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Heightened Scrutiny

As mentioned above, settings that fall within Category 4--that is, settings that the federal rule presumes to be institutional—must pass through the federal heightened scrutiny process in order to continue to participate in a Medicaid HCBS program. All of the settings that are presumed to be institutional will receive an on-site visit before December 31, 2016. During that visit, the State assessors will conduct the same review that they conduct on all 421 sites that receive an on-site visit, but the State will also seek out additional evidence to support those sites’ possible presentation to CMS for heightened scrutiny.  Assessors will use the below list as a guide for their visits to sites that are presumed to be institutional:
 
 
The State will use the results of the site visit, including any supplemental information collected by assessors, to determine whether presumed institutional sites are candidates to present to federal CMS for heightened scrutiny.  The State will communicate with affected sites as part of this determination process.
Based on its determinations, the State will work with sites to ensure that it has proper evidence to support the position that the sites have the qualities of an HCBS setting.  Before finally submitting its evidence to federal CMS, the State will, to the extent it can do so consistent with privacy protections, release for public comment the sites it proposes to submit for heightened scrutiny, along with documentation the State has collected regarding the sites. In its final submission to federal CMS, the State will also include any public comments and input from the agency, the general public, and HCBS participants and families.
CMS released a Home and Community based Settings Requirements Heightened Scrutiny FAQ that describes the heightened scrutiny process in greater detail.  
 

 


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Illinois Healthcare and Family Services

JB Pritzker, Governor • Theresa Eagleson, Director