DEPARTMENT OF HEALTH & HUMAN SERVICES
Centers for Medicare & Medicaid Services
7500 Security Boulevard, Mail Stop S2-14-26
Baltimore, Maryland 21244-1850
Medicaid Benefits and Health Programs Group
June 29, 2023
Ryan Moran, Deputy Secretary and Medicaid Director
Maryland Department of Health
201 West Preston Street, Room 525
Baltimore, MD 21201
Dear Deputy Secretary Moran:
This letter and accompanying attachment represent the Centers for Medicare & Medicaid
Services (CMS) approved corrective action plan (CAP) for the State of Maryland to bring
settings into compliance with the federal home and community-based services (HCBS)
The CAP provides the state with additional time to bring settings into compliance with the
regulatory criteria directly impacted by the COVID-19 public health emergency. For remaining
HCBS settings regulations not subject to the CAP, the state and all settings are expected to be
fully compliant by the end of the transition period on March 17, 2023.
The state will report to CMS on progress with activities, milestones, and timeframes outlined in
the attachment. Full compliance is achieved when all Medicaid-funded HCBS is rendered in a
compliant setting. Closure of the CAP will be granted after the state completes the activities
described in the attachment, at which point the state will be in full compliance with all HCBS
settings provisions of the regulation.
It is important to note that CMS approval of a CAP solely addresses the state’s compliance with
the applicable Medicaid authorities. CMS approval does not address the state’s independent and
separate obligations under the Americans with Disabilities Act, Section 504 of the Rehabilitation
Act or the Supreme Court’s Olmstead v. LC decision. Guidance from the Department of Justice
concerning compliance with the Americans with Disabilities Act and the Olmstead decision is
available at: http://www.ada.gov/olmstead/q&a_olmstead.htm.
Thank you for your efforts in establishing a CAP and completing this work to ensure all settings
are in compliance with the federal HCBS regulations. If you have questions or need further
assistance, please contact Ondrea Richardson at [email protected] or 410-786-
4606.
Page 2 – Moran
Sincerely,
Ryan Shannahan, Deputy Director
Division of Long-Term Services and Supports
Attachment
cc: Wendy Hill Petras, Acting Director, Division of HCBS Operations and Oversight,
CMCS, CMS
Ryan I.
Shannahan -S
Digitally signed by Ryan
I. Shannahan -S
Date: 2023.06.29
12:40:05 -04'00'
MEDICAID HOME AND COMMUNITY-BASED SERVICES SETTINGS REGULATIONS
CORRECTIVE ACTION PLAN FOR THE STATE OF MARYLAND
Medicaid authorities subject to the CAP
1915(c) HCBS Waivers:
• Home and Community-Based Options Waiver, MD.0265; and
• Waiver for Adults with Brain Injury, MD.40198.
Regulatory criteria subject to the CAP
All settings:
The setting is integrated in and supports full access of individuals receiving Medicaid HCBS to the greater community,
including opportunities to seek employment and work in competitive integrated settings, engage in community life, and receive
services in the community, to the same degree of access as individuals not receiving Medicaid HCBS at 42 CFR
§441.301(c)(4)(i) (entire criterion except for “control personal resources”),
The setting is selected by the individual from among setting options including non-disability specific settings and an option for
a private unit in a residential setting. The setting options are identified and documented in the person-centered service plan and
are based on the individual’s needs, preferences, and for residential settings, resources available for room and board at 42 CFR
§441.301(c)(4)(ii),
Optimizes, but does not regiment, individual initiative, autonomy, and independence in making life choices, including but not
limited to, daily activities, physical environment, and with whom to interact at 42 CFR §441.301(c)(4)(iv), and
Facilitates individual choice regarding services and supports, and who provides them at 42 CFR §441.301(c)(4)(v).
Provider-owned or controlled residential settings:
Individuals sharing units have a choice of roommate in that setting at 42 CFR §441.301(c)(4)(vi)(B)(2), and
Individuals have the freedom and support to control their own schedules and activities at 42 CFR §441.301(c)(4)(vi)(C) (entire
criterion except for “have access to food at any time”).
Page 2 – Attachment
State milestones and timeframes under the CAP
Milestone
Begin Date
Completion Date
Settings Remediation and Validation Activities for Residential Providers
Complete desk audits to review provider records, participant satisfaction
surveys, customer service questionnaires (CSQ), performance measures
associated with the 1915(c)
Waivers, participants’ plans of service, on-site
or
virtual site visits, and reportable event
s noting alleged or actual adverse
incidents
that occurred with participants to ascertain a
site’s compliance with
the final rule.
March 18, 2023
September 30, 2023
Issue a notice to suspend waiver participant admissions to the non-compliant
setting for a 90
-day period beginning October 1, 2023. Non-compliant
settings will still be paid for existing waiver participants at their location.
Providers that submit
documentation to indicate their compliance with the
f
inal rule within the 90-day time period may have the suspension lifted. The
notice will provide that failure to come into compliance
by December 31,
2023
will result in a termination from the program once all Medicaid waiver
participants are relocated to compliant settings.
October 1, 2023
December 31, 2023
Residential Provider Site Sanction Activities
Issue to suspended providers who have remained non-compliant since March
17, 2023
a 30-day final warning notice on December 1, 2023. Non-
compliant
providers
receiving this final warning remain in suspended status for waiver
participant admissions
. Supports Planners and Medicaid participants or their
representatives will be notified that their current provider
has received a final
notice
that they will be terminated due to non-compliance with the Final
Rule.
The notice will inform case managers, participants or their
representatives that relocation efforts will commence on January 1, 2024 to
move the participant to a compliant setting. The provider will be terminated
once all participants have been relocated.
December 1, 2023
December 1, 2023
Terminate Medicaid residential provider sites that remain non-compliant
after the final warning
. Non-compliant residential providers are notified of
their termination once all Medicaid waiver participants are relocated.
January 1, 2024
April 30, 2024
Page 3 – Attachment
Milestone
Begin Date
Completion Date
Relocation of Medicaid waiver participants residing in non-compliant
settings.
January 1, 2024
April 30, 2024
Heightened Scrutiny Activities
Address heightened scrutiny findings related to CMS’ heightened scrutiny
review including, as applicable, remediation of all similarly situated
settings that utilize a similar service delivery model and, as applicable, any
overall assessment processes of all providers of HCBS in the state to ensure
that all providers a
re being assessed appropriately against the regulatory
settings criteria.
Date CMS issues
findings to the state
3 months post the date
CMS issues findings to
the state
Statewide Compliance
Final compliance statewide with HCBS settings rule.
The later of April 30,
2024 or 3 months post
the date CMS issues
heightened scrutiny
findings to the state
