preferred for evidence submission.

CMS/Final Rule Guidance: A setting may be isolating individuals receiving Medicaid HCBS from the broader community of individuals not receiving Medicaid HCBS. This would include settings that may not look isolating, but because of rules and procedures followed at the setting, have the effect of isolating residents. In guidance, CMS has identified potential examples of settings that isolate, including farmsteads, gated or secured communities for people with disabilities, residential schools, and multiple settings clustered together and operationally related.

Policy & Evidence Expectation: Preferred evidence is a Policy(s)/Procedure(s) indicating persons-served are not isolated solely due to their disabilities and persons-served have the same access to the greater community, services and supports as those who do not have disabilities. An image showing addresses (if there are multiple owned/controlled setting and their distance from each other) could be acceptable but policy documentation indicating there is no isolation is preferred for evidence submission.

CMS/Final Rule Guidance: Preferred evidence is a Policy(s)/Procedure(s) indicating persons-served are not isolated solely due to their disabilities and persons-served have the same access to the greater community, services and supports as those who do not have disabilities. In guidance, CMS has identified potential examples of settings that isolate, including farmsteads, gated or secured communities for people with disabilities, residential schools, and multiple settings clustered together and operationally related.  This is ultimately not a question of where the site is located but if that location and the policies of that setting are isolating.

Policy & Evidence Expectation: Preferred evidence is a Policy(s)/Procedure(s) indicating persons-served are not isolated solely due to their disabilities and persons-served have the same access to the greater community, services and supports as those who do not have disabilities.

After an internal review of this question it has been determined this question is more about access and inclusion than it is purely about demographics.  The team does not wish to equate non-compliance with serving only people with disabilities, rather to underline the importance of communities formed entirely of this demographic taking steps to ensure access to the broader community is still available at the same level/rate as those who are not receiving HCBS services.  If a community is formed (group home, assisted living, etc.) it is important to note this community must still provide opportunities for its members to interact with the community at large at the same level/rate as those who are not receiving HCBS services.

CMS/Final Rule Guidance: A setting may be Isolating individuals receiving Medicaid HCBS from the broader community of individuals not receiving Medicaid HCBS. This would include settings that may not look isolating, but because of rules and procedures followed at the setting, have the effect of isolating residents. In guidance, CMS has identified potential examples of settings that isolate, including farmsteads, gated or secured communities for people with disabilities, residential schools, and multiple settings clustered together and operationally related.

Policy & Evidence Expectation: Preferred evidence would be policy or procedure indicating persons-served are able to receive medical, behavioral and therapy services wherever they choose.  Persons-served must be able to travel off-site to receive these services if they so desire. 

CMS/Final Rule Guidance: A setting may be Isolating individuals receiving Medicaid HCBS from the broader community of individuals not receiving Medicaid HCBS. This would include settings that may not look isolating, but because of rules and procedures followed at the setting, have the effect of isolating residents. In guidance, CMS has identified potential examples of settings that isolate, including farmsteads, gated or secured communities for people with disabilities, residential schools, and multiple settings clustered together and operationally related.

According to the Final Rule the setting is integrated in and supports full access of individuals receiving Medicaid HCBS to the greater community, including opportunities to seek employment and work in competitive integrated settings, engage in community life, control personal resources, and receive services in the community, to the same degree of access as individuals not receiving Medicaid HCBS.

[Shown for day service providers]

Policy & Evidence Expectation: Preferred evidence would be a policy(s)/procedure(s) indicating persons-served have autonomy, integration and choice, even if both residential and day services are offered at the same location. Policies a provider have should spell out day/residential specifically, and we encourage documentation for day services to be separate from that of residential services. 

CMS/Final Rule Guidance: A setting may be Isolating individuals receiving Medicaid HCBS from the broader community of individuals not receiving Medicaid HCBS. This would include settings that may not look isolating, but because of rules and procedures followed at the setting, have the effect of isolating residents. In guidance, CMS has identified potential examples of settings that isolate, including farmsteads, gated or secured communities for people with disabilities, residential schools, and multiple settings clustered together and operationally related.

According to the Final Rule setting is integrated in and supports full access of individuals receiving Medicaid HCBS to the greater community, including opportunities to seek employment and work in competitive integrated settings, engage in community life, control personal resources, and receive services in the community, to the same degree of access as individuals not receiving Medicaid HCBS.

[Shown for residential providers]

Policy & Evidence Expectation: Preferred evidence would be a policy(s)/procedure(s) indicating persons-served have autonomy, integration and choice, even if both residential and day services are offered at the same location. Policies a provider have should spell out day/residential specifically, and we encourage documentation for day services to be separate from that of residential services.

CMS/Final Rule Guidance: A setting may be Isolating individuals receiving Medicaid HCBS from the broader community of individuals not receiving Medicaid HCBS. This would include settings that may not look isolating, but because of rules and procedures followed at the setting, have the effect of isolating residents. In guidance, CMS has identified potential examples of settings that isolate, including farmsteads, gated or secured communities for people with disabilities, residential schools, and multiple settings clustered together and operationally related.

According to the Final Rule the setting is integrated in and supports full access of individuals receiving Medicaid HCBS to the greater community, including opportunities to seek employment and work in competitive integrated settings, engage in community life, control personal resources, and receive services in the community, to the same degree of access as individuals not receiving Medicaid HCBS.