The Federal Settings Rule

What is it?

It is a Federal Medicaid Mandate that seeks to guarantee certain freedoms to all of those living with an intellectual disability and/or autism spectrum disorder.

It explains that people have the right to live in a setting that:

Is integrated in & supports full access to the community

Is chosen by the person from different options presented

Is physically accessible

Ensures the person’s rights of privacy, dignity, respect, and freedom from pressure and restraint

Maximizes freedom and independence in making life choices

Assists with choice regarding services and who provides them

Has a lease / other legal agreement that gives them these rights

Has locks on doors for privacy

Has the choice of roommates

Has the choice to decorate the living area as the person wants

Offers control over the person’s own schedule

Allows for the individual to have the food they choose and to have it at anytime

Allows for the individual to have visitors at any time

Is there an exception to the rule?

Sometimes it might be unsafe for a person to lock their door. The only time a lock may be deactivated is when it poses a risk to the person’s health or safety due to physical, medical and/or emotional needs.

Health and safety concerns must be evaluated through a Needs Assessment. The health and/or safety need rationale for an exception to the rule and must be documented in the ISA.

  • The Service Coordinator must document the reason for the exception, including a clear description of the condition and the associated risks. The Service Coordinator documents what attempts have been made to address this issue.

  • Service Coordinator includes evidence of the ongoing need for the exception to the ISA. They document steps to work to having a lock, as appropriate, and removing the exception. If removing the exception is not appropriate, document if the condition is long-term and is likely not to change over time.

  • Include established timelines for periodic reviews to determine ongoing need for the exception.

  • Service Coordinator documents the informed consent of the individual and guardian, if there is one, in a signed ISA.

  • Service Coordinator includes a description of the steps to be taken to reduce the risk of harm to the individual due to the exception.

The State will check if people are following this guidance by:

Periodic reviews. The Developmental Disabilities Services Division (DDSD) Quality Management Unit (QMU) reviews services at each agency. Using the Guidelines for the Quality Review Process for Developmental Disabilities Services, QMU staff look at Medicaid-funded services for a sample of individuals.

For individuals who live in settings that the Locks on Doors for Privacy Guidance applies, the QMU team will be confirming compliance.

The guidance around the Settings Rule has been provided from DAIL:

Criteria: Locks on Doors for Privacy

This is intended to support an individual’s personal privacy in their home; specifically in the bedroom and any bathroom they use in the home. Everyone has privacy in their sleeping or living unit: units have entrance doors lockable by the individual, with only appropriate staff having keys to doors. Any changes to this must be supported by a specific assessed need and justified in the person-centered service plan (the ISA).

Residential living arrangements in Vermont that are a provider-owned or a controlled residential setting and are funded through DDHCBS, must comply with this rule.

In Vermont, these settings include Staffed Living, Group Living, Shared Living (i.e., with a Shared Living Provider), and Supervised Living arrangements when the agency owns or leases the home setting, or contracts or hires Direct Support Workers for supports in the home.

Home settings that are not considered to be provider-owned or controlled, and are thus excluded from this rule, include situations when people live independently without paid home support or with an unpaid family member.

Please do the best you can to meet this requirement as soon as possible. If you are struggling to make this happen or have questions, please contact your Families First Service Coordinator or Joshua (joshua@familiesfirstvt.org). Families First is here to support you through these changes.

What kind of locks are acceptable?

Locks that disengage with the turn of the inside knob or push of an inside lever.

Locks whose door handles meet the physical needs of the individual (e.g., lever handle).

Key-coded entry system.

Electronic pin or card-based door entry systems that can be disengaged by a computer.

Spring lock / Pin hole locks

What kind of locks are NOT acceptable?

Security locks with deadbolts.

Locks requiring keys to exit a room.

Locks that can only be unlocked from inside the room.

Locks that can only be unlocked from outside the room.

Moving Forward:

Locks must be installed on bedroom & bathroom doors where there are currently none so that individuals have the option to close and lock their own bedroom door and the door to any bathroom they use.

This includes locking their door when they leave.

It is the choice of the individual when and how they use the lock. Individuals do not have the choice to decline having a lock on their door. They may instead choose not to lock their doors, but that is their choice and not that of Direct Support Workers.

Only authorized Direct Support Workers should have keys to these doors. The keys should be used to enter only under limited circumstances, including in an emergency, as agreed to by the individual and their legal guardian, if there is one, and documented in the Individual Support Agreement (ISA).

Direct Support Workers and other housemates must always knock first and obtain permission before entering an individual’s room or personal living space to respect the individual’s right to privacy.

The ability to exit the bedroom or bathroom without delay is required, regardless of the specific model of lock used on the door.

The ability of individuals and Direct Support Workers to use non-traditional keys (e.g., electronic pin, card-based) during power outages must be considered.

This rule does not apply to out-of-home respite.

Federal Settings Rule Continued:

Criteria: Residency Agreements

Create a Residency Agreement between a Home Provider and an individual residing with them or when an individual is living in a home owned or leased by a Designated Agency or Specialized Services Agency.

A copy of this completed Residency Agreement, including signatures of all required parties, must be maintained by the Home Provider, the Individual / Guardian, and the Authorized Agency.

This Agreement must be completed prior to move-in, be reviewed annually, and revised only as conditions of the living arrangement change.

When will Residency Agreements be completed?

Families First is planning to have these prepared to be signed by people in services, their guardians, and the home providers by the end of October 2023.

The Home Provider must provide the person in services with at least 30 days’ notice before directing them to move out. The Agency will help the person find a new place to live.

The Home Provider may direct that the person move out for the following reasons:

  • If the room and board is not paid, the Home Provider can request that they move out. All room and board must be paid for during the time they live with the Home Provider.

  • If they don’t follow the terms of this agreement, the Home Provider can request they move out.

  • If they commit any crimes or participate in illegal drug activity, the Home Provider can request that they move out.

  • If their actions are violent and threaten the health and safety of other residents, the Home Provider can request they move out.

The Home Provider’s notice must include the exact date that the person must move out by. For example, if the notice was given on March 1, the move out date is March 31st.

The person in services has the right to defend against the Home Provider directing them to move out. They also have the right not to pay for room and board if the living conditions do not meet a certain standard. You may need the help of a lawyer to understand what your rights are.

The Home Provider may seek help from the court system to make the person in their home pay for any damage to their home. The Home Provider may also ask for help from the Agency, law enforcement, or the court system to have the person in services removed from the residence if they are required to move out and refuse.

If the Agency ends their contract with the Home Provider, the Agency or the Home Provider will notify everyone. The Agency or Home Provider will give everyone the date by which the person must move out. It may be less than 30 days, depending on the circumstances. If this happens, the person does not have the same rights to defend against having to move out. “Defend” means to explain, in legal terms, why you think you should not have to move out. The Agency will help find them a new place to live.

If the Agency ends their contract with the Home Provider, the person should not stay in the Home Provider’s house after the move-out date. Unless there is Home Provider consent and the Agency’s approval.