New Jersey Department of Human Services Division of Developmental Disabilities

Home and Community Based Settings Criteria

In accordance with the Home and Community Based Services (HCBS) Final Rule, all HCBS must be delivered in settings that are integrated in, and support full access to, their community. This includes opportunities to seek employment and work in competitive settings within the community, engage in a community life, control personal resources, and receive services in a similar way as individuals who do not receive HCBS.

Additional characteristics of a Home and Community Based Setting include, but are not limited to:

The setting is selected by the individual from among setting options, including nondisability specific settings and an option for a private unit in a residential setting. A private unit is defined as a private bedroom with lockable doors or can also be a private rental unit. The settings options are identified and documented in the person-centered plan and are based on the individual’s needs, preferences, and, for residential settings, resources available for room and board;
The setting ensures an individual’s rights of privacy, dignity, respect, and freedom from coercion and restraint. Any circumstances requiring restrictions must have approval through a Human Rights Committee and be documented in the person centered service plan;
The setting facilitates individual choice regarding services and supports, and who provides them;
The individual has a lease or other legally enforceable agreement (ie. residency agreement) providing similar protections;
The setting ensures the individual has privacy in their sleeping or living unit including lockable doors, choice of roommates, and freedom to furnish or decorate the unit;
The setting ensures the individual has the freedom and support to control his/her own schedule and activities, and have access to food at any time;
The individual can have visitors of his/her choosing at any time, unless otherwise indicated in their person centered service plan;
The setting is physically accessible to the individual.

Settings must not have the qualities of an institution. This includes:

Any setting that is located in a building that is also a publicly or privately operated facility that provides inpatient institutional treatment;
Any setting that is located in a building on the grounds of, or immediately adjacent to, a public institution; or
Any other setting that has the effect of isolating individuals receiving Medicaid Waiver HCBS from the broader community of individuals not receiving Medicaid HCBS.

Please complete one assessment for each HCB setting where your agency provides services. This includes both licensed and unlicensed provider managed residential settings as well as facility based day services settings.The information provided should be a representation of how the setting operates. If a HCBS characteristic is not presently met in its entirety, a corrective action plan which includes remediation strategies and timeframe for improvements must be created and submitted to the ddd.hcbshelpdesk@dhs.nj.gov.

Where applicable, corrective action plans must be developed by the provider and may include, but are not limited to changes to operational policies and procedures, staff trainings, environmental modifications.

Corrective action plan templates are forthcoming and will be available on the Division website.

Question Title

* 1. Provide the following information:

Name/Title of Person Completing Survey *

Provider Name *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Provider NPI

Email Address *

Phone Number *

Question Title

* 2. Provide the following information about the service setting

Site Name *

Site NPI# *

Site VID# (Residential Sites Only)

Address *

City/Town *

State/Province *

ZIP/Postal Code *

Facility Type

Site Capacity (Residential=Bed Size, Day=Max Occupancy) *

Number of Waiver Participants Supported at Site *

Question Title

* 3. Is the setting located in a building that is also a publicly or privately operated facility that provides inpatient institutional treatment?

Yes

Question Title

* 4. Is the setting in a building located on the grounds of, or immediately adjacent to, a public institution where in patient care is provided?

Yes

Question Title

* 5. Settings that do not demonstrate HCBS characteristics and offer limited opportunity for community engagement may have the effect of isolating. Does the service setting have the effect of isolating individuals receiving Medicaid HCBS from the broader community of individuals not receiving HCBS?

Yes