HCBS Settings Rule: Heightened Scrutiny

The Wisconsin Department of Health Services (DHS) looks 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.

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 reviews materials submitted by these providers and visits each setting. During each visit, DHS talks to staff and residents.

DHS has found enough evidence to show that the new settings it reviewed met the HCBS settings rule and are not institutional. The evidence from these heightened scrutiny reviews is documented in each setting’s evidentiary summary below.

Evidentiary summaries

The evidentiary summaries include a list of the settings DHS reviewed and their supporting documentation. The public comment summaries provide an overview of the public comments DHS collected.

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.