Home Services Long-Term Care Alternatives (Home and Community-Based Service Options) HCBS Statewide Transition Plan

HCBS Statewide Transition Plan

The California Department of Health Care Services (DHCS) submitted the revised Statewide Transition Plan (STP) to the Centers for Medicare & Medicaid Services (CMS) on November 23, 2016. The STP describes how the State will come into compliance with new Federal Home and Community-Based (HCB) Settings Final Rule that became effective March 17, 2014. These regulations are CMS 2249-F and CMS 2296-F, which affect 1115, 1915(c), 1915(i) and 1915(k) Home and Community-Based Services (HCBS) waivers and State Plan programs. All 115, 1915(c), 1915(i) and 1915(k) HCBS waivers and State Plan programs must be in full compliance with the new federal rules by the new extended date of March 17, 2023. CMS issued guidance to states on July 14, 2020, indicating that the transition period for ensuring compliance with the HCBS Final Rule was extended in response to the COVID-19 pandemic. See the Federal Policy Guidance.

DHCS has worked with partner agencies, including the Department of Developmental Services (DDS), the California Department of Aging (CDA), the California Department of Public Health (CDPH), California Department of Social Services (CDSS), Stakeholders, and other entities to develop the revised STP and attachments. DHCS is committed to working with partner agencies and stakeholders throughout the transition period.

Below is California’s revised Statewide Transition Plan (STP) that describes the State’s current efforts and proposed actions to ensure Home and Community-Based Service (HCB) providers achieve compliance with the federal HCB settings rule. CMS granted initial approval of California’s STP on February 23, 2018.

As required under the American Recovery and Reinvestment Act of 2009 (ARRA), DHCS seeks advice from designees of Indian Health Programs, and Urban Indian Organizations on Medi-Cal matters having a direct effect on Indians, Indian Health Programs, or Urban Indian Organizations. The STP was submitted for tribal review on October 7, 2022. The public comment period will be held October 14, 2022 through November 13, 2022, with the intention of submitting the STP to CMS for final approval following the notice period. For more information on the CBAS STP, please visit the CBAS STP landing page.

On June 30, 2023, DHCS received final approval from CMS on the STP to bring settings into compliance with federal HCBS Setting Final rule regulations. Final approval was granted after DHCS, in partnership with DDS and CDA, conducted a comprehensive site-specific assessment and validation of all settings serving individuals receiving Medicaid-funded HCBS, included in the STP the outcomes of these activities, and proposed remediation strategies to rectify any uncovered issues; outlined a detailed plan for identifying settings that are presumed to have institutional characteristics, including qualities that isolate HCBS clients, as well as the proposed process for evaluating the settings and preparing for submission to CMS for review under heightened scrutiny; developed a process for communicating with members who are currently receiving services in settings the state has determined cannot or will not come into compliance with the HCBS settings criteria; and established ongoing monitoring and quality assurance processes to ensure all settings providing HCBS continue to remain fully compliant with the HCBS Settings Final rule in the future. DHCS will work collaboratively with CMS to identify any areas that may need strengthening with respect to the state’s remediation and heightened scrutiny processes as the state implements each of the key elements of the STP.

Final Approval of California’s Statewide Transition Plan, June 30, 2023
Statewide Transition Plan for Compliance with Home and Community Based Settings Rules – June 2023
Attachment I Draft Community-Based Adult Services (CBAS) Home and Community-Based (HCB) Settings Transition Plan
Attachment II DHCS Residential On-Site Assessment Tool
Attachment III MSSP Adult ADC On-site Day Center (ADC) On-site Assessment Tool
Attachment IV MSSP Congregate Meal On-site Assessment Tool
Attachment V DDS Non-residential Virtual Site Assessment Tool
Attachment VI DDS Residential Virtual Site Assessment Tool
Attachment VII MSSP Adult ADC On-site Day Center (ADC) Self-Assessment Instructions and Tool
Attachment VIII MSSP Congregate Meal Self-Assessment Instructions and Tool
Attachment IX MSSP Site Self-Assessment Instructions and Tool
Attachment X Residential Rental Agreements Guidelines
Attachment XI Setting Assessment Process
Attachment XII STP Timeline and Milestones
Attachment XIII – STP On-Site Assessment Tool – Residential
Attachment XIV – STP On-Site Assessment Tool – Non-Residential
Attachment XV – STP Provider Self-Survey Tool – Residential
Attachment XVI – STP Provider Self-Survey Tool – Non-Residential

Corrective Action Plan

On November 30, 2022, the State submitted an STP Corrective Action Plan (CAP) to CMS to request additional time to implement specific provisions of the HCBS Final Rule past the transition deadline of March 17, 2023. CMS is allowing states to request additional time to come into full compliance with the Final Rule in recognition of the impact the COVID-19 public health emergency (PHE) has had on the direct care workforce. The State is requesting an extension through June 2024 to implement the following regulatory criteria:

Ensuring individuals have full access to the broader community.
Ensuring individuals have opportunities for employment.
Ensuring individuals have the option for a private room and/or choice of roommate.
Ensuring individuals have a choice of non-disability specific settings.

California DHCS Heightened Scrutiny Settings Packets

The California Department of Health Care Services (DHCS) has posted the following HCBS Settings Final Rule documents for public comment:

Heightened Scrutiny summary sheets for facilities that may have an isolating effect for residents.
The public comment period will be from July 29, 2022 to August 28, 2022

Follow the link to view the Heightened Scrutiny Setting Packets and Leave Comments

Public Comment Periods

DHCS conducted public comment periods for stakeholder feedback on the STP and On-Site Assessment and Provider Self-Survey Tools:

Final STP Comment Period October 14, 2022 through November 13, 2022
Heightened Scrutiny Setting Comment Period July 29, 2022 through August 8, 2022
Statewide Conference Call, September 27, 2016
Draft STP Comment Period, August 29, 2016, through September 29, 2016
Final STP, On-Site Assessment, and Provider Self-Survey Tools Stakeholder Conference Call, August 20, 2015
Draft STP, On-Site Assessment, and Provider Self-Survey Tools Stakeholder Conference Call, July 13, 2015
Draft STP Public Comment Period, July 2, 2015, through July 31, 2015
On-Site Assessment and Provider Self-Survey Tools Public Comment Period, May 22, 2015, through June 30, 2015
Stakeholder Conference Call, December 2, 2014
Draft STP Public Comment Period November 7, 2014, through December 8, 2014
Stakeholder Conference Call, October 21, 2014
Draft STP Public Comment Period September 19, 2014, through October 20, 2014

Additional Links

HCB Settings Rule:

HCBS Training*

HCBS Setting Final Rule Training Webinar
Training Notification (Q & A Registration)
HCBS Final Rules Live Q&A – Transcript
Achieving Compliance with HCBS Settings Final Rule
Remediation Work Plan Trainings -Strategies for Compliance
HCBS Final Rule and Person Centered Planning
Care Coordination Agencies- Service Plan Training – Assisted Living Waiver
ISP Provider Training – Assisted Living Waiver

*These trainings are not compatible with Microsoft Explorer. Please launch training in Google Chrome or Firefox.

For more information regarding the new Federal HCBS setting requirements, please visit:

Medicaid.gov Home and Community-Based Services website

If you have additional questions or comments regarding the Statewide Transition Plan, please email STP@dhcs.ca.gov