HCBS Waiver Coverage Requirements

(A) Limitations on Covered Services. The MassHealth agency pays for HCBS waiver services provided to a participant who resides in a home- or community-based setting, which may include, without limitation, a temporary residence. With the exception of respite services, as described in 130 CMR 630.427, and transitional assistance, as described in 130 CMR 630.435, the MassHealth agency does not pay for HCBS waiver services provided to a participant who is a resident or inpatient of a hospital, nursing facility, Intermediate Care Facility for Individuals with Intellectual Disability (ICF/IID), or any other medical facility subject to state licensure or certification. (B) Least Costly Form of Care. The MassHealth agency pays for HCBS waiver services only when services are the least costly form of comparable care available in the community.