CMS: CCRCs Count as Community-Based Care Settings

In updating guidance from a final rule published in January, the Centers for Medicare & Medicaid Services rule that continuing care retirement communities (CCRCs) do count as community-based care settings.

Unlike more institutionalized settings such as nursing homes, CCRCs do not raise the same concerns regarding isolation, particularly since CCRCs “typically include residents who live independently in addition to those who receive HCBS,” writes a memorandum from CMS on the updated guidance.

In January, CMS issued its final rule on what types of community living fall under the agency’s Medicaid home- and community-based service programs for senior and those living with disabilities. 


CCRCs fit the requirement from CMS as their independent living units are considered to be home- and community-based, the agency said in response to comments on the rule. 

“Nursing facilities are statutorily prohibited from being considered home and community-based and is considered an institutional setting,” CMS said.

A CCRCs independent living and assisted living units would only be considered “institutional,” according to CMS’s definition, if they are either located in the same building as the nursing home or if they are located on the grounds of, or immediately adjacent to, a public institution.


One commenter on the final rule noted that utilizing the settings and services that CCRCs provide can often be “very expensive” and “well out of the reach” of people who are likely to need Medicaid assistance. 

To allow those who might not be able to afford CCRC services, CMS also noted that some “innovative providers” of subsidized housing have, in some cases, co-located assisted living settings on the same location or converting parts of their buildings to assisted living—blurring the lines for what CMS requires in its home- and community-based services rule. 

Preventing housing types such as these from being eligible to participate in Medicaid HCBS programs could have a “chilling effect” on developing innovation and could restrict such services only to those with substantial resources, CMS said. 

“It it not our intent to hinder innovative ideas for future development of HCBS,” the agency said. “Thus, we believe that developers and states should use this as a foundation as they look at developing plans to provide long-term care services and supports in their communities.”

View the final rule

Written by Jason Oliva