What it requires: HCBS settings must function like a genuine part of the community, not an institution regardless of size or location. Core requirements include resident/individual choice in living arrangements and daily schedule, privacy (including lockable doors), unrestricted visitor access, and real opportunities for community engagement and employment.
How it works in SC: CMS granted final approval of South Carolina's Statewide Transition Plan (plan dated Feb. 4, 2020). SCDHHS directed HCBS and Community Program Coordination (CPC) providers to complete a state-created self-assessment tool for every residential and non-residential facility type.
Common compliance gap: This rule is as much about staff practice and program culture as physical environment — a facility with fully compliant architecture but staff who default to institutional routines and restricted choice is still a real compliance risk. Observing staff practice, not just walking the building, is the better test.
Ongoing obligation: Redo your self-assessment any time your physical environment or program practices change — not just on whatever schedule SCDHHS last required.
General information, not legal advice. Requirements change; confirm against the official source before you act, or ask us how this applies to your organization.