Additional HCBS Settings Rule Heightened Scrutiny State Reports Coming Soon

The Centers for Medicare and Medicaid Services (CMS) continues to engage states to ensure compliance with the federal Home and Community Based Services (HCBS) Settings Rule (Settings Rule) by the deadline of March 2023. Part of the ongoing work is CMS’ review of states’ Statewide Transition Plans that outline how each state is working to bring its settings into compliance with the Settings Rule. CMS is also currently working with states on corrective action plans for states that are requesting additional time to comply with staff-dependent provisions of the Settings Rule impacted by the direct support workforce crisis

In addition, CMS has been conducting site visits in several states to assess 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. CMS has posted its determinations under heightened scrutiny site visits listed by state. CMS has posted its determinations under heightened scrutiny site visits listed by state. In addition to the determinations currently posted on the CMS website, ANCOR has received notice from stakeholder partners in Ohio and Vermont that CMS has started issuing new reports to states in response to heightened scrutiny reviews. While those determinations are not yet publicly posted, ANCOR anticipates they will be posted soon.