My Choice My Way

In January 2014, the Centers for Medicare & Medicaid Services (CMS) issued new regulations that require home and community-based services (HCBS) to be provided in community like settings. The new rules define settings that are not community like and after a transition period, those settings that do not meet the new rules cannot be used to provide federally funded HCBS.

The intent of these rules is to ensure that people who receive HCBS have the opportunity to access the benefits of community living and receive services in the most integrated settings. States will be allowed until March 14, 2022 [extended to March 17, 2023, due to the public health emergency] to make the transition. The requirements for submitting a transition plan to CMS rest with the single-state Medicaid agency. The Hawai`i Department of Human Services, Med-QUEST Division (DHS/MQD) has taken the lead for meeting the requirements for the transition plan. Hawai`i proposes the transition plan with the following timetable and deliverables to come into compliance with the CMS HCBS Final Rule.

On March 2015, Hawai`i submitted the first My Choice My Way transition plan to CMS. The plan defined the key activities the state would complete to ensure that specific HCBS settings are in compliance with the regulations. These settings include:

  • Adult Day Care Programs
  • Adult Day Health Programs
  • Adult Residential Care Homes/Expanded Adult Residential Care Homes
  • Assisted Living Facilities
  • Community Care Foster Family Homes
  • Developmental Disabilities Domiciliary Homes
  • Developmental Disabilities Adult Foster Homes
  • Employment Programs

On January 2017, Hawai`i received initial approval of the My Choice My Way transition plan.

On November 2019, CMS approved the My Choice My Way transition plan. The approval letter and the approved Plan are linked below under the heading “Approved State Transition Plan​".

Approved State Transition Plan 

Past State Transition Plans

Heightened Scrutiny Settings for Public Comment

The final rule provides the State the opportunity to evaluate settings through a heightened scrutiny process if the setting: 

(i) “is located in a building that is also a publicly or privately operated facility that provides inpatient  

institutional treatment,”  

(ii) is located “in a building on the grounds of, or immediately adjacent to, a public institution,” or  

(iii) otherwise “has the effect of isolating individuals receiving Medicaid HCBS from the broader community of individuals not receiving Medicaid HCBS,”  

The setting is then “presumed to be a setting that has the qualities of an institution unless CMS determines through heightened scrutiny, based on information presented by the State, that the setting does not have the qualities of an institution and that the setting does have the qualities of home and community-based settings.” 

The State identified 4 settings that required heightened scrutiny. The State determined that a setting overcame the institutional presumption by verifying that the setting met (or had an accepted plan of correction) for meeting each requirement of the HCBS Setting Final Rule. 

The HCBS Heightened Scrutiny Settings Summary (below) includes the list of settings, summary of findings, and additional supporting evidence may be available upon request. 

Hale Makua Adult Day Health (1115 Waiver QUEST Integration)

Palolo Chinese Home Senior Day Care (1115 Waiver QUEST Integration)

Opportunities and Resources, Inc. Adult Day Health (1915c I/DD Waiver)

Opportunities and Resources, Inc.  Developmental Disabilities Domiciliary Homes (1915c I/DD Waiver)

The State hereby notifies the public of the opportunity to comment on these settings. Written comments will be accepted from May 15,2024 to June 20, 2024. The State will also hold a public forum. All interested parties are invited to join the public forum and to state their views regarding these settings.   

Via Webinar

Date:            June 4, 2024 

Time:            10:00 a.m. to 11:00 a.m.     


 After registering, you will receive a confirmation email containing information about joining the webinar. 

In lieu of joining the public forum by webinar, written comments can be sent through email at [email protected] or mailed to: 

 Department of Human Services 

Med-QUEST Division 

Attention:  Health Care Services Branch 

P.O Box 700190 

Kapolei, Hawaii  96709-0190 

HCBS Setting Final Rule Heightened Scrutiny Public Forum 06-04-2024

HCBS Setting Final Rule Heightened Scrutiny Public Forum Recording - 06-04-2024

Passcode: r5@9T3Y.

Questions or Comments?

Hawai`i welcomes all individuals receiving HCBS services, family members, advocates, providers, and the broader community to review the posted documents and submit comments at any time.

Email us at [email protected]