CIB: Heightened Scrutiny Review of Newly Constructed Presumptively Institutional Settings

Today the Centers for Medicare & Medicaid Services (CMS) issued an Informational Bulletin that describes how heightened scrutiny applies to construction of new settings that are presumed institutional as outlined in the home and community-based services (HCBS) settings rule at 42 CFR 441.301(c)(5). The Bulletin revises prior guidance issued in 2016 to now allow states to submit a setting to CMS for heightened scrutiny review prior to Medicaid beneficiaries receiving services in the setting.

CMS also clarifies in the Bulletin when Federal Financial Participation for Medicaid-funded HCBS will be available upon CMS determination that a newly constructed presumptively institutional setting adheres to the home and community-based settings requirements.

• CIB: Heightened Scrutiny Review of Newly Constructed Presumptively Institutional Settings