• Introduction and Learning Objectives
• Waiver Basics
• HCBS Roles and Responsibilities
• Assurances in Action

• Level of Care
• Service Plan
• Qualified Providers
• Health and Welfare
• Financial Accountability
• Administrative Authority

Background, cont'd

The first time a state submits an HCBS waiver application, CMS approves the program for three years; when a state submits a renewal application, CMS approves it for five years.

After its HCBS waiver is approved, a state must submit
evidence to CMS documenting that the HCBS waiver program
is operating as approved and is in compliance with each of the six assurances.

Challenges in assuring quality in home-based settings

HCBS waivers are person centered. They invite individuals to play active roles in deciding the services they want to receive and when. This can make a big difference in quality of life. But delivering services in home and community settings raises new challenges to assure the quality of these programs.

There is no one on site to monitor care and services at all times.


Participants rely on many people for their care and safety.


Participants may be vulnerable and unable to seek help.


People may be afraid of losing their services if they report problems.

So what are the assurances, and how do they relate to you?