New Provider Enrollment for Waiver Payment Reliant on Compliance with HCBS Settings Rule

Posted on October 19, 2023 by Bobbie Guidry

This month, the Minnesota Department of Human Services (DHS) announced required heightened scrutiny assessments for new home and community-based services (HCBS) settings that are in or adjacent to an institution.

The requirement is retroactive to the end of the State Transition to full rule implementation of the HCBS Settings Rule last March 18.

As of that date, new adult day service, adult foster care, and customized living providers cannot bill for waiver services in settings in or adjacent to an institution until approved by DHS and the Centers for Medicare and Medicaid Services (CMS) through the heightened-scrutiny process. This change applies to services through Alternative Care, Elderly Waiver, and Essential Community Supports.

An institution for this requirement is defined as a:

• Nursing facility
• Hospital
• Intermediate care facility for persons with developmental disabilities (ICF/DD)
• Institution for mental disease (IMD).

To initiate a heightened scrutiny review for a new setting, email the Aging and Adult Services HCBS unit and include “Heightened Scrutiny” in the subject line. Include the setting’s name, address, contact information, and license number, if available.

Providers must complete a self-assessment of HCBS compliance and provide copies of policies and documents for DHS to review and verify compliance with HCBS standards and requirements. DHS staff will give providers a self-assessment tool that includes a list of required documents/policies to submit, including information about how to submit the documents securely to DHS.

DHS will conduct a scheduled on-site assessment at the proposed provider setting to determine HCBS compliance and that the setting does not have the qualities of an institution.

Should DHS believe the setting meets all HCBS standards and does not have the qualities of an institution, DHS will submit an evidentiary package to CMS for heightened scrutiny. CMS expects DHS to submit several types of information and documentation in the evidentiary package to support its position that a particular setting has the qualities of home and community-based services and does not have the qualities of an institution. DHS must receive CMS approval for the setting before it may pay for HCBS waiver services in that setting.

For additional policy information, see:

• Adult Day Services
• Adult Foster Care
• Customized Living, including Assisted Living

For more information, refer to DHS – Requirements for new HCBS settings.