Home and community-based services (HCBS) are medical, social and supportive services for Iowans with functional, cognitive and other physical or mental health needs. These services are meant to help people live and receive services in a home and community-based setting instead of an institution.
HCBS are funded through Iowa Medicaid's HCBS waivers and Habilitation programs. In addition to the services available through an HCBS waiver, waiver-enrolled members have access to Medicaid covered services and benefits. For more information, see the HCBS Waivers Program webpage.
Visit the Iowa Medicaid webpage to learn more about waivers, Habilitation and other Iowa Medicaid programs.
To learn more about the HCBS waivers, visit the HCBS Waivers Program webpage.
Search for HCBS providers on the Find a Provider webpage.
Visit the Iowa Medicaid webpage to learn more about waivers, Habilitation and other Iowa Medicaid programs.
For more about the HCBS waivers, visit the HCBS Waivers Program webpage.
To learn how to apply to be an HCBS provider, visit the Provider Enrollment webpage.
Iowa Medicaid's Quality Improvement Organization (QIO) has a team of professionals dedicated to quality oversight and technical assistance for HCBS and Community-Based Neurobehavioral Rehabilitation Services (CNRS) providers. HCBS Specialists generally serve providers with main office locations based within the Specialist's assigned region.
Some Specialists are dedicated to managing incidents and complaints related to HCBS and CNRS providers or members.
One Specialist is dedicated to reviewing applications, providing technical assistance and supporting applicants and new providers.
Click the links below for the current region map and listing of HCBS Specialists.
Providers wishing to discontinue or disenroll from specific services, settings or the entire organization may contact their HCBS Specialist for assistance.
Effective March 17, 2023, HCBS Waiver and Habilitation providers must report and receive approval for new residential and non-residential settings prior to using HCBS funding in the setting. March 17, 2023, marked the end of the transition period for states to fully comply with the Centers for Medicare & Medicaid Services (CMS) final rule for HCBS settings. The HCBS settings rule requires states to ensure all settings where HCBS waiver and Habilitation services are provided comply with HCBS settings requirements rule prior to receiving HCBS funding in the setting.
For instructions for reporting new settings, see Informational Letter (IL) No. 2571.
In 2014, The Centers for Medicare and Medicaid (CMS) made rules defining HCBS and outlining under what circumstances HCBS funding can be used. The goal of these rules was to make sure HCBS funding is truly used to support people to lead non-institutional lifestyles. The rules required HCBS to be provided in such a way that recipients:
The time between the establishment of the final rule and the deadline for all states to comply is referred to as the “transition period." The transition period ended on March 17, 2023.
Each state had to develop a plan to map out how their state would move from learning about the rule to fully complying with the HCBS setting final rule. These plans were called "statewide transition plans" or STPs.
Initial STPs were developed and submitted to CMS explaining how each state planned to carry out a discovery, assessment, remediation and monitoring process to make sure all settings in the state complied. The initial STP also described any progress made in implementation up to that point in time.
Iowa's initial STP was approved on August 9, 2016.
Final STP were developed and submitted to CMS explaining the results of the state's discovery, assessment, remediation and monitoring processes. The final STP also outlined the state's ongoing monitoring processes.
Iowa's final STP was approved on March 17, 2023.
Even though Iowa's final STP was approved, there was still some work that needed to be done to fully demonstrate compliance. Iowa, and many other states are working through a corrective action plan (CAP) to finish up work around heightened scrutiny and validation of results.
Some HCBS settings are determined to be institutional in nature or "presumptively institutional." CMS requires these settings to undergo a "heightened scrutiny" review to determine if the setting can comply with or without modification (remediation) or if the setting is unable to comply and cannot continue as an HCBS setting.
CMS named three "categories" or "prongs" of heightened scrutiny:
When a state discovered a setting requiring heightened scrutiny review, the state performed the first assessment of the setting and made a determination about the setting's ability to comply with or without modifications. If modifications were necessary, the state ensured those modifications were made and re-assessed to ensure the setting could now comply. Any settings that could not comply, even after modifications, had to transition away from HCBS funding prior to the end of the transition period (March 17, 2023).
Settings that could comply with or without modifications were to be referred to CMS for final approval after the state received input from the public on their findings.
Later, CMS decided that states must submit all Category 1 and Category 2 settings for heightened scrutiny review, but Category 3 settings need only be submitted for review if they had not complied prior to July 1, 2021.
Iowa discovered several settings meeting the definitions of both Category 1 and Category 3. No Category 2 settings were discovered.
Ultimately, Iowa referred approximately 75 Category 1 settings to CMS for heightened scrutiny review and 4 Category 3 settings that had not complied prior to July 1, 2021.
Iowa Medicaid has had a robust HCBS quality oversight system in place for over thirty years. This quality oversight system includes regular, ongoing review of providers of HCBS waiver and Habilitation services. Iowa Medicaid's QIO HCBS team is responsible for all quality oversight activities for the HCBS waiver and Habilitation providers, including the review and assessment of HCBS settings.
Quality oversight includes, but is not limited to, annual provider self-assessment, Periodic or Certification Reviews, CNRS Periodic Reviews, Focused Reviews and review of incidents and complaints (also known as Targeted Reviews).
The HCBS Provider Quality Self-Assessment is required of all providers enrolled for the services identified, regardless of whether those services are currently being provided. The self-assessment must be completed, submitted and approved at application, annually and anytime there is a change in the provider's enrollment that warrants an updated self-assessment.
If you have questions about the 2023 HCBS Provider Quality Self-Assessment, contact the assigned HCBS Specialist. You can also send questions via email to hcbsqi@dhs.state.ia.us
2023 HCBS Provider Quality Self-Assessment
Please see the Medicaid Provider Trainings webpage to learn more about completing the 2023 HCBS Provider Quality Self-Assessment. Training is updated annually.
A separate Provider Quality Self-Assessment for Community-Based Neurobehavioral Rehabilitation Services (CNRS) providers can be found on the CNRS webpage.
Iowa HHS, in collaboration with the Iowa Association of Community Providers (IACP), the Iowa Coalition for Integration and Employment (ICIE) and the managed care organizations (MCOs), has developed an Employment Matrix. This tool was created to provide an easy-to-follow guide to HCBS-funded employment services and supports. The Employment Matrix also provides guidance regarding the employment service provider staff qualifications and training requirements and the processes for service authorization for employment services for both fee-for-service (FFS) and the MCOs.
Iowa HHS, in partnership with employment stakeholders, has developed an Employment First Guidebook. This Guidebook was created to provide case managers, care managers, service coordinators and Integrated Health Home (IHH) care coordinators with critical information, resources and tools to help them do the best possible job of assisting transition-age youth and working-age adults with disabilities they support to work.
Supported Community Living (SCL) services are provided within the member’s home and community, according to the individualized member need as identified in the member’s service plan. SCL services are intended to provide for the daily living needs of the member and are available as needed during any 24-hour period. The services are intended to develop, increase and maintain independent living-skills and include personal and home skills training services, individual advocacy services, community skills training services, personal environment support services, transportation and treatment services.
The Department has developed a Legally Responsible Persons and Legal Representatives of Supported Community Living (SCL) Guidance Document. This tool was created to provide an easy-to-follow guide to the delivery of SCL to minors and adults by legally responsible persons and legal representatives through the HCBS Brain Injury and Intellectual Disability Waivers.
The Department has developed a SCL provided in a Host Home Guidance Document. This tool was created to provide an easy-to-follow guide in the delivery of SCL in a Host Home through the HCBS Habilitation program and the HCBS Brain Injury and Intellectual Disability Waivers.
The Department has developed a Frequently Asked Questions document related to SCL delivered in a Host Home. This tool was created to provide answers to the most frequently asked questions related to the delivery of SCL in a Host Home.
The Department has developed a SCL delivered through the Remote Support Modality Policy. This policy was developed to provide an easy-to-follow guide in the delivery of SCL via remote support under the HCBS Brain Injury and Intellectual Disability Waivers.
The Department has developed a Frequently Asked Questions (FAQs) document related to Medical Day Care for Children and Adult Day Care delivered in the home. This tool was created to provide answers to the most frequently asked questions related to the delivery of Medical Day Care for Children and Adult Day Care in the home.