Requirements for new HCBS settings

Note: The information on this page applies only to new presumptively institutional settings under the Elderly Waiver and Alternative Care program.

Effective March 18, 2023, new adult day service, adult foster care and customized living providers must comply with all home and community-based settings standards before they enroll with Minnesota Health Care Programs.

Important: Providers cannot bill for waiver services provided in settings in or adjacent to an institution (as described in the definitions below) until approved by DHS and the federal Centers for Medicare & Medicaid Services (CMS) through the heightened-scrutiny process.

Definitions
Review process
Request a review
Evidentiary packages

Definitions
- Prong 1 settings: Located in a publicly or privately owned institution. For example, the waiver service setting and the institution share the same address, share a common wall or are connected by a walkway/skywalk or other enclosed corridor.
- Prong 2 settings: Located adjacent to a publicly owned institution. For example, the waiver service setting is touching the institution or its property with no intervening parcel of land between the two settings.
- Institution means:
  - Nursing facility
  - Hospital
  - Intermediate care facility for persons with developmental disabilities (ICF/DD)
  - Institution for mental disease (IMD).
- Publicly owned means: An institution that is financed and operated by a tribal nation, county, state, municipality or other unit of government. A privately owned nursing facility is not a public institution.
Review process

Providers will be required to 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.
Request a review

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.

Notes
- DHS encourages potential providers to start the heightened-scrutiny process as soon as possible and before providing services to people enrolled in AC, EW or ECS. You will not be paid until CMS approves the setting as HCBS-compliant. See the Review process tab for more information.
- CMS allows states to submit a setting for a heightened-scrutiny review while only non-Medicaid beneficiaries are receiving services in the new setting. If the new setting is considered presumptively institutional (defined as a prong 1 or 2 settings), CMS believes state and federal officials can accurately assess its compliance with the HCBS setting requirements based on experiences of non-Medicaid beneficiaries. For more information about CMS guidance on heightened scrutiny of new presumptively institutional settings, see Heightened scrutiny review of newly constructed presumptively institutional settings (PDF).
Evidentiary packages

Evidentiary packages submitted for heightened scrutiny:

Settings that provide adult day services

We will add evidentiary packages to this section as we complete them.

Settings that provide adult foster care services

We will add evidentiary packages to this section as we complete them.

Settings that provide customized living services
- The Emeralds at Grand Rapids (PDF)