HCBS Settings Rule: Right to Live and Work in a Site that is Physically Accessible

Illinois Department of Human Services

Division of Developmental Disabilities

Information Bulletin



This Information Bulletin (IB) outlines the requirement that providers will ensure that all individuals receiving Home and Community Based Services (HCBS) waiver-funded services live and work in a site that is physically accessible to them. This includes individuals receiving services in individually controlled Community Integrated Living Arrangements (CILAs), provider owned/controlled CILAs, Child Group Homes (CGHs), Community Living Facilities (CLFs of 16 residents or fewer), and Community Day Services (CDS).


The Centers for Medicare and Medicaid Services (CMS) has specific rights that must be afforded individuals receiving services funded by the HCBS waiver, regardless of the setting type. Among those rights is the expectation that waiver participants are assured the right to live and work in a site that is physically accessible to them.

Details of the HCBS Settings Rule requirements may be reviewed at 42 CFR §441.301(c)(4)(i-v) and include:

 8) The setting is physically accessible to the individual.


Right to Live and Work in a Site that is Physically Accessible

Individuals have the right to live and work in a site that is physically accessible. The Federal Person-Centered Planning and Settings Rules dictate assessment and documentation of an individual's needs and preferences, with the expectation that settings options presented to the individual can accommodate those needs and preferences. There are no exceptions to this part of the Settings Rule and therefore, there should never be a modification in an individual's Personal Plan or Implementation Strategy regarding physical accessibility.

All providers must have a policy affirmatively stating that individuals will live and/or work in a site that is physically accessible to them, and staff must be trained on the policy and the underlying concept.


Neither Individual Service Coordination agencies (ISCs) nor service providers may refer or admit an individual who walks with assistance or uses a wheelchair to a waiver funded setting that is not licensed to accept individuals who walk with assistance or uses a wheelchair. That is a clear violation of the Federal Settings Rule and Rules 115, 119 and 120. If any such situation pre-exists this IB, steps must be taken to immediately remedy the situation. Several avenues are available to the ISC and provider: 1) The provider may take steps to make the current setting accessible, and then call in the Bureau of Accreditation, Licensure and Certification (BALC) to relicense the setting for individuals who walk with assistance or use a wheelchair; 2) The provider may identify another setting within its purview that has been licensed for individuals who walk with assistance or use a wheelchair to offer to the individual in need of an accessible setting; or 3) The ISC may work with the individual and/or their guardian as appropriate to identify a new setting that meets their ambulation needs. Under no circumstances can a current violation of this expectation of the Settings Rule be allowed to persist. If such a situation does exist, the provider must immediately document all efforts to remedy the violation to present to state or federal regulators upon request. These same steps apply in a situation where an individual who previously had no ambulation issues now walks with assistance or requires the use of a wheelchair.

The ISCs share the IDHS: Right of Individuals Form, IL462-1201.pdf (state.il.us) document when they initiate services and annually thereafter and require a signature from the person and/or guardian indicating they have read and understand their rights. Providers also should share the document and review it with individuals whom they support, as well as staff, at least annually. Guardians should also be provided a copy of the rights document. Providers are welcome to develop and share additional information with individuals as well.


If an individual, guardian or concerned person does not feel a person is receiving services compliant with the HCBS Settings Rule, they can report this to the provider or to the ISC. They can also go through the formal HCBS Settings complaint process by using the web form: IDHS: DHS DD Services Complaints (state.il.us), email: DHS.HCBScomplaints@illinois.gov or phone number: (877) 657-0005.

Effective Date:

This Information Bulletin is effective April 9, 2024