North Dakota recently received approval from the Centers for Medicare & Medicaid Services (CMS) to provide Medicaid Home and Community-Based Waiver funded residential housing and day services on the grounds of the North Dakota Life Skills and Transition Center (LSTC), a state funded intermediate care facility (ICF/IID). [IID = Individuals with Intellectual Disabilities]
Federal approval for housing and day services on the ICF/IID campus came after a heightened scrutiny review by CMS, as required by the federal "community" regulation which requires all HCBS-funded services meet specific criteria. The proximity of the housing and day services on the campus of an ICF triggered "heightened scrutiny."
This is believed to be the first ruling under a heightened scrutiny review. The North Dakota Protection and Advocacy Project, North Dakota Center for Persons with Disabilities, and The Arc of North Dakota sent a letter registering their significant upset and opposition to the ruling and for not being involved as “stakeholders.”
Read their letter to CMS here.
From Questions and Answers Regarding Home and Community-Based Settings
[page 7] Question: Are settings on the grounds of or adjacent to “private” institutions considered not to be home and community-gassed (HCB)?
Answer: It depends. Settings that are on the grounds of or adjacent to a private institution are not automatically presumed to have the characteristics of an institution. However, if the setting isolates the individual from the boarder community or otherwise has the characteristics of an institution or fails to meet the characteristics of a home and communit-based setting, the setting would not e considered to be compliant with the regulation. States will need to assure that these settings fully comply with the requirements…to qualify for Medicaid reimbursement under 1915(c), (i), or (k) as noted in the transition plan. A state’s assessment of settings that isolate should be informed by the public comments received prior to submission of the transition plan. Also, states may elect to adopt more stringent settings characteristics that would not allow a setting to be on the grounds of a private institution….
Read more from CMS on the new rule here.