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What is Heightened Scrutiny?

  • Some HCBS Settings will be required to submit additional evidence if they are presumed to have the qualities of an institution
  • CMS has identified three categories of residential and non-residential settings that are presumed to have the qualities of an institution:
  • Settings that are located in a building that is also a publicly or privately operated facility that provides inpatient institutional treatment;
  • Settings that are in a building located on the grounds of, or immediately adjacent to, a public institution; and
  • Any other settings that have the effect of isolating individuals receiving Medicaid home and community-based services
    (HCBS) from the broader community of individuals not
    receiving Medicaid HCBS.
  • KDADS will review the evidence and notify providers of the State’s determination
  • If KDADS concludes that the setting can overcome the qualities of an institution, the evidence will be sent to CMS and CMS will make the final determination on whether or not the setting can continue to provide HCBS
  • If KDADS concludes that the setting cannot overcome the qualities of an institution, KDADS will inform people in the setting who receive HCBS and assist them in finding a compliant setting to transition to prior
    to March 17, 2022.