If You Want to Be in Compliance with the CMS HCBS Settings Rule... Eliminate "Blanket Rules."


Frank is a Coke addict. He loves Coke. He will tell you that himself. And if you ask him, he will also tell you that he is 42 years YOUNG (not old), lives with his mother, and has a job. Frank isn’t shy about telling everyone he sees “I work. I do good work.”


Frank works two days a week at a local thrift store. The other three days of the week he attends a day program. I asked Frank what he liked best: going to the day program or going to his job. Frank didn’t give me a direct answer, but what he did tell me was very interesting. He told me that at his job he can have two Cokes during the day (if he wants), but at the day program he can only have one Coke. (And remember…. Frank LOVES Coke.)


At first, I wondered if Frank had some kind of health condition that would require him to limit the number of Cokes he drank each day. But that didn’t make sense because Frank said he drank two Cokes at his job. Then I thought that maybe I misunderstood what Frank told me. But when I asked the day program supervisor for clarification I learned that program participants were only allowed to purchase one (1) soft drink per day. I also learned that this “Limit of 1 Soft Drink Purchase a Day” rule only applied to program participants. It did not apply to employees or visitors. (So... I can purchase 100 Cokes if I want, but Frank can only purchase one.)


The “Limit of 1 Soft Drink Purchase a Day” rule is what I call a “blanket rule.”


Tip: If you want to be in compliance with the CMS HCBS Settings Rule...eliminate "blanket rules."


A “blanket rule” is any rule (written or unwritten) that applies to ALL individuals who receive home and community-based services, BUT…would NEVER apply to you, me, or any other person who is not receiving services. I’m not talking about the federal, state, or local rules that you are required to follow when you provide services to individuals. I’m talking about rules that an organization creates…and has the power to change.


Why is it important to eliminate “blanket rules?”


"Blanket rules" are commonly found in institutions. The CMS HCBS Settings Rule requires that home and community-based services not have the quality of an institution. Therefore, when “blanket rules” are found in home and community-based services it is a sign that the provider may be operating more like an institution.


What “blanket rules” should you look for?


Some “blanket rules” are more likely than others to not be in compliance with the CMS HCBS Settings Rule. So when evaluating your organization’s rules for compliance with the CMS HCBS Settings Rule, you want to look more closely at these rules:


  • Rules that apply ONLY to the individuals who receive services and do NOT apply to employees and visitors.

Example: Program participants can only purchase one soft drink each day, but employees and visitors are not limited to one soft drink purchase.


  • Rules that presume ALL individuals with a disability need the same level of support, regardless of the individual’s diagnosis or level of functioning.

Example: A rule that requires all individuals who receive services to wear a bib when eating.

  • Rules that appear to be created for the convenience of the organization.

Example: “No eating after 7:00 PM.”

  • Rules that have a TIME requirement or a TIME limit.

Examples: “No TV after 8:00 PM” “Video games can only be played for 30 minutes.”

  • Rules (practices) that require all individuals who receive services to do the same thing.

Example: Everyone goes to the zoo on Saturday.

  • Rules that prohibit ALL individuals who receive services from doing something.

Example: No one is allowed to have visitors to spend the night.


An organization’s rules could keep the organization from being in compliance with the CMS HCBS Settings Rule. However, using the checklist above to look for “blanket rules” can help you identify rules that may need to be eliminated or modified.


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