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The HCBS settings rule in an ALW home: the steps to remember

The short step lists from each lesson of The HCBS Settings Rule in an ALW home: rights, choice and modifications, on one page. Print it for the station or the break room. Each list points back to its lesson, where the sources are linked.

Open the coursePrint a poster with a QR code

Decision guide

Can the home put this limit on a resident in place?

Is the limit a house rule for all residents, rather than a limit for one person?

  • Yes

    Do not adopt it as a house rule. A setting condition may be modified only for one person, through that person's plan. Ask the CCA to review any one person's need.

  • No

    Would it physically restrain the person, shut them in alone, or use a drug to sedate or restrict them?

    • Yes

      Do not use it. The waiver prohibits restraints and seclusion in community care facilities. A drug used this way needs the treating physician's prescription and the ISP; ask the CCA and the physician.

    • No

      Is a specific, individual need written down, beyond a diagnosis or a single complaint?

      • Yes

        Have positive supports and less intrusive methods been tried and written down, and did they not work?

        • Yes

          Has the CCA written the limit into the ISP, and has the person given informed consent?

          • Yes

            Carry out the limit exactly as the ISP describes it, keep the data it asks for, and give it to the CCA at monthly visits.

          • No

            Do not apply it. Ask the CCA to complete the ISP. If the person will not consent and the home cannot serve them without it, the CCA helps them find another provider.

        • No

          Try them first and record what happened. The CCA can use the home's own records of these efforts.

      • No

        Do not limit the right yet. Document the specific need and share it with the CCA; a diagnosis alone is not enough.

This guide helps a home and a CCA check a proposed limit. It does not decide whether a modification is allowed: the ISP goes to DHCS, and DHCS direction and your licensing rules govern.

Step through it one question at a time: alwbeta.com/training/courses/hcbs-settings-rule#decision-guide

Lesson 1

What the settings rule asks of every ALW home

Every ALW home is a home and community-based setting under federal law. Before you admit, plan for or review a participant, you need the rule's basic qualities in mind. This lesson names them, so you can tell a home-like setting from one with the qualities of an institution.

  1. Full community access, to the same degree as people without HCBS
  2. The person picks the setting; the plan records the options
  3. Privacy, dignity, respect; no coercion or restraint
  4. Support choices; do not regiment the day
  5. Isolating or institution-linked settings are presumed institutional

Lesson: alwbeta.com/training/courses/hcbs-settings-rule#lesson-hcbs-what-the-rule-asks

Lesson 2

Daily life: schedule, food, visitors and freedom from coercion

Most settings problems show up in ordinary routines: a locked kitchen, a visiting cutoff, a lost privilege. This lesson prepares you to decide whether a house routine respects each person's rights, or limits a right that only the person-centered plan can limit.

  1. Each person controls their own schedule, with support
  2. Food at any time: there is a way to eat after meals
  3. Visitors of their choosing at any time; licensing hours are a floor
  4. No punishment, threats or retaliation for using a right
  5. No restraints or seclusion; a chemical restraint needs a prescription and the ISP
  6. Privacy in care, visits and calls

Lesson: alwbeta.com/training/courses/hcbs-settings-rule#lesson-hcbs-daily-life-rights

Lesson 3

The person's own unit and the written agreement

In a provider-owned or controlled home, the rule adds conditions about the person's own room and the agreement that lets them live there. This lesson prepares you to check a unit and an admission agreement against those conditions before a participant moves in, and again at each review.

  1. A door she can lock; keys only to appropriate staff
  2. A choice of roommate in a shared unit
  3. Furnish and decorate within the agreement
  4. A written agreement with eviction protections comparable to tenant law
  5. Evictions only on grounds state law lists; no waiver of rights
  6. Physical access to her own space cannot be modified

Lesson: alwbeta.com/training/courses/hcbs-settings-rule#lesson-hcbs-unit-and-agreement

Lesson 4

Modifying a right through the person-centered plan

Sometimes a home says it cannot serve a person safely unless one setting condition is limited. You decide whether a limit can be made at all, and what the person-centered plan must show first. This lesson sets out the steps, and who does each one.

  1. One person, one assessed need; a diagnosis alone is not enough
  2. Positive supports and less intrusive methods first, documented
  3. A limit proportionate to the need, with data and review dates
  4. Informed consent and a no-harm assurance
  5. Provider implements; CCA monitors monthly; update the Patient's Rights Form
  6. No consent and the home cannot serve: help find another provider

Lesson: alwbeta.com/training/courses/hcbs-settings-rule#lesson-hcbs-modifying-a-right

Lesson 5

How the state checks settings, and where concerns go

Compliance is not settled once a home enrolls. DHCS checks at enrollment and again on audits, and people can raise concerns at any time. This lesson prepares you to answer an audit finding, act on it, and tell a participant or family where a concern can go.

  1. New homes: desk review and on-site readiness review before enrolling
  2. Audits: site, staff and participant interviews, case files with modifications
  3. Noncompliance: enrollment restriction and a CAP until fixed
  4. Home will not comply: notice, transition plan, the participant chooses
  5. Concerns: compliance inbox, voicemail or letter; CCAs must report
  6. Grievances any time; no retaliation; ombudsman and CDSS contacts

Lesson: alwbeta.com/training/courses/hcbs-settings-rule#lesson-hcbs-state-monitoring

Beta’s ALW team, course version 2026.10.3, text checked against its sources on October 22, 2026. Educational only. Not continuing-education, licensure or regulatory credit. Follow your employer’s current procedure and the person’s current plan. Call 911 for a medical emergency.

Call the ALW teamFit check