This program allows Indiana Medicaid programs to pay for services that are provided in a person’s home or other community setting, rather than a Medicaid funded facility or institution. Persons must qualify for institutional care in order to be eligible for home and community-based services. Waiver refers to the waiving of certain federal requirements that otherwise apply to Medicaid program services. The Division of Aging oversees two waivers; they are the Aged and Disabled Waiver (A&D) and the Traumatic Brain Injury Waiver (TBI).
- Where to begin to become a HCBS waiver provider
- Current approved waivers
- Public Notice Regarding Renewal of the Aged & Disabled Waiver January 31, 2018
- HCBS Proposed Waiver Rates Effective as of July 1, 2018
Aged and Disabled Waiver (A&D)
The Aged & Disabled (A&D) Waiver provides an alternative to nursing facility admission for adults and persons of all ages with a disability. The waiver is designed to provide services to supplement informal supports for people who would require care in a nursing facility if waiver or other supports were not available. Waiver services can be used to help people remain in their own homes, as well as assist people living in nursing facilities to return to community settings such as their own homes, apartments, assisted living or Adult Family Care.
The Traumatic Brain Injury (TBI) waiver provides home and community-based services to individuals who, but for the provision of such services, would require institutional care. Through the use of the TBI, the Indiana Office of Medicaid Policy and Planning and the Indiana Division of Aging seek to increase availability and access to cost-effective traumatic brain injury waiver services to people who have suffered a traumatic brain injury. Indiana defines a traumatic brain injury as a trauma that has occurred as a closed or open head injury by an external event that results in damage to brain tissue, with or without injury to other body organs. Examples of external agents are: mechanical; or events that result in interference with vital functions. Traumatic brain injury means a sudden insult or damage to brain function, not of a degenerative or congenital nature. The insult of damage may produce an altered state of consciousness and may result in a decrease in cognitive, behavioral, emotional, or physical functioning resulting in partial or total disability not including birth trauma related injury.
Program of All-Inclusive Care for the Elderly (PACE®)
The Program of All-Inclusive Care for the Elderly (PACE®) model is centered on the belief that it is better for the well-being of seniors with chronic care needs and their families to be served in the community whenever possible. PACE serves individuals who: are ages 55 or older; certified by their state to need nursing home care; able to live safely in the community at the time of enrollment; and live in a PACE service area. While all PACE participants must be certified to need nursing home care to enroll in PACE, only about seven percent of PACE participants nationally reside in a nursing home. If a PACE enrollee needs nursing home care, the PACE program pays for it and continues to coordinate the enrollee's care.
Delivering all needed medical and supportive services, a PACE program is able to provide the entire continuum of care and services to seniors with chronic care needs while maintaining their independence in their home for as long as possible. Services include the following:
- adult day care that offers nursing, physical, occupational and recreational therapies, meals, nutritional counseling, social work, and personal care;
- medical care provided by a PACE physician familiar with the history, needs, and preferences of each participant;
- home health care and personal care;
- all necessary prescription drugs; • social services; • medical specialties, such as audiology, dentistry, optometry, podiatry, and speech therapy;
- respite care;
- hospital and nursing home care when necessary; and
The Franciscan Senior Health & Wellness PACE program currently provides services to older adults who live in the following ZIP codes in Indianapolis, Beech Grove, Greenwood, Franklin and Johnson County: 46201, 46219, 46229, 46203, 46107, 46237, 46239, 46227, 46259, 46142, 46143, 46184, and 46131. For more information, please contact Area 8, CICOA Aging & In-Home Solutions at 317-254-5465.
The Division of Aging (DA) is continuing the hiatus for Adult Family Care and Structured Day Program provider applications through approximately February, 2018.
Effective September 1, 2017, the DA is lifting the hiatus for Adult Day Service providers that are NOT presumed institutional.
Effective March 6, 2017, the DA is lifting the hiatus for Assisted Living providers that are NOT presumed institutional, i.e. those that are free-standing, not co-located with a nursing facility and do not have a secure memory care unit.
Effective January 19, 2018, FSSA has decided to suspend current efforts regarding the Settings Rule and regroup to better reflect the partnerships between FSSA, the Indiana State Department of Health and other regulatory agencies to work with stakeholders, including CMS, as we better understand how to meet our members’ needs. As a result, there is a hiatus in place on the certification of any new assisted living, adult day service, or adult family care providers until further notice.
During the hiatus, DA will continue to process changes of ownership for providers.
The purpose of the hiatus is to allow the DA time to develop a transition plan for Home and Community-Based Services following the March 17, 2014, Centers for Medicare and Medicaid Services (CMS) rule. This CMS rule requires states to ensure that all Medicaid Waiver services are delivered in settings that meet the requirements of a home and community-based setting.
For additional details regarding the CMS rule and the DA’s implementation please visit http://www.in.gov/fssa/4917.htm.
Please note that effective March 1, 2017, new Assisted Living providers will need to include with their application for certification a waiver of RCF licensure provisions approved by the Indiana State Department of Health for those requirements that are in conflict with the Settings Rule. Additionally, they will need to include a copy of their standard lease/residency agreement. Providers are also reminded to use the new AL Certification Tool for their self-assessment as it will be used by DA staff doing their site surveys and to include a copy of their standard lease/residency agreement with their documentation.
After reviewing the information provided above you will need to complete an application for certification. A table indicating required documents for each waiver service is available for you to review. Any additional questions or inquiries may be submitted to the Waiver Provider Specialist by phone at 317-232-4650 or by email at firstname.lastname@example.org.
Please note:The Division of Aging office in Indianapolis is not set up to accommodate walk-ins. We urge you to use the tools and information on the website first. Again, questions may be emailed to email@example.com, as most questions can be resolved by email or phone call. If it becomes necessary to have an in-person meeting, Division staff will schedule a meeting with you in advance.
Please submit final application and all required documents at firstname.lastname@example.org and paper applications will continue to be accepted and may be mailed o the address below.
ATTN: Waiver/Provider Analyst
Family and Social Services Administration
Indiana Health Coverage Programs (IHCP)
DA Home and Community-Based Services Waivers
402 West Washington Street, Room W454, MS 21
P.O. Box 7083
Indianapolis, IN 46027
Once all documentation and forms are received by the Division of Aging, the Waiver Provider Analyst will review your Provider Application packet. There may be some follow-up questions or additional information needed. You may be contacted via email or telephone. It is important that you reply as soon possible in order to avoid any unnecessary delays in processing your application. If the necessary documentation is not submitted in a timely manner, the application may be returned to you with the request to resubmit.
- If you are applying to be an Assisted Living provider or an Adult Day Services provider, you will also need to have an onsite survey conducted by the Division of Aging.
- If you are applying to be an Assisted Living provider, you must complete a Disclosure for Housing with Services Establishments form, downloadable here.
- Upon completion of the application process through the Division of Aging, you will be notified by mail that your certification has been approved or denied. Information regarding the appeal process will also be included, in the event your application is denied.
- If approved, you will then be directed to download your Indiana Health Coverage Programs Waiver Billing Provider Application and Profile Maintenance packet through HP. (See HCBS waiver manual, Section 1. Helpful hints are also included). You will be notified by letter when the process is complete and your waiver billing number is assigned.
- NOTE: YOU MUST SUBMIT YOUR APPLICATION TO HP WITHIN 90 DAYS OF RECEIPT OF YOUR WAIVER PROVIDER CERTIFICATION FROM THE DIVISION OF AGING
- You may begin providing services when you receive you HP billing number, are activated in the waiver provider database and receive your Notice of Action.