Settings Rule
The Home and Community Based Services (HCBS) Settings Rule ensures that people who receive services and supports through Medicaid’s HCBS programs have full access to the benefits of community living and are able to receive services in the most integrated setting. It protects individuals’ autonomy to make choices and to control the decisions in their lives, a right most people take for granted. This includes controlling personal resources; being treated with privacy, dignity, respect, and freedom from coercion and restraint; deciding what and when to eat; having visitors; being able to lock doors; and having the protections of a lease or other legally enforceable agreement. The rule requires a person-centered process for planning HCBS, which means that the individuals receiving services direct the planning process and the plan reflects their own preferences and goals they have set for themselves.
Under the rule, a setting that is truly home and community based is one that:
- Is integrated in and supports access to the greater community
- Provides opportunities to seek employment and work in competitive integrated settings, engage in community life, and control personal resources
- Ensures the individual receives services in the community to the same degree of access as individuals not receiving Medicaid home and community-based services
- Is selected by the individual from among setting options, including non-disability specific settings and an option for a private unit in a residential setting
- Person-centered service plans document the options based on the individual’s needs, preferences; and for residential settings, the individual’s resources
- Ensures an individual’s rights of privacy, dignity, respect, and freedom from coercion and restraint
- Optimizes individual initiative, autonomy, and independence in making life choices
- Facilitates individual choice regarding services and supports, and who provides them
Person Centered Language
Person-first (or person-centered) language refers to choosing and using words that recognize and refer to individuals – first and foremost – as people. This demonstrates respect for each person’s basic humanity. It emphasizes their unique traits, strengths, and worth.
Ex: “A diabetic “ – incorrect. “A person living with diabetes” – Correct, person first.
Ex: “A disabled man” – incorrect. “A man with a disability” – Correct, person first.
Person centered Planning – put the individual at the center, the person directs the plan. The goals are what the person wants, not what caretakers want for the person.
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