Settings That Offer Waiver Services

Settings that offer waiver-funded services must meet five required primary characteristics outlined by the Centers for Medicare and Medicaid Services.

This applies to residential and non-residential settings, including facility-based employment and day programs.

  1. The setting is integrated in and supports the person accessing services in having  full access to the greater community.

  2. This includes opportunities to

      • Work in integrated settings

      • Engage in community life

      • Receive services in the community to the same degree of access as people not enrolled in waivers

  3. The setting is selected by the person from among non-disability specific settings.

  4. The setting ensures individual's rights of privacy, dignity and respect, and freedom from coercion.

  5. The setting optimizes, but does not regiment, individual initiative, autonomy and independence in making life choices.

  6. The setting facilitates individual choice regarding services and supports and who provides them.

The definition is designed to be outcome-oriented and experiential. This means a determination about whether or not a setting meets these characteristics is based upon the needs of the people receiving services there, as reflected in their person-centered plans. It is not based upon the physical location of the setting, the size of the setting, or a prescribed duration or number of community-based activities.

See the criteria for demonstrating home and community-based characteristics that CMS has established for each type of setting.

Settings Evaluation
This evaluation, developed in partnership with stakeholders, is used to assess sites where waiver services are provided.

Heightened Scrutiny
​Providers that self-identified as being located at an isolating location but believe their services overcome that barrier and provide ample opportunity for people served to participate in community living can request a special review of their site.

Remediation Plan
Providers that make changes to their site may be required to formalize these changes in a remediation plan submitted to DODD.

Suitability of Services and Settings
​With a workgroup of stakeholders the department developed a rule ensuring the suitability of services and settings in which HCBS services may be delivered (OAC 5123:2‐9‐02). 

The rule seeks to ensure that home and community-based services waivers maximize opportunities for people to access the benefits of community living and receive services in the most integrated setting and in the least restrictive manner setting.

Waiver services must be explored in homes; day activities with one or two people should be considered before large group schedules. This applies to services delivered during the day and residential services.
About Services

A person receiving waiver services must have access to activities that are:

  • Age appropriate
  • Meaningful and reflect their interests
  • Chosen by the person

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About Settings
This rule includes the specific requirements for a lease or rental agreement. Leases and rental agreements seek to ensure that a person enrolled in waiver service

  • Can choose their own roommates,
  • Maintains their right to privacy including locks and keys to living spaces,
  • Is able to personalize their living spaces,
  • And is able to set their own hours and schedules, specifically meal times and access to food.

Read more about specific requirements for rental agreements and find templates created to support compliance efforts below. 

What the rule means for people receiving waiver servicesWhat it DOES NOT mean
People have greater opportunities to try new things.
Everybody is required to work in community-based settings.
​People are able to make informed choices, based on experiences, about community employment and what community-based activities/involvement they may enjoy.People cannot spend time during the day with other people with developmental disabilities.
People may get involved in community employment and/or other community based activities based on their interests and desired level of involvement.When not working in the community, no other day program options will be available.
People who do not want to receive waiver services in disability-specific settings, such as workshops, day programs, group homes, etc. cannot be made to do so. People are required to spend a specific amount of time in or participate in a certain number of community-based activities each day/week/month