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Home and Community-Based Services Program Transition



 Tribal Notice


Michigan Department of Health and Human Services Behavioral and Physical Health and Aging Services Administration


Home and Community Based Services Public Comment for Heightened Scrutiny (HS) Settings


 Please see L-letter L 22-34  at the following link: 2022 Medicaid Provider L Letters (



This phase of the Heightened Scrutiny process will cover  all HCBS settings that require an HS review statewide.



MDHHS contracted with Michigan State University to gather evidence from settings related to the reasons they were on Heightened Scrutiny (HS).

This information was then uploaded into a format to allow the Heightened Scrutiny Review Committee (HSRC) to review each settings information and provide the department with feedback.

The HS review forms were redacted in the following ways:

  • Information related to specific locations of settings, such as the name of a local coffee shop, or a specific area attraction were redacted to support the goal of unbiased reviews. The Heightened Scrutiny Review Committee was not aware of the specific name or location of the setting they were reviewing.
  • Specific diagnoses were often removed to protect the privacy of the individuals’ receiving services in a setting. When redacted this information was deemed unnecessary to assess the HBCS compliance of a setting.
  • Symptoms of a behavioral health diagnosis were often redacted and replaced with less personal or private information in most cases this information is not needed to assess the HCBS compliance of a setting.
  • MDHHS has instituted a process where all the individualized plans of service (IPOS) of waiver participants were reviewed for compliance to the rule. These plans are private and have not been shared with anyone outside of MDHHS consistent with laws around privacy.
  • When a redaction was made, replacement information that is less revealing is inserted and will look like this <additional information>.





Alcona County

Gogebic County

Muskegon County

Allegan County

Grand Traverse County

Newaygo County

Alpena County

Houghton County

Oakland County

Antrim County

Ingham County

Oceana County

Baraga County

Kalamazoo County

Ogemaw County

Bay County

Kalkaska County

Otsego County

Berrien County

Kent County

Ottawa County

Branch County

Lake County

Presque Isle County

Calhoun County

Lapeer County

Roscommon County

Charlevoix County

Lenawee County

Sanilac County

Cheboygan County

Mackinac County

St. Clair County

Chippewa County

Macomb County

St. Joseph County

Clinton County

Marquette County

Van Buren County

Delta County

Menominee County

Washtenaw County

Dickinson County

Monroe County

Waukesha, Wisconsin

Eaton County

Montcalm County

Wayne County

Genesee County

Montmorency County

Wexford County

 To review a setting, you will search for it through the link  below by identifying following information

  • County where setting is located
  • City where setting is located
  • Name of setting

Please follow this link to  the setting list



Click on the link below. This will take you to a search function that will allow you to review specific settings.


When you have completed your review of the information provided you will see a survey link at the bottom of the page. If you would like to leave feedback related to the setting you may complete the survey. MDHHS will review feedback as part of our full review process in determining which setting, we will move forward to the Centers for Medicaid and Medicare Services (CMS) for their final approval.

When this process is completed MDHHS will post information related to those settings that successfully completed the HS review and those that did not.

A consultative summary will be posted on this webpage following the completion of the HS review process where we will identify and respond to concerns noted.

There is no public hearing scheduled for the HS public comment. Input regarding HS is highly encouraged, and comments regarding this notice of intent may be submitted to Lorna Elliott-Egan, MDHHS Liaison to the Michigan tribes. Lorna can be reached at 517-512-4146 or via email at  Please provide all input by October 3, 2022.


If you encounter difficulties utilizing the survey webpage, please contact the help desk at

If you have questions related to the HCBS Final Rule policy, you may contact MDHHS at

If you need assistance identifying a setting, please  contact MDHHS at you must include the name and city of the setting in your email in order for us to assist you

For assistance related to the survey page  please contact


NEW Home and Community-Based Settings Regulation - Implementation Timeline Extension and Revised Frequently Asked Questions State Medicaid Director Letter

Extension of Transition Period for Compliance with HCBS Criteria

Final Rule

Medicaid Provider Manual Bulletin and New HCBS Chapter (Effective January 1, 2018)



Statewide Transition Plan

The Michigan Department of Health and Human Services developed a Statewide Transition Plan for bringing Medicaid waivers into compliance with the new rule. The Michigan Department of Health and Human Services submitted the first version of the Statewide Transition Plan to the Centers for Medicare and Medicaid Services on January 16, 2015.

The Centers for Medicare and Medicaid Services sent a response letter to the Department with requested revisions and clarifications to the Statewide Transition Plan. The letter is included below.

Letter from the Centers for Medicare and Medicaid Services 

L-20-54 (9/24/2020)

NEW - L 20-11 - MDHHS is accepting public comments on its revised Statewide Transition Plan - Comments due May 22, 2020

Revised Statewide Transition Plan for HCBS Waiver Programs (Oct 2020) 

Statewide Assessment, Remediation and Transition Strategy

Initial Approval Letter from the Centers for Medicare and Medicaid Services


Individual Waiver Transition Plans

The Centers for Medicare and Medicaid Services requires states to submit transition plans for individual waivers if the state makes an amendment to the waiver before the statewide implementation date. The Michigan Department of Health and Human Services has made amendments to three of its waivers: the MI Choice waiver, the Habilitations Supports Waiver, and the Waiver Program for Children with Serious Emotional Disturbances. These documents are available for your review at the links below:



Survey Tools and Process

As part of the transition process, the Department must determine whether settings under these waiver programs have "home and community-based" characteristics. For this purpose, the Department is developing a set of "survey tools" to assess individual settings for home and community-based characteristics.

The Department has published the survey tools for the following waiver programs.

1. MI Health Link HCBS Waiver

     A. Residential Survey - Sections 1 through 5

     B. Residential Survey - Section 6

     C. Non-Residential Survey - Section 1

     D. Non-Residential Survey - Section 2

2. MI Choice Waiver

     A. Residential Survey

     B. Non-Residential Survey

3. Habilitation Supports Waiver

     A. Participant Survey

     B. Residential Provider Survey

     C. Non-Residential Provider Survey

4.   Managed Specialty Services and Supports Waiver Program

      A. Participant Survey B Waiver

      B. Provider Survey B Waiver

      C. Home and Community Based Services (HCBS) 2018 Survey

5.  New Provider Provisional Approval Documents

     A.  MDHHS BHDDA New Home and Community Based Services Provider Requirements 

     B.  New HCBS Non-Residential Provisional Provider Survey (updated 12/2/2021)

     C.  New HCBS Residential Provisional Provider Survey (updated 12/2/2021)

6. Heightened Scrutiny Tools
These tools are not standalone documents. they are to be used in conjunction with each other and with the residential and non-residential surveys.

     A. MI Choice Participation Notification Settings in HS

     B. MI Choice Notification to Setting of HS status

     C. MI Choice Participation Letter of Upcoming Site visit

     D. MI Choice Setting Refusal Letter

     E. MI Choice Residential Site Survey

     F. MI Choice Non-Residential Site Visit Survey

     G. MI Choice Visit Staff Interview

     H. MI Choice Visit Participation Interview


For more information on the survey process for the Habilitation Supports Waiver (HSW) and Managed Specialty Services and Supports Waiver (B Waiver) HCBS Waiver, please send an email to


HCBS Surveys Memo


MDHHS and the Developmental Disabilities Institute developed the following documents to provide additional details on the survey process for the Habilitation Supports Waiver.

Memo on the National Core Indicators and Home and Community-Based Services Survey

Frequently Asked Questions for Survey Respondents


Remediation and Ongoing Compliance

The Michigan Department of Health and Human Services will post documents related to the remediation and ongoing compliance process on this page. These documents may provide further guidance to stakeholders regarding the implementation process for the rule and the process for individual settings to come into compliance.

The Michigan Department of Health and Human Services and the Department of Licensing and Regulatory Affairs have received several questions about how the rule intersects with state licensing laws. The two Departments issued the following guidance to stakeholders to help address these issues.

Heightened Scrutiny Setting Guidance Document

HCBS HS Provider Guidance (9/24/2020)

Managed Specialty Services and Supports Waiver (MSS and S) Documentation Guidance

Non-Residential Settings - HCBS Heightened Scrutiny Review Documentation Guidance

Residential Settings - HCBS Heightened Scrutiny Review Documentation Guidance

Summary of Resident Rights

MDHHS/LARA Joint Guidance Document

HCBS Provider Readiness Tool - Non-Residential Settings

HCBS Provider Readiness Tool - Residential Settings

HCBS Heightened Scrutiny Flowchart:  Isolation

HCBS Heighted Scruitny Flowchart:  Instution

HCBS Heightened Scrutiny Process

CAP Guidance Table


For additional information on licensing rules, please visit the Department of Licensing and Regulatory Affairs website through the following link.


Outreach and Education

Centers for Medicare and Medicaid Services (CMS) Webpage for the Rule (The federal toolkit for implementation as well as exploratory assessment questions are posted here.)

Guide for Individuals and Families (3/1/2020)

HCBS and Person Centered Planning (3/1/2020)

Person Centered Planning Toolkit for Individuals and Family Members (8/31/2020)

Person Centered Planning Fact Sheet for Individuals and Family Members (8/31/2020)

Person Centered Planning Frequently Asked Questions for Individuals and Family Members (8/31/2020)

HCBS Rule Heightened Scrutiny Guide for Individuals and Family Members (10/11/2019)

HCBS Guide for Individuals and Family Members - One Pager (8/31/2020)

HCBS Guide for Individual and Family Members

Updated HCBS Frequently Asked Questions (August 2020)

HCBS Reports in WSA for HSW Webinar

MI Choice and MI Health Link Educational Document

Centers for Medicare and Medicaid Services (CMS) Advisory on Home and Community-Based Settings

Developmental Disabilities Council Presentation

Medicaid Provider Manual Policy Bulletin MSA-17-31

Review of the Joint Guidance Document

2017 Waiver Conference Presentation



Home and Community Based Rule - Revised Heightened Scrutiny Process




HCBS Joint Guidance Document Webinar





Overview of Person Centered Planning Process Webinar Handouts

Overview of Person Centered Planning Process Webinar




Contact Information

BHDDA HCBS CMHSP Heightened Scrutiny Leads Contact Information (revised 2/13/2021)

HCBS PIHP Regional Leads Contact Information (revised 5/14/2021)

MDHHS Behavioral and Developmental Disabilities Administration HCBS transition e-mail

Developmental Disabilities Institute Home and Community Based Services Transition Webpage