ODPANN 23-013 Now Available: Pennsylvania’s Heightened Scrutiny Locations Submitted to the Centers for Medicare and Medicaid Services (CMS)

The announcement details the review process that will occur now that Pennsylvania’s heightened scrutiny locations have been submitted to CMS.

 CMS requires states to identify any locations where waiver services are provided that meet one or more of the following criteria: 

  • 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/or 
  • Any other settings that have the effect of isolating individuals receiving waiver services from the broader community of individuals not receiving Medicaid Home and Community-Based Services (HCBS). 

These locations are presumed to be institutional and must be submitted to CMS for a Heightened Scrutiny review. On February 1, 2023, the Department submitted all locations identified as requiring a Heightened Scrutiny review by CMS. CMS will complete a Heightened Scrutiny review of the information submitted by the Department. Through the following Heightened Scrutiny review process, CMS will determine whether each location has the qualities of a home and community-based setting: *

  • CMS will compile a random sample of locations to review. 
  • CMS will review all information presented by the Department and other parties for each location selected for the review sample. 
  • CMS will either approve the Department’s assertion that the location meets the Home and Community-Based Services Rule requirements or provide feedback to the Department on missing information, questions for clarity, or reason(s) why CMS cannot agree that a location is able to overcome the presumption that it is an institution. 
  • CMS may request to review additional locations or suggest changes to the Department’s heightened scrutiny review process if the sample review highlights concerns. If warranted, CMS may conduct an onsite review as well.

CMS will publish final heightened scrutiny review determinations available here.

For more information, please review ODPANN 23-013.

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