HCBS at bttr.
Your choices. Your rights. Your life.
Every bttr service is designed to respect the voice, preferences, dignity, privacy, and independence of the person receiving support.
What does HCBS mean?
HCBS stands for Home and Community Based Services. These are long term services and supports provided in a person’s home or community instead of an institutional setting.
The federal HCBS Settings Rule helps ensure that people receiving Medicaid funded services can make meaningful choices, participate in community life, build relationships, pursue employment or education, and live with the same dignity and freedom as anyone else. Medicaid is known as Medi Cal in California.
Services happen with the person, not to the person.
Rights protected by HCBS
The HCBS Settings Rule protects a set of everyday rights for every person receiving services.
Choice and control
The person participates in decisions about their goals, schedule, activities, services, and support.
Community access
The person can participate in community life and access places, activities, relationships, education, and employment available to other community members.
Privacy, dignity, and respect
Personal information, belongings, relationships, identity, culture, communication, and private space must be respected.
Independence and autonomy
Support should strengthen the person’s ability to make decisions and complete tasks without staff unnecessarily taking control.
Freedom from coercion and unnecessary restrictions
Services must not use threats, punishment, intimidation, or unnecessary restrictions. Any necessary modification must address a specific assessed need, follow the person centered plan, and use the least restrictive approach.
Choice of services and providers
The person should receive understandable information and meaningful options about available services and who provides them.
Control of personal resources
The person maintains control of personal money and belongings unless a properly documented plan identifies a specific need for support.
Person centered planning
Goals and services must reflect the person’s strengths, needs, preferences, communication, culture, and desired outcomes.
How bttr puts these principles into practice
The person’s voice comes first.
Staff begin sessions by confirming what the person wants to work on and how they would like to participate.
Real options are offered.
Staff explain meaningful choices instead of presenting one predetermined activity.
Support does not replace the person.
Coaches teach, model, prompt, and support. They do not take over tasks the person can complete independently or with appropriate assistance.
Informed choice includes dignity of risk.
Staff explain possible benefits and risks in understandable language while respecting the person’s right to make reasonable decisions.
The least restrictive support is used.
Support must protect health and safety without unnecessarily limiting independence, privacy, movement, communication, or community participation.
Identity and communication are respected.
Services consider the person’s language, culture, disability, gender identity, relationships, communication style, and personal preferences.
Community inclusion is intentional.
Staff help people access ordinary community spaces, relationships, opportunities, and activities based on their interests.
Documentation reflects the person’s participation.
Session notes identify the person’s choice, involvement, support provided, progress, and next steps. Notes must never describe the person as a passive recipient when they actively participated.
How this applies across bttr programs
Independent Living Services
Independent Living Services, ILSThe participant helps select the independent living goals, activities, schedule, and locations for services. Coaches teach practical skills while encouraging the participant to make decisions and complete as much of each task as possible.
Coordinated Family Supports
Coordinated Family Supports, CFSThe adult client remains central to planning and decisions. bttr works collaboratively with the client and family while protecting the client’s rights, preferences, privacy, and voice. Family involvement should support the client without replacing the client’s participation.
Tailored Day Services
Tailored Day Services, TDSThe participant chooses individualized goals related to employment, education, volunteering, community involvement, or personal development. Services are flexible and should reflect the participant’s interests and desired outcomes.
Supported Living Services
Supported Living Services, SLSThe participant directs daily routines, home life, relationships, community access, and personal decisions. Support should make it possible for the person to live with greater control, privacy, and independence.
In Home Respite Services
In Home Respite ServicesStaff provide safe and reliable support while respecting the person’s home, routines, communication, belongings, relationships, and preferences. Safety support should not create unnecessary control or restrictions.
Adaptive Skills Training
Adaptive Skills Training, ASTTraining goals and methods are individualized around the person’s assessed needs, communication, preferences, and meaningful life outcomes. Support must be respectful, measurable, and free from punishment or coercion.
Self Determination Program services
Self Determination Program, SDPThe participant directs the services included in the approved individual program plan and spending plan. bttr coordinates services through the participant’s Financial Management Service and follows the goals, authorization, and choices established through the Self Determination Program process.
What person centered support looks like
“You have to go grocery shopping because that is what the schedule says.”
“What would you like to work on today? We can practice grocery shopping, organize your space, review your budget, or choose another activity connected to your goals.”
The coach still provides structure and keeps the service connected to the person’s plan. The difference is that the person receives information, meaningful options, and an active role in the decision.
Your voice matters
A person receiving services may ask questions, express a preference, decline an activity, request another option, or report a concern. bttr reviews concerns respectfully and works with the person, family, Regional Center, FMS, and other authorized team members when appropriate.
Ask bttr about HCBSService information
Program availability, eligibility, authorization, service area, and funding requirements vary. Regional Center referrals are required for bttr’s vendored ILS and CFS services. Self Determination Program services must be included in the participant’s approved plan and coordinated through an FMS.