The 2014 Medicaid HCBS Final Rule aims to improve outcomes for individuals with intellectual and developmental disabilities (IDD) and enhance their rights and choices. The rule coincided with a slower decline in settings of seven or more residents from 2014 to 2020 compared to 2007 to 2013. The reasons for this are unclear, but states should continue reducing large settings. CMS must hold states and providers accountable to the HCBS rule.
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