In accordance with public notice requirements established at 42 CFR 447.205, the Indiana Family and Social Services Administration (FSSA) Office of Medicaid Policy and Planning intends to submit proposed amendments to the Aged and Disabled (A&D) Waiver and the Traumatic Brain Injury (TBI) Waiver to the Centers for Medicare and Medicaid Services (CMS) for consideration in October 2019. The waiver amendments will allow the DA to continue providing home and community-based services to individuals who, but for provisions of such services, would require institutional care. The goal of the waivers is to ensure qualified individuals continue to receive the appropriate services based on their needs and the needs of their families.

The proposed A&D and TBI amendments seek to increase the rates for the care manager service and payment methodologies. The increased rates for the care manager service aligns with the DA's efforts to ensure compliance with the HCBS Settings final rule by March 2022, as outlined in Indiana's Statewide Transition Plan. DA is updating service definition language in an effort to use more person-centered language for compliance to the HCBS Settings final rule. One example is the DA is changing the name of the Case Manager Service to Care Manager Service. The DA has also removed sociology degrees as a way to bypass the work requirement for the Care Manager Service. The DA is separating the requirements for the care manager and the requirements for the providers with regard to most of the documentation standards. The DA is updating the eligibility section to reflect the use of nursing facility level of care (NFLOC) and to better reflect the eligibility process. The 450 B form has been eliminated, and the DA is updating the number of unduplicated participants. The DA is also updating the medication management section to better reflect the DA provider requirements. The proposed TBI waiver amendment also includes the new payment methodologies to promote person-centered services, financial transparency, and sustainability. The amendment also proposes several changes throughout including an updated quality improvement strategy, clarification of services provided under this waiver with updated service definitions, system improvements, and system design changes.

A&D Waiver Amendment Fiscal Impact (in millions):

TBI Waiver Amendment Fiscal Impact (in millions):

The 30 day public comment period will run September 4, 2019, through October 4, 2019. Comments may be emailed to dacomments@fssa.in.gov or mailed to the address below:

The A&D and TBI waiver amendments are available for review and public comment on the DA Medicaid Public Comment Webpage located at https://www.in.gov/fssa/da/5479.htm. Hard copies of the proposed renewal are available upon request by emailing dacomments@fssa.in.gov. Copies of the renewal are also available at local Division of Family Resources offices as well as local Area Agencies on Aging. In-person consultations or phone calls are available upon request.

Jennifer Walthall, MD, MPH

Secretary

Family and Social Services Administration