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TMSIS Dataguide Medicaid.gov

Version:

3.38.0

CMS Technical Instructions

CMS Technical Instructions: Reporting Home and Community Based Services (HCBS) Services in T-MSIS to Align with ARP 2021 Values

Technical Instruction History

Date Description of Change
1/27/2025 Original technical instructions issued.

Brief Issue Description

This technical instruction document specifies requirements for reporting HCBS services in alignment with Section 9817 of the American Rescue Plan Act of 2021.

Background Discussion

Context

On March 11, 2021, President Biden signed the American Rescue Plan Act of 2021 (ARP) (Pub. L. 117-2). Section 9817 of the ARP provides qualifying states with a temporary 10 percentage point increase to the federal medical assistance percentage (FMAP) for certain Medicaid expenditures for HCBS beginning April 1, 2021, and ending March 31, 2025. CMS expects states to expend the funds by the March 31, 2025 deadline. This increased funding allows states the opportunity to identify and implement changes aimed at addressing existing HCBS workforce and structural issues, expand the capacity of critical services, and begin to meet the needs of people on HCBS waitlists and family caregivers.[1]

CMS recognizes the significant value of these additional funds and is committed to working with state partners to realize these improvements in the HCBS system. [2] To this end, participating states must submit HCBS spending narratives semi-annually and spending plans quarterly to CMS as outlined in the State Medicaid Director Letter SMD #22-002 issued on June 3, 2022. CMS publicly posts these plans and narratives.

To track the utilization of HCBS services as outlined in states’ publicly posted plans and narratives in a consistent way across states and over time, CMS recommends that states use definitions of HCBS as defined in ARP 2021. This standardization will enable meaningful tracking of HCBS use across states and over-time.

CMS T-MSIS Technical Instructions

The following technical instructions outline CMS expectations for reporting HCBS in T-MSIS claims files to align with ARP 2021 categories.

Please refer to the American Rescue Plan Act of 2021 (ARP) (Pub. L. 117-2) for categories of services considered to be HCBS and authorities defining each category.[3]

Three data elements may be used to capture HCBS services as covered in ARP 2021: 1) TYPE-OF-SERVICE (CIP257, CLT211, COT186, CRX134), 2) HCBS-SERVICE-CODE (COT187, CRX135[4] and PROGRAM-TYPE (CIP129, CLT079, COT065, CRX055). States should report HCBS-SERVICE-CODE values that correspond with the authority that grants the service (for example, if the service was authorized and provided under 1915(j) - the HCBS-SERVICE-CODE would be Valid Value of "2".

Tables 1-5 below outline the mapping of the three data elements to relevant ARP categories, ensuring states are able to reflect ARP 2021 categories of service in T-MSIS.

Table 1. Combinations of TYPE-OF-SERVICE, HCBS-SERVICE-CODE & PROGRAM-TYPE that align with ARP 2021 Category (i) Home Health Services

ARP 2021 Category TYPE-OF-SERVICE
(Value: Definition) 		HCBS-SERVICE-CODE
(Value: Definition) 		PROGRAM-TYPE
(Value: Definition) a - see below
(i) Home health care services 016: Home health services - Nursing services 6 OR 7: The HCBS service was not provided under the statutes identified by other valid values and was of an acute care nature OR of a long-term nature Any Valid Value not including 7, 11, 13, 14, or 16
(i) Home health care services 017: Home health services - Home health aide services 6 OR 7: The HCBS service was not provided under the statutes identified by other valid values and was of an acute care nature OR of a long-term nature Any Valid Value not including 7, 11, 13, 14, or 16
(i) Home health care services 018: Home health services - Medical supplies, equipment, and appliances suitable for use in the home 6 OR 7: The HCBS service was not provided under the statutes identified by other valid values and was of an acute care nature OR of a long-term nature Any Valid Value not including 7, 11, 13, 14, or 16
(i) Home health care services 019: Home health services - Physical therapy provided by a home health agency or by a facility licensed by the State to provide medical rehabilitation services 6 OR 7: The HCBS service was not provided under the statutes identified by other valid values and was of an acute care nature OR of a long-term nature Any Valid Value not including 7, 11, 13, 14, or 16
(i) Home health care services 020: Home health services - Occupational therapy provided by a home health agency or by a facility licensed by the State to provide medical rehabilitation services 6 OR 7: The HCBS service was not provided under the statutes identified by other valid values and was of an acute care nature OR of a long-term nature Any Valid Value not including 7, 11, 13, 14, or 16
(i) Home health care services 021: Home health services - Speech pathology and audiology services provided by a home health agency or by a facility licensed by the State to provide medical rehabilitation services 6 OR 7: The HCBS service was not provided under the statutes identified by other valid values and was of an acute care nature OR of a long-term nature Any Valid Value not including 7, 11, 13, 14, or 16

Table 2. Combinations of TYPE-OF-SERVICE, HCBS-SERVICE-CODE & PROGRAM-TYPE that align with ARP 2021 Category (ii) Personal Care Services

ARP 2021 Category TYPE-OF-SERVICE (Value: Definition) HCBS-SERVICE-CODE (Value: Definition) PROGRAM-TYPE (Value: Definition) a - see below
(ii) Personal Care Services 051: Personal Care Services 6 OR 7: The HCBS service was not provided under the statutes identified by other valid values and was of an acute care nature OR of a long-term nature Any Valid Value not including 7, 11, 13, 14, or 16

Table 3. Combinations of TYPE-OF-SERVICE, HCBS-SERVICE-CODE & PROGRAM-TYPE that align with ARP 2021 Category (v) Case Management Services

ARP 2021 Category TYPE-OF-SERVICE (Value: Definition) HCBS-SERVICE-CODE (Value: Definition) PROGRAM-TYPE (Value: Definition) a - see below
(v) Case Management Services 053: Targeted case management services 6 OR 7: The HCBS service was not provided under the statutes identified by other valid values and was of an acute care nature OR of a long-term nature Any Valid Value not including 7, 11, 13, 14, or 16
(v) Case Management Services 054: Case Management services other than those that meet the definition of primary care case management services or targeted case management services 6 OR 7: The HCBS service was not provided under the statutes identified by other valid values and was of an acute care nature OR of a long-term nature Any Valid Value not including 7, 11, 13, 14, or 16

Table 4. Combinations of TYPE-OF-SERVICE, HCBS-SERVICE-CODE & PROGRAM-TYPE that align with ARP 2021 Categories (vi) and (vii), Rehabilitative Services and Other Services

ARP 2021 Category TYPE-OF-SERVICE (Value: Definition) HCBS-SERVICE-CODE (Value: Definition) PROGRAM-TYPE (Value: Definition) a - see below
(vi) Rehabilitative Services 043: Rehabilitative services 6 OR 7: The HCBS service was not provided under the statutes identified by other valid values and was of an acute care nature OR of a long-term nature Any Valid Value not including 7, 11, 13, 14, or 16
(vii) Other services specified by the secretary of Health and Human Services 088: Any other health care services or items specified by the Secretary and not excluded under regulations. Any Valid Value not including 7, 11, 13, 14, or 16

Table 5. Combinations of TYPE-OF-SERVICE, HCBS-SERVICE-CODE & PROGRAM-TYPE that align with ARP 2021 Category (iv) Home and Community-Based Services

ARP 2021 Category TYPE-OF-SERVICE (Value: Definition) HCBS-SERVICE-CODE (Value: Definition) PROGRAM-TYPE
(Value: Definition) a - see below
(iv) Home and community-based services 043: Rehabilitative services 5: The HCBS service was provided under an 1115 waiver Any Valid Value not including 7, 11, 13, 14, or 16
(iv) Home and community-based services 053: Targeted case management services 5: The HCBS service was provided under an 1115 waiver Any Valid Value not including 7, 11, 13, 14, or 16
(iv) Home and community-based services   [RR1] [RR2] 062: HCBS - Case management services 1: The HCBS service was provided under 1915(i) 13: Home and Community Based Services (HCBS) State Plan Option (1915(i))
(iv) Home and community-based services 062: HCBS - Case management services 2: The HCBS service was provided under 1915(j) 16: 1915(j) (Self- directed personal assistance services/personal care under State Plan or 1915(c) waiver)
(iv) Home and community-based services 062: HCBS - Case management services 3: The HCBS service was provided under 1915(k) 11: Community First Choice (1915(k))
(iv) Home and community-based services 062: HCBS - Case management services 4: The HCBS service was provided under 1915(c) 07: Home and Community Based Care Waiver Services
(iv) Home and community-based services 062: HCBS - Case management services 5: The HCBS service was provided under an 1115 waiver. 00: No Special Program
(iv) Home and community-based services 063: HCBS - Homemaker services 1: The HCBS service was provided under 1915(i) 13: Home and Community Based Services (HCBS) State Plan Option (1915(i))
(iv) Home and community-based services 063: HCBS - Homemaker services 2: The HCBS service was provided under 1915(j) 16: 1915(j) (Self- directed personal assistance services/personal care under State Plan or 1915(c) waiver)
(iv) Home and community-based services 063: HCBS - Homemaker services 3: The HCBS service was provided under 1915(k) 11: Community First Choice (1915(k))
(iv) Home and community-based services 063: HCBS - Homemaker services 4: The HCBS service was provided under 1915(c) 07: Home and Community Based Care Waiver Services
(iv) Home and community-based services 063: HCBS - Homemaker services 5: The HCBS service was provided under an 1115 waiver. 00: No Special Program
(iv) Home and community-based services 064: HCBS - Home health aide services 1: The HCBS service was provided under 1915(i) 13: Home and Community Based Services (HCBS) State Plan Option (1915(i))
(iv) Home and community-based services 064: HCBS - Home health aide services 2: The HCBS service was provided under 1915(j) 16: 1915(j) (Self- directed personal assistance services/personal care under State Plan or 1915(c) waiver)
(iv) Home and community-based services 064: HCBS - Home health aide services 3: The HCBS service was provided under 1915(k) 11: Community First Choice (1915(k))
(iv) Home and community-based services 064: HCBS - Home health aide services 4: The HCBS service was provided under 1915(c) 07: Home and Community Based Care Waiver Services
(iv) Home and community-based services 064: HCBS - Home health aide services 5: The HCBS service was provided under an 1115 waiver. 00: No Special Program
(iv) Home and community-based services 065: HCBS - Personal care services 1: The HCBS service was provided under 1915(i) 13: Home and Community Based Services (HCBS) State Plan Option (1915(i))
(iv) Home and community-based services 065: HCBS - Personal care services 2: The HCBS service was provided under 1915(j) 16: 1915(j) (Self- directed personal assistance services/personal care under State Plan or 1915(c) waiver)
(iv) Home and community-based services 065: HCBS - Personal care services 3: The HCBS service was provided under 1915(k) 11: Community First Choice (1915(k))
(iv) Home and community-based services 065: HCBS - Personal care services 4: The HCBS service was provided under 1915(c) 07: Home and Community Based Care Waiver Services
(iv) Home and community-based services 065: HCBS - Personal care services 5: The HCBS service was provided under an 1115 waiver. 00: No Special Program
(iv) Home and community-based services 066: HCBS - Adult day health services 1: The HCBS service was provided under 1915(i) 13: Home and Community Based Services (HCBS) State Plan Option (1915(i))
(iv) Home and community-based services 066: HCBS - Adult day health services 2: The HCBS service was provided under 1915(j) 16: 1915(j) (Self- directed personal assistance services/personal care under State Plan or 1915(c) waiver)
(iv) Home and community-based services 066: HCBS - Adult day health services 3: The HCBS service was provided under 1915(k) 11: Community First Choice (1915(k))
(iv) Home and community-based services 066: HCBS - Adult day health services 4: The HCBS service was provided under 1915(c) 07: Home and Community Based Care Waiver Services
(iv) Home and community-based services 066: HCBS - Adult day health services 5: The HCBS service was provided under an 1115 waiver. 00: No Special Program
(iv) Home and community-based services 067: HCBS - Habilitation services 1: The HCBS service was provided under 1915(i) 13: Home and Community Based Services (HCBS) State Plan Option (1915(i))
(iv) Home and community-based services 067: HCBS - Habilitation services 2: The HCBS service was provided under 1915(j) 16: 1915(j) (Self- directed personal assistance services/personal care under State Plan or 1915(c) waiver)
(iv) Home and community-based services 067: HCBS - Habilitation services 3: The HCBS service was provided under 1915(k) 11: Community First Choice (1915(k))
(iv) Home and community-based services 067: HCBS - Habilitation services 4: The HCBS service was provided under 1915(c) 07: Home and Community Based Care Waiver Services
(iv) Home and community-based services 067: HCBS - Habilitation services 5: The HCBS service was provided under an 1115 waiver. 00: No Special Program
(iv) Home and community-based services 068: HCBS - Respite care services 1: The HCBS service was provided under 1915(i) 13: Home and Community Based Services (HCBS) State Plan Option (1915(i))
(iv) Home and community-based services 068: HCBS - Respite care services 2: The HCBS service was provided under 1915(j) 16: 1915(j) (Self- directed personal assistance services/personal care under State Plan or 1915(c) waiver)
(iv) Home and community-based services 068: HCBS - Respite care services 3: The HCBS service was provided under 1915(k) 11: Community First Choice (1915(k))
(iv) Home and community-based services 068: HCBS - Respite care services 4: The HCBS service was provided under 1915(c) 07: Home and Community Based Care Waiver Services
(iv) Home and community-based services 068: HCBS - Respite care services 5: The HCBS service was provided under an 1115 waiver. 00: No Special Program
(iv) Home and community-based services 069: HCBS - Day treatment or other partial hospitalization services, psychosocial rehabilitation services and clinic services (whether or not furnished in a facility) for individuals with chronic mental illness 1: The HCBS service was provided under 1915(i) 13: Home and Community Based Services (HCBS) State Plan Option (1915(i))
(iv) Home and community-based services 069: HCBS - Day treatment or other partial hospitalization services, psychosocial rehabilitation services and clinic services (whether or not furnished in a facility) for individuals with chronic mental illness 2: The HCBS service was provided under 1915(j) 16: 1915(j) (Self- directed personal assistance services/personal care under State Plan or 1915(c) waiver)
(iv) Home and community-based services 069: HCBS - Day treatment or other partial hospitalization services, psychosocial rehabilitation services and clinic services (whether or not furnished in a facility) for individuals with chronic mental illness 3: The HCBS service was provided under 1915(k) 11: Community First Choice (1915(k))
(iv) Home and community-based services 069: HCBS - Day treatment or other partial hospitalization services, psychosocial rehabilitation services and clinic services (whether or not furnished in a facility) for individuals with chronic mental illness 4: The HCBS service was provided under 1915(c) 07: Home and Community Based Care Waiver Services
(iv) Home and community-based services 069: HCBS - Day treatment or other partial hospitalization services, psychosocial rehabilitation services and clinic services (whether or not furnished in a facility) for individuals with chronic mental illness 5: The HCBS service was provided under an 1115 waiver. 00: No Special Program
(iv) Home and community-based services 070: HCBS - Day Care 1: The HCBS service was provided under 1915(i) 13: Home and Community Based Services (HCBS) State Plan Option (1915(i))
(iv) Home and community-based services 070: HCBS - Day Care 2: The HCBS service was provided under 1915(j) 16: 1915(j) (Self- directed personal assistance services/personal care under State Plan or 1915(c) waiver)
(iv) Home and community-based services 070: HCBS - Day Care 3: The HCBS service was provided under 1915(k) 11: Community First Choice (1915(k))
(iv) Home and community-based services 070: HCBS - Day Care 4: The HCBS service was provided under 1915(c) 07: Home and Community Based Care Waiver Services
(iv) Home and community-based services 070: HCBS - Day Care 5: The HCBS service was provided under an 1115 waiver. 00: No Special Program
(iv) Home and community-based services 071: HCBS - Training for family members 1: The HCBS service was provided under 1915(i) 13: Home and Community Based Services (HCBS) State Plan Option (1915(i))
(iv) Home and community-based services 071: HCBS - Training for family members 2: The HCBS service was provided under 1915(j) 16: 1915(j) (Self- directed personal assistance services/personal care under State Plan or 1915(c) waiver)
(iv) Home and community-based services 071: HCBS - Training for family members 3: The HCBS service was provided under 1915(k) 11: Community First Choice (1915(k))
(iv) Home and community-based services 071: HCBS - Training for family members 4: The HCBS service was provided under 1915(c) 07: Home and Community Based Care Waiver Services
(iv) Home and community-based services 071: HCBS - Training for family members 5: The HCBS service was provided under an 1115 waiver. 00: No Special Program
(iv) Home and community-based services 072: HCBS - Minor modification to the home 1: The HCBS service was provided under 1915(i) 13: Home and Community Based Services (HCBS) State Plan Option (1915(i))
(iv) Home and community-based services 072: HCBS - Minor modification to the home 2: The HCBS service was provided under 1915(j) 16: 1915(j) (Self- directed personal assistance services/personal care under State Plan or 1915(c) waiver)
(iv) Home and community-based services 072: HCBS - Minor modification to the home 3: The HCBS service was provided under 1915(k) 11: Community First Choice (1915(k))
(iv) Home and community-based services 072: HCBS - Minor modification to the home 4: The HCBS service was provided under 1915(c) 07: Home and Community Based Care Waiver Services
(iv) Home and community-based services 072: HCBS - Minor modification to the home 5: The HCBS service was provided under an 1115 waiver. 00: No Special Program
(iv) Home and community-based services 073: HCBS - Other services requested by the agency and approved by CMS as cost effective and necessary to avoid institutionalization 1: The HCBS service was provided under 1915(i) 13: Home and Community Based Services (HCBS) State Plan Option (1915(i))
(iv) Home and community-based services 073: HCBS - Other services requested by the agency and approved by CMS as cost effective and necessary to avoid institutionalization 2: The HCBS service was provided under 1915(j) 16: 1915(j) (Self- directed personal assistance services/personal care under State Plan or 1915(c) waiver)
(iv) Home and community-based services 073: HCBS - Other services requested by the agency and approved by CMS as cost effective and necessary to avoid institutionalization 3: The HCBS service was provided under 1915(k) 11: Community First Choice (1915(k))
(iv) Home and community-based services 073: HCBS - Other services requested by the agency and approved by CMS as cost effective and necessary to avoid institutionalization 4: The HCBS service was provided under 1915(c) 07: Home and Community Based Care Waiver Services
(iv) Home and community-based services 073: HCBS - Other services requested by the agency and approved by CMS as cost effective and necessary to avoid institutionalization 5: The HCBS service was provided under an 1115 waiver. 00: No Special Program
(iv) Home and community-based services 074: HCBS - Expanded habilitation services - Prevocational services 1: The HCBS service was provided under 1915(i) 13: Home and Community Based Services (HCBS) State Plan Option (1915(i))
(iv) Home and community-based services 074: HCBS - Expanded habilitation services - Prevocational services 2: The HCBS service was provided under 1915(j) 16: 1915(j) (Self- directed personal assistance services/personal care under State Plan or 1915(c) waiver)
(iv) Home and community-based services 074: HCBS - Expanded habilitation services - Prevocational services 3: The HCBS service was provided under 1915(k) 11: Community First Choice (1915(k))
(iv) Home and community-based services 074: HCBS - Expanded habilitation services - Prevocational services 4: The HCBS service was provided under 1915(c) 07: Home and Community Based Care Waiver Services
(iv) Home and community-based services 074: HCBS - Expanded habilitation services - Prevocational services 5: The HCBS service was provided under an 1115 waiver. 00: No Special Program
(iv) Home and community-based services 075: HCBS - Expanded habilitation services - Educational services 1: The HCBS service was provided under 1915(i) 13: Home and Community Based Services (HCBS) State Plan Option (1915(i))
(iv) Home and community-based services 075: HCBS - Expanded habilitation services - Educational services 2: The HCBS service was provided under 1915(j) 16: 1915(j) (Self- directed personal assistance services/personal care under State Plan or 1915(c) waiver)
(iv) Home and community-based services 075: HCBS - Expanded habilitation services - Educational services 3: The HCBS service was provided under 1915(k) 11: Community First Choice (1915(k))
(iv) Home and community-based services 075: HCBS - Expanded habilitation services - Educational services 4: The HCBS service was provided under 1915(c) 07: Home and Community Based Care Waiver Services
(iv) Home and community-based services 075: HCBS - Expanded habilitation services - Educational services 5: The HCBS service was provided under an 1115 waiver. 00: No Special Program
(iv) Home and community-based services 076: HCBS - Expanded habilitation services - Supported employment services, which facilitate paid employment 1: The HCBS service was provided under 1915(i) 13: Home and Community Based Services (HCBS) State Plan Option (1915(i))
(iv) Home and community-based services 076: HCBS - Expanded habilitation services - Supported employment services, which facilitate paid employment 2: The HCBS service was provided under 1915(j) 16: 1915(j) (Self- directed personal assistance services/personal care under State Plan or 1915(c) waiver)
(iv) Home and community-based services 076: HCBS - Expanded habilitation services - Supported employment services, which facilitate paid employment 3: The HCBS service was provided under 1915(k) 11: Community First Choice (1915(k))
(iv) Home and community-based services 076: HCBS - Expanded habilitation services - Supported employment services, which facilitate paid employment 4: The HCBS service was provided under 1915(c) 07: Home and Community Based Care Waiver Services
(iv) Home and community-based services 076: HCBS - Expanded habilitation services - Supported employment services, which facilitate paid employment 5: The HCBS service was provided under an 1115 waiver. 00: No Special Program
(iv) Home and community-based services 077: HCBS-65-plus - Case management services 1: The HCBS service was provided under 1915(i) 13: Home and Community Based Services (HCBS) State Plan Option (1915(i))
(iv) Home and community-based services 077: HCBS-65-plus - Case management services 2: The HCBS service was provided under 1915(j) 16: 1915(j) (Self- directed personal assistance services/personal care under State Plan or 1915(c) waiver)
(iv) Home and community-based services 077: HCBS-65-plus - Case management services 3: The HCBS service was provided under 1915(k) 11: Community First Choice (1915(k))
(iv) Home and community-based services 077: HCBS-65-plus - Case management services 4: The HCBS service was provided under 1915(c) 07: Home and Community Based Care Waiver Services
(iv) Home and community-based services 077: HCBS-65-plus - Case management services 5: The HCBS service was provided under an 1115 waiver. 00: No Special Program
(iv) Home and community-based services 078: HCBS-65-plus - Homemaker services 1: The HCBS service was provided under 1915(i) 13: Home and Community Based Services (HCBS) State Plan Option (1915(i))
(iv) Home and community-based services 078: HCBS-65-plus - Homemaker services 2: The HCBS service was provided under 1915(j) 16: 1915(j) (Self- directed personal assistance services/personal care under State Plan or 1915(c) waiver)
(iv) Home and community-based services 078: HCBS-65-plus - Homemaker services 3: The HCBS service was provided under 1915(k) 11: Community First Choice (1915(k))
(iv) Home and community-based services 078: HCBS-65-plus - Homemaker services 4: The HCBS service was provided under 1915(c) 07: Home and Community Based Care Waiver Services
(iv) Home and community-based services 078: HCBS-65-plus - Homemaker services 5: The HCBS service was provided under an 1115 waiver. 00: No Special Program
(iv) Home and community-based services 079: HCBS-65-plus - Home health aide services 1: The HCBS service was provided under 1915(i) 13: Home and Community Based Services (HCBS) State Plan Option (1915(i))
(iv) Home and community-based services 079: HCBS-65-plus - Home health aide services 2: The HCBS service was provided under 1915(j) 16: 1915(j) (Self- directed personal assistance services/personal care under State Plan or 1915(c) waiver)
(iv) Home and community-based services 079: HCBS-65-plus - Home health aide services 3: The HCBS service was provided under 1915(k) 11: Community First Choice (1915(k))
(iv) Home and community-based services 079: HCBS-65-plus - Home health aide services 4: The HCBS service was provided under 1915(c) 07: Home and Community Based Care Waiver Services
(iv) Home and community-based services 079: HCBS-65-plus - Home health aide services 5: The HCBS service was provided under an 1115 waiver. 00: No Special Program
(iv) Home and community-based services 080: HCBS-65-plus - Personal care services 1: The HCBS service was provided under 1915(i) 13: Home and Community Based Services (HCBS) State Plan Option (1915(i))
(iv) Home and community-based services 080: HCBS-65-plus - Personal care services 2: The HCBS service was provided under 1915(j) 16: 1915(j) (Self- directed personal assistance services/personal care under State Plan or 1915(c) waiver)
(iv) Home and community-based services 080: HCBS-65-plus - Personal care services 3: The HCBS service was provided under 1915(k) 11: Community First Choice (1915(k))
(iv) Home and community-based services 080: HCBS-65-plus - Personal care services 4: The HCBS service was provided under 1915(c) 07: Home and Community Based Care Waiver Services
(iv) Home and community-based services 080: HCBS-65-plus - Personal care services 5: The HCBS service was provided under an 1115 waiver. 00: No Special Program
(iv) Home and community-based services 0081: HCBS-65-plus - Adult day health services 1: The HCBS service was provided under 1915(i) 13: Home and Community Based Services (HCBS) State Plan Option (1915(i))
(iv) Home and community-based services 0081: HCBS-65-plus - Adult day health services 2: The HCBS service was provided under 1915(j) 16: 1915(j) (Self- directed personal assistance services/personal care under State Plan or 1915(c) waiver)
(iv) Home and community-based services 0081: HCBS-65-plus - Adult day health services 3: The HCBS service was provided under 1915(k) 11: Community First Choice (1915(k))
(iv) Home and community-based services 0081: HCBS-65-plus - Adult day health services 4: The HCBS service was provided under 1915(c) 07: Home and Community Based Care Waiver Services
(iv) Home and community-based services 0081: HCBS-65-plus - Adult day health services 5: The HCBS service was provided under an 1115 waiver. 00: No Special Program
(iv) Home and community-based services 082: HCBS-65-plus - Respite care services 1: The HCBS service was provided under 1915(i) 13: Home and Community Based Services (HCBS) State Plan Option (1915(i))
(iv) Home and community-based services 082: HCBS-65-plus - Respite care services 2: The HCBS service was provided under 1915(j) 16: 1915(j) (Self- directed personal assistance services/personal care under State Plan or 1915(c) waiver)
(iv) Home and community-based services 082: HCBS-65-plus - Respite care services 3: The HCBS service was provided under 1915(k) 11: Community First Choice (1915(k))
(iv) Home and community-based services 082: HCBS-65-plus - Respite care services 4: The HCBS service was provided under 1915(c) 07: Home and Community Based Care Waiver Services
(iv) Home and community-based services 082: HCBS-65-plus - Respite care services 5: The HCBS service was provided under an 1115 waiver. 00: No Special Program
(iv) Home and community-based services 083: HCBS-65-plus - Other medical and social services 1: The HCBS service was provided under 1915(i) 13: Home and Community Based Services (HCBS) State Plan Option (1915(i))
(iv) Home and community-based services 083: HCBS-65-plus - Other medical and social services 2: The HCBS service was provided under 1915(j) 16: 1915(j) (Self- directed personal assistance services/personal care under State Plan or 1915(c) waiver)
(iv) Home and community-based services 083: HCBS-65-plus - Other medical and social services 3: The HCBS service was provided under 1915(k) 11: Community First Choice (1915(k))
(iv) Home and community-based services 083: HCBS-65-plus - Other medical and social services 4: The HCBS service was provided under 1915(c) 07: Home and Community Based Care Waiver Services
(iv) Home and community-based services 083: HCBS-65-plus - Other medical and social services 5: The HCBS service was provided under an 1115 waiver. 00: No Special Program
(iv) Home and community-based services 088: Any other health care services or items specified by the Secretary and not excluded under regulations. 5: The HCBS service was provided under an 1115 waiver Any Valid Value not including 7, 11, 13, 14, or 16
(iv) Home and community-based services 115: Residential care 5, 6 OR 7: The HCBS service was provided under an 1115 waiver, or the HCBS service was not provided under the statutes identified by other valid values and was of an acute care nature or of a long-term nature Any Valid Value not including 7, 11, 13, 14, or 16
(iv) Home and community-based services 144: Payments to individuals for personal assistance services under 1915(j) 2: The HCBS service was provided under 1915(j) 16: 1915(j) (Self- directed personal assistance services/personal care under State Plan or 1915(c) waiver)

a) For ARP Category iv, each applicable HCBS-SERVICE-CODE values has a corresponding PROGRAM-TYPE value. For other ARP Categories, each applicable HCBS-SERVICE-CODE value does not directly correspond to a PROGRAM-TYPE value.

[1] Source: https://www.medicaid.gov/medicaid/home-community-based-services/guidance/strengthening-and-investing-home-and-community-based-services-for-medicaid-beneficiaries-american-rescue-plan-act-of-2021-section-9817/index.html

[2] Source: https://www.medicaid.gov/medicaid/home-community-based-services/guidance/strengthening-and-investing-home-and-community-based-services-for-medicaid-beneficiaries-american-rescue-plan-act-of-2021-section-9817/index.html

[3] Source: Text - H.R.1319 - 117th Congress (2021-2022): American Rescue Plan Act of 2021 | Congress.gov | Library of Congress

[4] HCBS-SERVICE-CODE is expected to be reported on the OT (and less commonly, the RX file). HCBS Services are not reported on the IP or LT claims file types.