Incorporation of Heightened Scrutiny in the Transition Plan Process
	State assesses settings 
 
	Identification of settings presumed to
	have qualities or characteristics of an institution 
 
 
	State proposes the setting does not have the characteristics of
	institution 
	State determines setting has characteristics
	of an institution 
 
	*Substantive changes to the Transition Plan
	will require a public comment period. For
	additional guidance please reference “CMS Guidance on State’s
	Transition Plan to Align with HCBS Characteristics/Settings
	Requirements” 
	CMS accepts state’s determination of
	home and community-based settings and approves in Transition Plan 
	CMS reviews Transition Plan and applies
	heightened scrutiny to determine which settings meet the criteria
	for home and community-based settings 
	State develops a plan to bring setting into
	alignment or relocate individuals to compliant home and
	community-based settings options 
	State must modify Transition Plan* 
	CMS denies state’s determination(s)
	under heightened scrutiny 
	CMS identifies settings presumed institutional
	not identified in Transition Plan njj 
	State posts the final document for public
	transparency and submits to CMS 
	State incorporates input from public comment
	period and provides summary of disposition of that input into the
	Transition Plan 
	State submits Transition Plan for public
	comment 
	State incorporates into Transition Plan 
	State develops the justification the Secretary
	will use to determine if the setting does not have the qualities of
	an institution and does have the qualities of home and
	community-based settings 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
	
	
	
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document | 
| Author | TIMOTHY JONES | 
| File Modified | 0000-00-00 | 
| File Created | 2021-01-21 |