Individual choice is not only a value. It is a federal requirement for Home and Community-Based Services (HCBS). The CMS HCBS Final Rule (2014) established that people receiving Medicaid-funded services must have real control over where they live, who supports them, and how they spend their time (CMS, 2014).
For providers, the challenge is turning that principle into daily practice while maintaining compliance.
What Individual Choice Means in HCBS
At its core, individual choice means that the person directs their own life. They can:
- Select where they live and with whom
- Decide how their services are delivered
- Choose community activities and daily routines
- Change providers when they wish
These rights apply across HCBS waiver programs, including intellectual and developmental disabilities, aging, and behavioral health waivers. The person-centered plan (PCP) documents and protects these choices.
Compliance Starts with Person-Centered Planning
CMS defines person-centered planning as a process led by the individual, reflecting their preferences, goals, and desired outcomes. Providers should ensure:
- Documented Choice: Each preference or goal is written clearly in the plan.
- Informed Decision-Making: Individuals understand their options and any potential risks.
- Consent and Revisions: The plan can be updated at any time, not just once a year.
- Community Inclusion: The plan supports genuine participation in community life, not only facility-based activities.
Example: If an individual prefers to work at a local grocery store rather than a sheltered workshop, the provider must document that choice and coordinate supports to make it possible.
Where Providers Fall Short
Even strong agencies can miss the mark. Common compliance issues include:
- Using generic care plans that limit real choice
- Overriding preferences for staff convenience
- Failing to document how risks were discussed
- Treating safety as a reason to deny autonomy
CMS and state surveyors frequently flag these gaps during HCBS site reviews.
Building Systems that Protect Choice
To stay compliant and uphold dignity, agencies can embed good habits into operations.
1. Train for AutonomyTrain all direct support professionals (DSPs) on person-centered language, rights, and respectful support. Staff should ask, not assume.
2. Audit for Practice, Not PaperConduct quarterly internal audits that check for real evidence of choice. Look for photos, activity logs, or progress notes that show people living their plans.
3. Update Policies and ProceduresAlign documentation, risk plans, and supervision practices with current CMS expectations.
4. Listen and AdjustUse satisfaction surveys or interviews to identify patterns where individuals feel restricted or unheard.
Compliance Checklist
✔ Document individual choices in every PCP
✔ Train all staff on HCBS rights and self-determination
✔ Offer informed options rather than preset routines
✔ Conduct quarterly reviews of PCP implementation
✔ Revise policies to match current CMS guidance
Why It Matters
When people have control over their lives, outcomes improve. Engagement, satisfaction, and health all rise. CMS enforces these standards not only to regulate, but to ensure that community-based services are truly centered on the individual.
FAQ
Sources
- Centers for Medicare & Medicaid Services (CMS). HCBS Final Rule: 42 CFR §441.301(c)(4).
- U.S. Department of Health and Human Services (HHS). Person-Centered Planning and Practice Guidelines(2023).
- Medicaid.gov. Home and Community-Based Services Requirements.
Next Step
Magnate Consulting helps providers align with HCBS requirements, strengthen person-centered documentation, and prepare for compliance reviews. Contact us today to build systems that put choice and compliance first.
