Capitol Correspondence - 11.22.22

CMS Releases Additional HCBS Settings Rule Information Focused on Heightened Scrutiny Site Visits

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On Wednesday, the Centers for Medicare and Medicaid Services (CMS) held a webinar identifying themes from CMS’ site visits to seven states: Montana, Nevada, New Hampshire, North Dakota, Ohio, Oregon, and Wisconsin. The purpose of the site visits is for CMS to determine whether states are on track for compliance with the Home and Community Based Services (HCBS) Settings Rule. During the visits, CMS assesses community-based settings using a process known as heightened scrutiny, which applies to settings with certain factors that trigger a presumption that those settings are institutional. Settings with these factors may submit evidence that despite this presumption, they are compliant with the rule and not institutional settings.


In calendar years 2022-2023, approximately 15 states have received, or will receive, a site visit from CMS. As a result of its ongoing work with states to fully implement the HCBS Settings Rule, CMS has posted its determinations under heightened scrutiny site visits listed by state.


CMS is also encouraging states to meet with their provider networks to discuss the need for a corrective action plan (CAP), if necessary, to delay the compliance deadline. CMS has stated that it will send a reminder to states about the December 1 deadline to submit CAPs and will encourage states to consider where additional time may be needed.