March 2019
The Centers for Medicare & Medicaid Services (CMS) has issued Frequently Asked Questions (FAQs) that provide more information to State Medicaid programs on what settings have the qualities of an institution and are ineligible for Home and Community Based Services (HCBS), which settings qualify for HCBS, and under what circumstances CMS needs to conduct a review with heightened scrutiny to determine if the setting qualifies for HCBS. The guidance clarifies that while rural settings may appear to meet the criteria to conduct a heightened scrutiny review, States should only request such a review if a setting has the qualities of an institution and if individuals qualifying for HCBS in a rural area do not have the same access to engage in the community as enrollees not receiving Medicaid HCBS in the same area.