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HCBS settings transition plan

In 2014, the federal Centers for Medicare & Medicaid Services (CMS) published regulations in the Federal Register that changed the definition of home and community-based settings for the 1915(c) and 1915(i) Medicaid HCBS waivers. The new definition considers a person’s experience and outcomes in addition to a setting’s location, geography or physical characteristics. CMS has given states until March 2023 (see update below) to bring their systems into compliance with the new HCBS settings requirements. View the Home and Community-Based Services Rule Overview video for more information.

DHS launches free customized support for HCBS providers

DHS contracted with STAR Services to provide customized support to HCBS providers. The customized support will be provided at no cost to the organizations selected and will focus on HCBS settings topic areas identified in each organization’s application. To read more, click on the News tab below.

CMS grants final approval to statewide transition plan 

On Feb. 12, 2019, CMS gave its final approval to Minnesota’s Home and Community-Based Services Rule Statewide Transition Plan (PDF) to bring settings into compliance with the federal HCBS regulations. To read more, see the Feb. 12 approval letter from CMS to DHS (PDF).

CMS issues guidance for new heightened-scrutiny process

CMS requires states to submit evidentiary packages for settings that CMS presumes are not home and community-based to undergo a heightened-scrutiny process. Evidentiary packages include information gathered during on-site visits and the provider-attestation process. On March 22, 2019, CMS issued guidance describing the new heightened-scrutiny process (PDF). To read more see the HCBS settings heightened-scrutiny process page. This page also includes evidentiary packages available for public comment.

Update: CMS extends timelines for regulation of HCBS settings

As states respond to the COVID-19 public health emergency, it is clear that COVID-19’s impact requires changes to ongoing efforts to comply with the home and community-based settings (HCBS) settings criteria.

On July 14, 2020, the federal Centers for Medicare & Medicaid Services (CMS) released guidance (in a letter [PDF]) announcing an extension to the implementation of the HCBS regulation timelines. In this letter, CMS extended the deadline for states to bring their systems into compliance with the HCBS settings requirements by a year (from March 17, 2022, to March 17, 2023).

CMS also delayed several other requirements in its announcement:

  • It issued a one-year delay of the deadline for when settings determined to have isolating characteristics (Prong 3) can remediate themselves without being submitted to CMS for heightened scrutiny. The original timeline was July 1, 2020. The new timeline is July 1, 2021.
  • CMS also will allow a year delay for states to submit to CMS settings that isolate (Prong 3) for a heightened scrutiny review if those settings have not completed necessary remediation (by July 1, 2021). The original timeline was Oct. 31, 2020. The new deadline is Oct, 31, 2021.
  • CMS requests that states submit information on settings located in the same building as a public or private institution (Prong 1) or on the grounds of or adjacent to a public institution (Prong 2) by March 31, 2021. The original timeline was March 31, 2020.

What does this mean for Minnesota?

Minnesota intends to stay on track with the timelines and milestones in Minnesota's approved statewide transition plan (STP), (PDF). However, Minnesota’s plans could be affected if CMS does not have the capacity to align our STP timelines with the heightened scrutiny review process.

Several months ago, DHS submitted all settings located in the same building as an institution (Prong 1) or on the grounds of or adjacent to a public institution (Prong 2) to CMS for heightened scrutiny. We are awaiting feedback from CMS on these settings. Setting-specific feedback will help DHS work with the provider to remediate any areas CMS identifies as non-compliant.

We also are working with settings that were determined to have isolating characteristics (Prong 3) and only plan to submit settings that cannot remediate themselves by July 2021.

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