Home and Community Based Settings (HCBS) Rules: Heightened Scrutiny

Settings that are Presumed to have Qualities of an Institution

1. Any setting that is located in a building that is also a publicly or privately operated facility that provides inpatient institutional treatment

2. Any setting that is located in a building on the grounds of, or immediately adjacent to, a public institution

3. Any other setting that has the effect of isolating individuals receiving Medicaid HCBS from the broader community of individuals not receiving Medicaid HCBS

Why Heightened Scrutiny?

1. Preserve settings that are initially presumed to have institutional qualities and presumed not compliant with the HCBS Rules

2. If the state asserts the setting complies with the HCBS Rules, including working on a remediation plan to come into compliance…

- CMS must make a determination whether or not the evidence supports the setting is or can become compliant during the transition period.

Heightened Scrutiny Process

1. Notify providers and members

2. Prepare evidentiary packet for public comment

3. Implement public comment period and modify the evidentiary packet per input received

4. Submit evidentiary packet to CMS

Evidentiary Packet

• Assessment tools

    - Provider Self Assessment

        1. Copy of procedures that indicate evidence of access to and demonstrated support for beneficiary              integration in community activities in the broader community

        2. Descriptions of processes in place or actions taken by staff to support, monitor, improve and                        enhance member integration

        3. Summary of examples of how schedules are varied according to member preferences

        4. Procedures in place to routinely monitor individual access to services and activities of the broader              community

        5. Description of how staff are trained and monitored on their understanding of the settings criteria              and the role of person-centered planning

Evidentiary Packet: Narrative Summary

1. Qualities of the setting and how it is integrated in and supports the full access of individuals receiving        home and community based services into the greater community

2. Remediation strategies the setting has implemented to rectify and fully overcome its former                        institutional qualities or characteristics that isolate individuals from the broader community

        a. Description of the MCOs oversight of milestones in the CAP to ensure
            completion of actions

3. Summary of the public comment process and the stakeholder comments received

For more information visit Medicaid.gov

Visit the AHCCCS Home and Community Based Settings Rules webpage

To see the AHCCCS Home and Community Based Services provider training click Here