State Centers are licensed as ICFs/IDD (Intermediate Care Facilities for Individuals with Intellectual Disabilities) by the federal agency CMS (Center for Medicaid & Medicare Services). ICFs must meet all federal requirements for certification in order to operate. Annual Medicaid certification requires adherence to (9) Conditions of Participation (42 CFR Part 483, Subpart I): Governing Body & Management, Client Protections, Facility Staffing, Active Treatment Services, Client Behavior and Facility Practices, Healthcare Services, Physical Environment, Emergency Preparedness, and Dietetic Services. The model includes everything: 3 shifts of awake caregivers, weekend shifts and holiday shifts, transportation, room and board, pharmacy, medical, laundry, maintenance of buildings, therapies, administration costs.
By contrast, there are NO federal regulations governing the operation of HCBS "Community" services.