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.