CMS Approves Waiver Amendment for Medicaid HCBS H&W and TBI Waivers (BT202614)

What this rule requires your agency to do

• 1Attendant Care reimbursed to a paid relative and/or paid legal guardian caregiver must not exceed 40 hours per week per such caregiver; paid family caregivers do not include the spouse, parent of a minor, or legal guardian of a minor.(CMS Approves Waiver Amendment for Medicaid HCBS H&W and TBI Waivers (BT202614))
• 2Paid caregivers providing Attendant Care must document each hour of their shift, including in/out times, specific services provided, participant signature verifying service, and employee signature (minimally last name and first initial), all aligned with the participant's PCISP.(CMS Approves Waiver Amendment for Medicaid HCBS H&W and TBI Waivers (BT202614))
• 3Attendant Care will not be reimbursed when provided by an LRI if the participant is self-directing that service.(CMS Approves Waiver Amendment for Medicaid HCBS H&W and TBI Waivers (BT202614))
• 4Benefits Counseling may not be provided by the parent of a minor child participant, the spouse (LRI), a relative, or legal guardian, and must be included on the PCISP.(CMS Approves Waiver Amendment for Medicaid HCBS H&W and TBI Waivers (BT202614))
• 5A home modification assessment must not be performed by the same provider that performs the subsequent home modification.(CMS Approves Waiver Amendment for Medicaid HCBS H&W and TBI Waivers (BT202614))
• 6Personal services agency licensure is still required for Attendant Care and Home and Community Assistance unless the person is self-directing those services (the home health agency license requirement was removed effective Jan. 1, 2026).(CMS Approves Waiver Amendment for Medicaid HCBS H&W and TBI Waivers (BT202614))
• 7Attendant Care reimbursed when provided by legally responsible individuals under the extraordinary care allowance must not exceed an aggregate of 40 hours per week across all extraordinary care caregivers.(CMS Approves Waiver Amendment for Medicaid HCBS H&W and TBI Waivers (BT202614))