Home and Community-Based Services (HCBS) Settings Rule – Heightened Scrutiny

The federal HCBS settings rule, 42 C.F.R. § 441.301(c)(4) and 42 C.F.R. § 441.301(c)(5) requires the Rhode Island Medicaid Program, Executive Office of Health and Human Services (Rhode Island Medicaid) and the Centers for Medicare and Medicaid Services (CMS)to  conduct a heightened scrutiny review of HCBS settings that appear to be institutional in nature as a result of any or all of the below listed categories:

• Being located in a publicly or privately owned facility providing inpatient treatment, including nursing facilities (Category 1);
• Being located on the grounds of or next to a public institution (Category 2); or
• Isolating people from the broader community of people who do not receive Medicaid HCBS (Category 3).

In order to be certified as a Medicaid provider in Rhode Island and to receive Medicaid payment, any setting that fits into one (1) of these categories must demonstrate that they fully meet the requirements of the HCBS settings rule. A team at Rhode Island Medicaid reviews policies and documents from the provider and visits the setting. Rhode Island Medicaid makes an initial recommendation based on this review and submits a portfolio to CMS for final approval.

In accordance with the Updated Transition Plan to Implement the Settings Requirement for Home and Community Based Services, approved by CMS in March 2023, Rhode Island Medicaid must notify affected individuals and advocacy groups and share the evidence demonstrating compliance with the HCBS settings rule for a thirty (30) day public comment period. Individuals residing in the setting, their guardians (if applicable), their families, and aging and disability rights advocacy organizations are notified about and have the opportunity to provide input. 

After the State reviews feedback and determines compliance with the HCBS settings rule, all evidence is submitted to CMS for final approval.