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HCBS settings heightened-scrutiny process

The Centers for Medicare & Medicaid Services 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 Frequently Asked Questions Regarding the Heightened Scrutiny Review Process and Other Home and Community-Based Settings Information (PDF) (see definitions below). CMS randomly selected prong 1 and 2 settings to undergo the heightened-scrutiny process using a list provided by the state. The guidance also addresses the process for settings presumed to be isolating (Prong 3).

Update: CMS extends timelines for regulation of HCBS settings

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.
For more information, visit the HCBS settings transition plan page.
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