This guidance leaves unchanged the regulatory requirement that states send for CMS heightened scrutiny review those HCBS settings that are (1) co-located with an institutional setting, (2) in a building located on the grounds of or immediately adjacent to a public institution (e.g., county-owned nursing center), or (3) any other settings that have the effect of isolating beneficiaries.
The
guidance provides some clarity on the following:
· CMS clarifies the factors it will
consider in determining whether a setting may have the effect of isolating
individuals.
· CMS does not consider rural settings
automatically presumed to be isolating and subject to heightened scrutiny. For
settings in a rural area, just like for settings in any geographic area, states
should refer to the factors used to determine whether a setting may have the
effect of isolating individuals.
· Given the large number of settings
that are required by regulation to undergo heightened scrutiny, CMS will
conduct its heightened scrutiny review via a random sampling process. The
agency provides some detail on the random sampling selection, the three
possible CMS responses to a review, and when states can provide CMS with
additional information. CMS also provides a more detailed list on what
information states should submit to CMS for those settings randomly selected to
undergo heightened scrutiny review.
· States are not expected to assess an
individual’s private residence for compliance with the settings criteria when
that resident receives non-residential HCBS. Additionally CMS does not require,
but states have the option to require, that individuals receiving
non-residential HCBS must reside in a compliant setting. For example, this
could apply if a person receives adult day services but lives in a
non-compliant setting.
Providers of Medicaid HCBS should stay tuned for new information from their state affiliates and Medicaid or Aging Departments.
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