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How does a state comply with the level of care assurance?

A state confirms that the entities responsible for conducting level of care determinations are following the state’s policies and procedures. A state may also review participant records to assess whether:

  • The individual meets institutional level of care criteria.

  • Level of care determinations were made before the participant received HCBS waiver services.

  • A review of an individual’s continued eligibility for institutional level of care was conducted at least annually.

A state summarizes their findings in an evidence report to CMS. Examples of evidence that the state is meeting the level of care assurance may include:

  • The percent of participants who had a comprehensive level of care evaluation by an appropriate agency prior to HCBS waiver service delivery.

  • For participants on the HCBS waiver for more than one year, the percent of individuals on HCBS waiver services who received annual Level of Care assessments.
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