HCBS Settings Rule: Heightened Scrutiny

The Wisconsin Department of Health Services (DHS) is looking at certain residential settings more closely. The goal is to see if they can get paid by Medicaid for waiver-funded services. We call this process heightened scrutiny review. DHS wants your input on our findings. That’s why we’re opening a 30-day public comment period.

A setting can get paid by Medicaid if it is a home and community-based setting. The federal home and community-based services (HCBS) settings rule sets guidelines. Guidelines say a setting is not home and community-based if it:

• Is located in a publicly or privately owned facility providing inpatient treatment (including skilled nursing facilities).
• Is on the grounds of, or next to, a public institution.
• Keeps people away from the broader community of people who do not get Medicaid HCBS waiver services.

When a provider requests to receive Medicaid funding, and if any of these are true, the setting needs a heightened scrutiny review to see if it is home and community-based.

DHS reviewed materials submitted by these providers and visited each setting. During each visit, DHS talked to staff and residents. DHS has found enough evidence to show that the new settings it reviewed meet the HCBS settings rule and are not institutional. The evidence from these heightened scrutiny reviews is documented in each setting’s evidentiary summary. View the 2024 HCBS heightened scrutiny evidentiary summaries (PDF) to see the settings under review and their supporting documentation.

Request for public comment by August 19, 2024

Public comment is a time to share your thoughts on facility-submitted documentation and onsite visits.

Submit your comments by August 19, 2024. You can:

• Email your comments to DHS at dhsltcpubliccomment@dhs.wisconsin.gov.
• Mail your written comments to:
  Division of Medicaid Services
  Bureau of Programs and Policy
  Attn: Public Comments–Wisconsin Medicaid HCBS Heightened Scrutiny
  PO Box 309
  Madison, WI 53701-0309

You can get paper copies of the evidentiary packages mailed to you. Call 877-498-9525.

Previous heightened scrutiny evidentiary summaries

Comments received regarding specific provider settings during the February 22, 2021–March 24, 2021, public comment period have been added to that provider's evidentiary summary. Comments received that were not specific to an individual provider setting are also included.

• HCBS heightened scrutiny public comment summaries (PDF)
• HCBS heightened scrutiny evidentiary summaries (PDF)

Contact information

If you cannot find the answer to your question, send us an email at dhshcbssettings@dhs.wisconsin.gov or call 877-498-9525.