Eleven pages of guidance containing additional clues about how the Centers for Medicare & Medicaid Services (CMS) will scrutinize states’ efforts to comply with the Home-and Community-based Services (HCBS) Final Rule were released on June 26.
In the form of FAQs, the new guidance attempts to answer states’ questions pertaining to the following issues and processes pursuant to the final rule:
• Heightened scrutiny
• Respite services
• Tenancy (leases and residency agreements)
• Residents’ access to visitors
• Managed care arrangements
• State flexibility
Of note is the fact that the first nine pages of the document are devoted to the heightened scrutiny process. According to CMS’ initial guidance on the final rule, heightened scrutiny should be applied to provider settings that meet the following criteria: settings in a publicly or privately-owned facility providing inpatient treatment; settings on the grounds of, or adjacent to, a public institution; or settings with the effect of isolating individuals from the broader community of individuals not receiving Medicaid HCBS.
The document contains further details about what information states should submit to CMS for this process, what criteria CMS uses to review states’ requests for heightened scrutiny, how states can demonstrate that settings meet the HCBS characteristics, and more.
Of particular concern to assisted living providers are the following instructions to states as they conduct site visits to settings that should be designated under heightened scrutiny: “Look for evidence that settings have institutional characteristics, such as cameras; individual’s schedules or other personal information posted; lack of uniqueness in room décor; indicators of seclusion or restraint such as quiet rooms with locks, restraint chairs, or posters of restraint techniques; regimented meal times and other daily activities; and barriers that inhibit community member involvement, such as fences or gates…”
The new guidance can be found at this link: