Heightened Scrutiny

Illinois Heightened Scrutiny Locations

The HCBS Settings Regulation describes three categories or "prongs" of residential or non-residential settings that are presumed to have the qualities of an institution, but for which states can submit evidence for the application of heightened scrutiny:

Prong 1: Settings that are located in a building that is also a publicly or privately operated facility that provides inpatient institutional treatment;

Prong 2: Settings that are in a building located on the ground of, or immediately adjacent to, a public institution; and

Prong 3: Any other settings that have the effect of isolating individuals receiving Medicaid home and community-based services (HCBS) from the broader community of individuals receiving Medicaid HCBS.

Between 2016 and 2018, Illinois identified Heightened Scrutiny locations through provider response to self-surveys and on-site assessments conducted by State Waiver Operating Agency staff.  The State has since refined their list of Heightened Scrutiny locations to be reflective of guidance issued by Federal CMS on March 17, 2019: SMD # 19-001 Re: Home and Community-Based Settings Regulation – Heightened Scrutiny (see here). 

The following sites have been removed due to closure:

• Advocate Health & Hospital d/b/a Advocate BroMenn Adult Day Center
• Champaign County Nursing Adult Day Care
• McDonough Adult Health Services
• Midwest Medical Center d/b/a Galena-Stauss Adult Day Center
• Gottlieb Adult Day Center
• St. Mary's Adult Day Center

The following sites have been removed due to their withdrawal from the Supportive Living Program (SLP) waiver:

• Lavender Ridge Dementia Care Supportive Living
• Saint Clare's Villa Supportive Living

The Supportive Living Program (SLP) waiver has been amended to require Elopement Risk Assessments for each individual participant and if there is no identified safety risk, the individual participant will be provided with guidance on how to circumvent the delayed egress.  As a result, the following Supportive Living sites no longer meet Prong 3 criteria and have been removed from the list:

• Asbury Court Dementia Care
• Asbury Gardens Dementia Care
• Asbury of Kankakee Dementia Care
• Cedarhurst of Quincy Dementia Care
• Cottages at Carlinville Dementia Care
• Cottages at Salem Dementia Care
• Eagle's View Memory Care (formerly Katy's Cottage
• Legacy Memory Support
• The Pointe at Kilpatrick Dementia Care
• Rockford Supportive Living Center Dementia Care
• White Oaks at Heritage of South Elgin Dementia Care

The following sites have been removed from the list as the State determined these sites did not meet the three categories (or prongs) of residential or non-residential settings that are presumed to have the qualities of an institution:

• Circle of Friends Adult Day Center
• Friends & Family Adult Day Center

The Supportive Living Program (SLP) previously identified sites as meeting criteria for Prong 2 (on the ground of, or immediately adjacent to a public institution), but determined that these sites were actually adjacent to private institutions.  The following sites have been removed from the list:

• Carlyle Senior Living (formerly Villa Catherine) Supportive Living
• Castle Manor Supportive Living
• Courtyard Estates of Canton Supportive Living
• Courtyard Estates of Sullivan Supportive Living
• Covenant Home of Chicago Supportive Living
  
• Evergreen Place (Litchfield) Supportive Living
• Foxes Grove Supportive Living, Oak Wood Estates Supportive Living
• The Pointe at Kilpatrick Supportive Living
• Prairie Crossing Supportive Living
• Supportive Living of Wabash
• Supportive Living of Washington
• Vistas Fox Valley (formerly Aurora Supportive Living) 

Supportive Living Program (SLP) Heightened Scrutiny Locations

1. Asbury Court Supportive Living
2. Asbury Gardens Supportive Living
3. Evergreen Place Beardstown Supportive Living
4. Evergreen Place Streator Supportive Living
5. Hawthorne Inn of Clinton Supportive Living
6. Hawthorne Inn of Freeport Supportive Living
7. Hawthorne Inn of Princeton Supportive Living
8. Magnolia Terrace Supportive Living
9. Maple Point Supportive Living
10. Park Point Supportive Living
11. Symphony Residences of Lincoln Supportive Living
    

1. Heritage Woods of DeKalb Supportive Living  

1. Cherished Place Adult Day Services (Arlington Heights) 
   
2. OSF Senior World Peoria Adult Day Center  
   

In 2020, IDHS-DDD released a provider self-survey to identify IDHS-DDD Heightened Scrutiny locations with institutional or isolating characteristics.  DDD further examined their sites for these characteristics through direct outreach to Provider Agencies, discussions with their Quality Assurance staff, and a mandatory Pre-Validation Survey that was made available to Provider Agencies from December 2021 through mid-February 2022. 

Through an existing contract, the State sought assistance with compliance validation reviews and on-site assessments for IDHS-DDD Heightened Scrutiny locations from Public Consulting Group (PCG), a Quality Improvement Organization (QIO). 

All IDHS-DDD provider settings, including settings subject to Heightened Scrutiny review, were required to submit evidence of compliance with Federal HCBS Settings requirements.  IDHS-DDD posted their evidence and policy submission tools as well as a link for submission of those materials at: here. IDHS-DDD held provider trainings prior to the start of validation processes and maintained weekly webinars for providers throughout the validation processes.  Resources for providers were posted on IDHS-DDD's HCBS Settings compliance webpage at:  here. 

On July 1, 2022, IDHS-DDD's policies regarding Residency Agreements and Lockable Doors and Privacy became effective.  The Residency Agreement Policy is located at: here. The Lockable Doors and Privacy policy is located at: here.  On 10/01/2022, required use of IDHS-DDD's updated Personal Plan, Discovery, and Implementation Strategy tools became effective.  The updated tools can be located at: here. IDHS-DDD provider settings are required to complete Implementation Strategy tools.  The Implementation Strategy tool was developed to align with documentation requirements for modifications within the HCBS Settings rule (42 CFR 44.301(c)(4)(vi)(F)). Residential IDHS-DDD provider settings were required to attest to compliance with Residency Agreements and Lockable doors policies.  All IDHS-DDD provider settings were required to attest to compliance with use of Implementation Strategy Tools.

Please click the link below to view the tool used by Public Consulting Group (PCG) and State staff to review evidence of compliance submitted by IDHS-DDD provider settings.

• Validator Tool for Site Evidence 

Please click the link below to view the tool used by PCG when conducting on-site visits to IDHS-DDD Heightened Scrutiny provider settings.

• On-Site Validation Tool for Site Evidence 

IDHS-DDD provider settings were excluded from the State's Heightened Scrutiny list if:

• The provider setting closed or became vacant during the COVID-19 pandemic, with no plans of re-opening prior to March 17, 2023
• The provider-setting was individually-controlled
• The provider setting was 100% state-funded and NOT HCBS waiver-funded

Below, the State presents lists of IDHS-DDD Heightened scrutiny provider settings by facility type and Prong category.  The State also includes compliance summaries for IDHS-DDD Heightened Scrutiny provider settings by facility type.

• Non-Residential Community Day Service (CDS) Settings 
• Residential Children's Group Home (CGH) Settings  
  
• Residential Community Integrated Living Arrangement (CILA) Settings 
  
• Residential Community Living Facility (CLF) Settings 

IDHS-DDD Heightened Scrutiny provider settings with one or more non-compliance concerns identified by the State received Compliance Action Plan (CAP) letters and templates.  Provider settings were required to submit a completed CAP template by e-mail to IDHS-DDD within 14 days of receiving their letters.  Once provider settings submitted their completed CAPs, they had 60 days to furnish evidence of remediation to IDHS-DDD.  IDHS-DDD has conducted web-based meetings twice weekly for provider settings with questions and concerns regarding CAPs.  Please click the below links to view IDHS-DDD's CAP Letter, IDHS-DDD's CAP Template, and examples of how IDHS-DDD provider settings have remediated non-compliance concerns. 

• Compliance Action Plan (CAP) Letter 
• Compliance Action Plan (CAP) Template
  
• Examples of Remediation  

By 10/21/2022, 98% of CAPs had been distributed to IDHS-DDD Heightened Scrutiny Locations.  All CAPs are expected to be distributed by 11/01/2022, with full provider setting remediation anticipated by 01/01/2023.  Quality Assurance reviews of completed CAPs will be conducted to ensure compliance with all HCBS Settings requirements.  Standard compliance monitoring tools have been updated to monitor for compliance with HCBS Settings requirements.  IDHS-DDD Quality Assurance monitoring staff will be provided with completed validation tools and CAPs for reference during future compliance assessments of IDHS-DDD HCBS provider settings.  

• State Response to Public Comments Regarding IDHS-DDD Heightened Scrutiny Locations (pdf) 
  

CMS and their partners, New Editions and Administration for Community Living (ACL) have visited Heightened Scrutiny locations in states to assess for compliance with the Home and Community-Based Services (HCBS) Settings Rule.  Five Illinois Heightened Scrutiny locations received visits from October 17, 2022, through October 20, 2022.  CMS' reports regarding their visits to Heightened Scrutiny locations in Illinois and other states can be located here.  Illinois has developed a written response to CMS based on the site visits. The response includes how the state will remediate any findings to ensure compliance with the HCBS Settings Rule.

Illinois Response to CMS On-Site Report (pdf)

In May of 2022, CMS announced an updated strategy for implementation of the HCBS Settings Rule that allowed states to request additional time to transition to compliance with certain Settings requirements.  Slides from CMS' May 24, 2022 All-State presentation can be located here. CMS determined that the COVID-19 public health emergency exacerbated the direct-service workforce crisis, thus inhibiting the ability of states to transition to compliance with the following Settings requirements:

• Access to the broader community;
• Opportunities for employment;
• Option for a private unit and/or choice of a roommate; and
  
• Choice of non-disability specific settings.

States were informed they had until December 1, 2022, to request additional time for transitioning to one or more of the above Settings requirements through the form of a Compliance Action Plan (CAP) request.  Illinois determined the State did not need to take advantage of the new flexibilities.  However, in  November of 2022, CMS outreached State Medicaid Directors to assert "states that have submitted presumptively institutional settings to CMS for a heightened scrutiny review and have yet to receive final adjudication of those settings should request a CAP to authorize additional opportunities to complete discussions with CMS."  The State of Illinois continues to await final adjudication of 529 presumptively institutional settings submitted to CMS for heightened scrutiny review. Consequently, Illinois requested a CAP on 12/07/2022 to authorize additional time for collaboration with CMS to ensure full compliance with HCBS Settings criteria among our presumptively institutional settings.

• Illinois Corrective Action Plan (CAP) (pdf)