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Heightened Scrutiny

Providers that self-identify as being located at an isolating location but believe their services overcome that barrier and provide ample opportunity for people served to participate in community living, can request a special review of their site.

When the Centers for Medicare and Medicaid published its rule about the characteristics of home and community-based services, it defined certain settings as presumably institutional.

These settings are

  • Settings located in a building that is also a private or public intermediate care facility, skilled nursing facility or hospital
  • Settings located on the grounds of or immediately adjacent to a public intermediate care facility, skilled nursing facility or hospital
  • Settings having the effect of isolating individuals receiving home and community-based services from the broader community

DODD is required to first identify any settings that meet any one of these descriptions.

If DODD concludes that the setting actually does have the qualities of a home and community-based setting, DODD will submit that setting and evidence supporting the site’s home and community-based qualities to CMS for its heightened scrutiny.

CMS will review that information and perhaps conduct its own site visit.

If CMS agrees that the setting has sufficient home and community-based characteristics, it will approve the setting to provide waiver services.

If CMS does not approve the setting, people accessing waivers services will need to select another location to receive services.

Remediation Plans

Providers that make changes to their site may be required to formalize these changes in a remediation plan submitted to DODD.

The department is conducting site visits to residential settings and adult day settings who self-identified as requiring heightened scrutiny or as being unable to comply with HCBS settings rule outlined by CMS.

The department is incorporating HCBS settings criteria into regular compliance reviews. These site visits include observations, interviews with people receiving services and their guardians, interviews with provider agency staff and documentation review. 

Settings in a building with a public or private intermediate care facility may face the largest hurdles in achieving HCBS characteristics.

Settings on the grounds of a public intermediate care facility or settings with the effect of isolating people accessing services should be able to meet HCBS requirements with sufficient effort. All settings which currently do not meet HCBS requirements will be offered an opportunity to submit remediation plan.

Upon approval of a remediation plan, providers will submit quarterly progress reports to DODD. DODD will also conduct another site visit in order to determine whether to submit the setting to CMS for its scrutiny.