HCBS Heightened Scrutiny Round 2

Pursuant to the requirements of the Home and Community-Based Services (HCBS) Settings Rule regulations (CMS 2249-F/2296-F) issued by the Centers for Medicare and Medicaid Services (CMS) on March 17, 2014, the Alabama Medicaid Agency (Medicaid) is issuing this request for public review and comment on settings identified as requiring heightened scrutiny for Settings Rule compliance. HCBS waiver programs are offered as alternatives to nursing homes and intermediate care facilities; therefore, the Settings Rule requires HCBS to be provided in noninstitutional settings. In brief, this public comment opportunity focuses on the Settings Rule requirements that HCBS services be delivered in non-institutional settings and addresses the State’s examination process of settings with characteristics presumed to be institutional in nature but, after additional review, have overcome this presumption.

The Alabama Department of Mental Health/Developmental Disabilities Division (ADMH/DDD), in collaboration with Medicaid, has worked to identify settings potentially at risk of not complying with the Home and Community-Based Services (HCBS) Settings Rule. They reviewed and updated certification procedures and conducted assessments to ensure compliance with federal regulations. The State has implemented a plan to ensure that settings adhere to the following requirements:

• Settings must support full access to the community, including opportunities for employment, community life, and personal resource control.
• Individuals must be able to choose their settings, including options for private units in residential settings.
• Settings must ensure privacy, dignity, respect, and freedom from coercion and restraint.
• Settings should optimize individual initiative, autonomy, and independence in making life choices.
• Individuals must have the freedom to choose their services and providers.
• In provider-owned or controlled residential settings, additional conditions must be met, such as having legally enforceable agreements, privacy in living units, freedom to furnish and decorate, control over schedules and activities, access to food,

Medicaid welcomes public comments on the State’s efforts to comply with the heightened scrutiny requirements of the HCBS Settings Rule. The public is invited to review the posted Heightened Scrutiny summaries and submit written comments beginning December 6, 2024. This comment period will conclude at 11:59 PM CST on January 6, 2025. Comments can be emailed to PublicComment@medicaid.alabama.gov or mailed to the provided address. Comments should include the Setting Name and Provider Name.

Alabama Medicaid Agency
ATTN: LTC Healthcare Reform Division, Specialized Waiver Unit
P.O. Box 5624
Montgomery, Alabama 36103-5624

Please note that public comments submitted in response to this notice are considered public documents. Submitted public comments and Alabama’s Statewide Transition Plan (STP) materials will be available for public review at the following link on the Medicaid website: Alabama Statewide Transition Plan