Division of Aging Follow Up to Settings Rule Meeting on 8/3/20

A message and update from

Darcy Tower, MSW

Provider Relations Director

Division of Aging – FSSA

Dear, Providers,

We appreciate your willingness to participate in the Settings Rule discussion on Monday, 8/3/2020.  The Division of Aging recognizes facilities are inundated working to care for residents during COVID, and we want to be as supportive and helpful to you as we’re able with regard to Settings Rule remediation.

In order to keep our momentum moving forward with Settings Rule remediation, the Division of Aging has compiled the attached questions from CMS to help us better understand how your assisted living facility is separate from your nursing facility.  The intent of these questions is to help the Division of Aging assist each facility in overcoming a presumed institutional designation.  Our goal is to assist providers in showing CMS how our co-located facilities render quality, person centered, home and community based services.  These 17 questions will inform the division about each facility’s practices so we are able to best represent the good work you do.  Your responses to the attached questions will assist the division in informing CMS.  Please submit your responses to Patti.Bailey@fssa.in.gov no later than December 31, 2020.

Once the division receives your responses, we will summarize your answers to post for public comment per CMS guidance.  Prior to submitting these summaries for public comment, we will share the summary with each individual facility to ensure it represents the facility’s work.  As we mentioned during the 8/3/2020 meeting, CMS has required States to post information about presumed institutional facilities for public comment.  As opposed to submitting detailed packets about each facility for public viewing, CMS is allowing States to summarize the work of facilities to demonstrate how assisted living is separate from the nursing facility.

As you review the attached document, you will see that CMS requests documentation from each facility, this documentation is not yet needed by the Division of Aging, but the Division does expect to eventually need this information, so please feel free to include now if the information is easily available.

As you review the attached document, there may be some concern about submitting “financial documentation” to CMS.  As outlined in questions 4, 5, & 6 from the CMS guidance link below, all speak to interconnectedness including financial. The division’s interpretation is that these CMS questions are not individually deterministic, but instead will likely be a totality review. Therefore, if a co-located facility is separated by means other than physical, such as operating as a separate legal entity, or the facility retains separate accounting, or has different personnel, etc., then that would likely be a positive for a potential CMS review. However, any one of these factors by themselves would be unlikely to either gain an approval or a denial from CMS.


If you have questions about the intent of any of the attached questions, please feel free to reach out to myself or Jesse Wyatt for additional clarification.  We are here to help you through this process!

We appreciate your collaboration!

Darcy Tower, MSW

Provider Relations Director

Division of Aging – FSSA

402 W. Washington St. RM W454

Indianapolis, IN 46204-7083