Heightened Scrutiny is a presumption of institutional and/or isolating characteristics in home and community-based settings. As a result, Kansas must take a closer look at the setting to determine whether institutional like characteristics are occurring, that persons are not being isolated from the broader community and that individuals are not being isolated from persons not receiving home and community-based services. A few examples of institutional like characteristics in a setting: affiliation with an institution, large numbers of persons being served, limited or no privacy, everyone eats at the same time, medications are given at the same time, no choice of services offsite, no or very limited access to the greater community for persons, etc.
The Centers for Medicare and Medicaid Services (CMS) has identified 3 categories of heightened scrutiny that must be assessed by the state when providing home and community-based services:
Settings that are in a building that is also a publicly or privately operated facility which provides inpatient institutional treatment.
Settings that are in a building located on the grounds of, or immediately adjacent to, a public institution.
Any other settings that have the effect of isolating individuals receiving Medicaid home and community-based services from the broader community of individuals not receiving Medicaid home and community-based services.
Settings that are in a building that is also a publicly or privately operated facility which provides inpatient institutional treatment.