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Home & Community Based Services Health and Welfare

States are responsible for continuously and effectively assuring the health and welfare of participants in Home and Community Based Services (HCBS) programs. Under Section 1915(c) of the Social Security Act, HCBS waivers must provide assurances to the Centers for Medicare & Medicaid Services (CMS) that the state has necessary safeguards to protect the health and welfare of participants receiving services.

States must demonstrate they have an effective incident management system for assuring waiver participant health and welfare, and that they continually identify, address, and seek to prevent instances of abuse, neglect, exploitation, and unexplained death. CMS provides resources intended to assist states in addressing health and welfare concerns in their HCBS programs and design robust incident management systems that enable states to proactively respond to incidents and implement actions that reduce the risk of future incidents.