TITLE 455 DIVISION OF AGING
Proposed Rule
LSA Document #06-129
DIGEST
Adds 455 IAC, concerning the Division of Aging's adult foster care service under the Aged and Disabled Waiver administered by the Family and Social Services Administration, to include sections regarding provider requirements, including eligibility, enrollment, certification, training, and care and service standards, provisions for consumer eligibility requirements, both medical and financial, as well as provisions regarding an assessment tool and consumer rights, case manager responsibilities, sections for quality assessment, monitoring, and provider compliance, and necessary definitions. Effective 30 days after filing with the Publisher.
SECTION 1.
455 IAC IS ADDED TO READ AS FOLLOWS:
TITLE 455 DIVISION OF AGING
ARTICLE 1. (RESERVED)
ARTICLE 2. (RESERVED)
ARTICLE 3. ADULT FOSTER CARE SERVICE PROVISION AND CERTIFICATION STANDARDS IN THE AGED AND DISABLED WAIVER
Rule 1. Purpose
455 IAC 3-1-1 General statement of purpose and intention of program
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 1. (a) AFC is a comprehensive service provided under the aged and disabled (A & D) HCBS Medicaid waiver, as administered through the family and social services administration's division of aging. This article refers specifically to the service as provided in the A & D waiver.
(b) An AFC consumer resides with a caregiver and up to two (2) other consumers, in a home owned, rented, or managed by the AFC provider, in order to receive personal assistance in a home setting that is safe and secure. The provider may not provide services to more than three (3) individuals within the home including private pay consumers.
(c) The goal of the HCBS Medicaid waiver service is to provide necessary care while emphasizing the consumer's independence. This goal is reached through a cooperative relationship between the:
(1) consumer or the consumer's legal guardian;
(2) consumer's HCBS Medicaid waiver case manager; and
(3) care provider;
in a setting that protects and encourages consumer dignity, choice, and decision-making. Consumer needs must be addressed in a manner that supports and enables the individual to maximize abilities to function at the highest level of independence possible. The service is designed to provide options for alternative long term care to persons who meet nursing facility level of care and whose needs can be met in an AFC setting.
(d) The goal is to preserve the dignity and self-respect by ensuring high quality, professional care in a noninstitutional setting. Care is to be furnished in a way that fosters the independence of each consumer to facilitate aging in place in a home environment that will provide the consumer with a range of care options as the needs of the consumer change.
(Division of Aging; 455 IAC 3-1-1)
Rule 2. Applicability
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 1. This article applies to the AFC program, a comprehensive service provided under the aged and disabled Medicaid waiver, as administered through the family and social services administration's division of aging.
(Division of Aging; 455 IAC 3-2-1)
Rule 3. Definitions
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 1. The definitions in this rule apply throughout this article.
(Division of Aging; 455 IAC 3-3-1)
455 IAC 3-3-2 "Activities of daily living" or "ADL" defined
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 2. "Activities of daily living" or "ADL" means a measurement of an individual's degree of independence when:
(1) eating;
(2) bathing;
(3) dressing;
(4) moving from one (1) place to another; and
(5) toileting.
The term also refers to an activity described in the long term care services eligibility screen referred to in IC 12-10-10-6.3.
(Division of Aging; 455 IAC 3-3-2)
455 IAC 3-3-3 "Adult foster care" or "AFC" defined
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 3. "Adult foster care" or "AFC" means a comprehensive service provided under the A & D Medicaid waiver in which a consumer of services resides with an unrelated caregiver and up to two (2) other consumers, in a home owned, rented, or managed by the AFC provider, in order to receive personal assistance designed to provide options for alternative long term care to persons who meet nursing facility level of care and whose needs can be met in an AFC setting.
(Division of Aging; 455 IAC 3-3-3)
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 4. "AFC home" means, as provided under the A & D waiver, the family home in which consumer care is provided to three (3) or fewer elderly individuals or adults with either physical or cognitive disabilities, or both, who are not members of the provider's or primary caregiver's family, in which care is provided in a home-like environment for compensation. For the purpose of these certification standards, the AFC home does not include any house, institution, hotel, or other similar living situation that supplies room or board, or both, only, if no consumer thereof requires any element of care.
(Division of Aging; 455 IAC 3-3-4)
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 5. "AFC provider" means a provider of AFC services who is enrolled in the HCBS Medicaid waiver programs for persons who are aged or medically disabled.
(Division of Aging; 455 IAC 3-3-5)
455 IAC 3-3-6 "Advance directive" defined
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 6. "Advance directive" means the legal document signed by the consumer giving instructions for health care should he or she no longer be able to give directions regarding his or her wishes. The directive gives the consumer the means to continue to control his or her own health care in any circumstance.
(Division of Aging; 455 IAC 3-3-6)
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 7. "Aging in place" means residing in a care environment that will provide the consumer with a range of care options as the needs of the consumer change. Aging in place does not preclude assisting a consumer in relocating to a new care environment, if necessary.
(Division of Aging; 455 IAC 3-3-7)
455 IAC 3-3-8 "Area agency on aging" or "AAA" defined
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 8. "Area agency on aging" or "AAA" means an established public agency within a planning and service area designated under Section 305 of the Older Americans Act that:
(1) has responsibility for assisting individuals in the waiver process; and
(2) contracts with the state to perform specific activities in relation to administration of the HCBS Medicaid waiver program.
(Division of Aging; 455 IAC 3-3-8)
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 9. "Attendant care" has the meaning set forth in 460 IAC 1-8-1(c).
(Division of Aging; 455 IAC 3-3-9)
455 IAC 3-3-10 "Behavioral interventions" defined
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 10. "Behavioral interventions" means those interventions that are intended to modify the consumer's behavior or the consumer's environment.
(Division of Aging; 455 IAC 3-3-10)
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 11. "Caregiver" means any person responsible for providing care and services to consumers, including the following:
(1) The provider.
(2) The primary caregiver.
(3) Any substitute or caregiver designated to provide care and services to consumers.
(Division of Aging; 455 IAC 3-3-11)
455 IAC 3-3-12 "Care plan" or "plan of care" defined
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 12. "Care plan" or "plan of care" means a plan that is written by the case manager from the comprehensive AFC assessment to establish supports and strategies intended to accomplish the individual's long term and short term goals by accommodating the financial and human resources offered, as well as behavioral-related assistance to the individual through paid provider services or volunteer services, or both, as designed and agreed upon by the individual.
(Division of Aging; 455 IAC 3-3-12)
455 IAC 3-3-13 "Case management services" defined
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 13. (a) "Case management services" means a comprehensive service comprised of a variety of specific tasks and activities designed to coordinate and integrate all other services required in the consumer's care plan. Case management is required in conjunction with the provision of any HCBS.
(b) Responsibilities that are included within case management services are found in 455 IAC 3-15.
(Division of Aging; 455 IAC 3-3-13)
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 14. "Case manager" means an individual that provides case management services to HCBS Medicaid waiver consumers as described under section 13 of this rule.
(Division of Aging; 455 IAC 3-3-14)
455 IAC 3-3-15 "Certification standards" defined
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 15. "Certification standards" means the specific AFC service standards established by this article and HCBS Medicaid waiver certification standards for all consumers and providers who participate in any of the HCBS Medicaid waiver programs for persons who are aged or medically disabled.
(Division of Aging; 455 IAC 3-3-15)
455 IAC 3-3-16 "Chemical restraint" defined
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 16. "Chemical restraint" means the use of any chemical method used to restrict the consumer's activities and behavior.
(Division of Aging; 455 IAC 3-3-16)
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 17. "Choice" means viable options that enable a consumer to exercise greater control over his or her life. Choice is supported by the provision of sufficient private and common space within the home to provide opportunities for consumers to select where and how to spend time and receive personal assistance.
(Division of Aging; 455 IAC 3-3-17)
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 18. "Complaint" means:
(1) an allegation that a provider has violated the provisions of this article;
(2) dissatisfaction relating to the condition of the AFC home or the consumer or consumers arising out of such an alleged violation; or
(3) any situation in which the consumer feels his or her rights have been violated by the provider.
(Division of Aging; 455 IAC 3-3-18)
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 19. "Consumer" means an individual who is eligible for the HCBS Medicaid waiver program under 460 IAC 1.2, and receives those services in an AFC home; a person living in an AFC setting for whom the service of AFC is paid through the FSSA waiver services HCBS Medicaid waiver program. The term includes the following:
(1) Former consumers when examining complaints about admissions, readmissions, transfers, or discharges.
(2) For decision-making purposes, the consumer's surrogate decision-maker in accordance with state law or at the consumer's request.
(Division of Aging; 455 IAC 3-3-19)
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 20. "Consumer contract" means an agreement or contract completed by the AFC services provider for each potential consumer that includes the following:
(1) A description of the following:
(A) Services to be provided to the consumer.
(B) The contract modification process.
(C) The complaint resolution process.
(2) Specific house rules.
(3) Other general information.
(Division of Aging; 455 IAC 3-3-20)
455 IAC 3-3-21 "Consumer rights" or "rights" defined
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 21. "Consumer rights" or "rights" means:
(2) the rights of citizenship that cannot be preempted by:
(A) this article;
(B) certification standards; or
(C) any other aspect of services provided in an AFC setting.
(Division of Aging; 455 IAC 3-3-21)
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 22. "DDRS" means the division of disability and rehabilitative services as established by IC 12-9-1-1, a division within FSSA in which the bureau of quality improvement services (BQIS) is located.
(Division of Aging; 455 IAC 3-3-22)
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 23. "Dignity" means providing support in such a way as to validate the self-worth of the individual. Dignity is supported by:
(1) designing a structure that allows personal assistance to be provided in privacy; and
(2) delivering services in a manner that shows courtesy and respect.
(Division of Aging; 455 IAC 3-3-23)
455 IAC 3-3-24 "Division of aging" or "division" defined
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 24. "Division of aging" or "division" means the division of aging as established by IC 12-9.1-1-1.
(Division of Aging; 455 IAC 3-3-24)
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 25. "Elderly" or "aged" means any person sixty-five (65) years of age or older who is in need of care provided under this article.
(Division of Aging; 455 IAC 3-3-25)
455 IAC 3-3-26 "FSSA waiver services" defined
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 26. "FSSA waiver services" means the unit within the division under which the HCBS Medicaid waiver program is administered. For purposes of this article, it may also include any designee providing oversight or collaboration regarding the provision of AFC service under the A & D waiver. This may include:
(1) other bureaus under DDRS;
(2) the OMPP;
(3) the division; or
(4) contractors or other entities to which FSSA waiver service duties have been formally delegated.
(Division of Aging; 455 IAC 3-3-26)
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 27. "HCBS" means home and community based services.
(Division of Aging; 455 IAC 3-3-27)
455 IAC 3-3-28 "HCBS Medicaid provider agreement" defined
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 28. "HCBS Medicaid waiver provider agreement" means a provider agreement signed by an AFC provider who is enrolled in the HCBS Medicaid waiver program.
(Division of Aging; 455 IAC 3-3-28)
455 IAC 3-3-29 "HCBS Medicaid waiver program" defined
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 29. "HCBS Medicaid waiver program" means supportive services provided by the HCBS Medicaid waiver program to help functionally impaired older adults or persons with disabilities living in the community to remain independent or self-sufficient. The functional impairment may be:
(1) temporary;
(2) short term; or
(3) a permanent or lasting condition.
(Division of Aging; 455 IAC 3-3-29)
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 30. "Home" means, for the purposes of this article, the physical structure:
(1) in which up to three (3) consumers and their caregiver live; and
(2) where AFC services under this article are provided.
(Division of Aging; 455 IAC 3-3-30)
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 31. "Home-like" means an environment that has the qualities of a home, including privacy, comfortable surroundings, and the opportunity to modify one's living area to suit one's individual preferences, which:
(1) promotes the dignity, security, and comfort of consumers through the provision of personalized care and services to encourage independence, choice, and decision-making by the consumers; and
(2) provides consumers with an opportunity for self-expression and encourages interaction with the community, family, and friends.
(Division of Aging; 455 IAC 3-3-31)
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 32. "House rules" means written rules managing or organizing home activities in an AFC home that are:
(1) developed by the provider or primary caregiver, or both; and
(2) approved by the HCBS Medicaid waiver program.
House rules may not be so restrictive as to interfere with a consumer's or citizen's rights under state and federal law.
(Division of Aging; 455 IAC 3-3-32)
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 33. "Independence" means:
(1) free from the control of others; and
(2) being able to assert one's own:
(A) will;
(B) personality; and
(C) preferences;
within the parameters of the house rules or consumer agreement.
(Division of Aging; 455 IAC 3-3-33)
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 34. "Level of service" means the specific level of service that the provider is authorized to provide:
(1) in accordance with the consumer's plan of care; and
(2) based on the assessed impairment level of the consumer.
(Division of Aging; 455 IAC 3-3-34)
455 IAC 3-3-35 "Level of service assessment tool" defined
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 35. "Level of service assessment tool" means the assessment instrument provided by the division that is utilized to determine the appropriate level of service to be provided and paid according to three (3) impairment levels, with:
(1) level 1 being the least impaired and most independent; and
(2) level 3 being the most impaired and least independent.
(Division of Aging; 455 IAC 3-3-35)
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 36. "Medical emergency" means:
(1) a change in the consumer's medical condition that requires immediate care of a level or type that the provider is unable to provide; or
(2) behavior that poses an imminent danger to the consumer or to other consumers or people living in the home.
(Division of Aging; 455 IAC 3-3-36)
455 IAC 3-3-37 "Medically disabled" or "disabled" defined
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 37. "Medically disabled" or "disabled" means a person who is eighteen (18) years of age or older with a physical, cognitive, or emotional impairment that, for the individual, constitutes or results in a functional limitation in ADL. The individual must meet nursing facility level of care to obtain AFC services.
(Division of Aging; 455 IAC 3-3-37)
455 IAC 3-3-38 "Medication management" defined
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 38. "Medication management" means:
(1) the provision of reminders or cues;
(2) the opening of preset commercial medication containers; or
(3) providing assistance in the handling or ingesting of medication.
For purposes of this definition, prescription and over-the-counter medications are included within the meaning of medication.
(Division of Aging; 455 IAC 3-3-38)
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 39. "Occupant" means anyone residing in or using the facilities of the AFC home including any of the following:
(1) The consumer.
(2) The provider.
(3) The primary caregiver.
(4) A substitute caregiver.
(5) A family member.
(Division of Aging; 455 IAC 3-3-39)
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
(Division of Aging; 455 IAC 3-3-40)
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 41. "OMPP" means the office of Medicaid policy and planning within the family and social services administration as established in IC 12-8-6-1.
(Division of Aging; 455 IAC 3-3-41)
455 IAC 3-3-42 "Physical restraint" defined
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 42. "Physical restraint" means any manual method or physical or mechanical device, material, or equipment attached to, or adjacent to, the consumer's body that the consumer cannot easily remove and restricts freedom of movement or normal access to his or her body. Physical restraints may include, but are not limited to, the following:
(1) Leg restraints.
(2) Soft ties or vests.
(3) Hand mitts.
(4) Wheelchair safety bars.
(5) Lap trays.
(6) Any chair that prevents rising.
(7) Gerichairs.
Side rails (bed rails) are considered restraints when they are used to prevent a consumer from getting out of a bed. When a consumer requests a side rail, for example, for the purpose of assisting with turning, the side rail is not considered a restraint.
(Division of Aging; 455 IAC 3-3-42)
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 43. "Primary caregiver" means the person:
(1) with whom the consumer resides; and
(2) who provides AFC services to the consumer on a regular basis under the jurisdiction of the FSSA waiver services HCBS Medicaid waiver program.
This person may be, but is not required to be, the provider. In homes in which the primary caregiver is not the provider, he or she is a contracted employee of that AFC service provider. The primary caregiver is the resident manager of AFC services for each consumer residing in that AFC home.
(Division of Aging; 455 IAC 3-3-43)
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 44. "Provider" means an individual, partnership, corporation, or other entity, that:
(1) enters into an agreement with FSSA waiver services HCBS Medicaid waiver program to provide AFC services to HCBS consumers; and
(2) is the person or persons responsible for the provision of room, board, care, and services in the daily operation of the home.
The provider may be, but is not required to be, the primary caregiver.
(Division of Aging; 455 IAC 3-3-44)
455 IAC 3-3-45 "Psychoactive medications" defined
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 45. "Psychoactive medications" means various medications used to alter mood, anxiety, behavior, or cognitive processes. For the purpose of this article, they include, but are not limited to, all of the following:
(1) Antipsychotics.
(2) Sedatives.
(3) Hypnotics.
(4) Antianxiety medications.
(Division of Aging; 455 IAC 3-3-45)
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 46. "Reside" means to make the AFC home the person's permanent residence.
(Division of Aging; 455 IAC 3-3-46)
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 47. "Room and board" means the provision of the following:
(1) Meals.
(2) A place to sleep.
(3) Laundry.
(4) Housekeeping.
(5) Furniture.
(6) Linens.
(Division of Aging; 455 IAC 3-3-47)
455 IAC 3-3-48 "Self-administration of medication" defined
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 48. "Self-administration of medication" means the act of a consumer placing a medication in or on his or her own body. This means the consumer manages and takes his or her own medications, in that the consumer:
(1) identifies the medication and the times and manners of administration; and
(2) places the medication internally or externally on his or her own body without assistance.
This may include reminders, cues, or opening of medication containers by caregiver when requested by a consumer. This does not include assistance with prescription eye drops, which must be self-administered.
(Division of Aging; 455 IAC 3-3-48)
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 49. "Self-preservation", in relation to private residence fire and life safety, means the ability of a consumer to:
(1) respond to an alarm without additional cues; and
(2) be able to reach a point of safety on their own.
(Division of Aging; 455 IAC 3-3-49)
455 IAC 3-3-50 "Substitute caregiver" defined
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 50. "Substitute caregiver" means any person who provides AFC services in an AFC home under the jurisdiction of the FSSA waiver services HCBS Medicaid waiver program, other than the provider or primary caregiver. This person may be subcontracted or employed by the provider to provide this service.
(Division of Aging; 455 IAC 3-3-50)
Rule 4. Provider Requirements
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 1. (a) The AFC service provider must follow the current provisions of the provider application, provider agreement, and this article, and eligibility determination as prescribed by the division or its designee. All:
(1) steps must be followed and documented; and
(2) standards required for Medicaid waiver provider status must be met;
in order to obtain certification. The burden of proof must be upon the provider to establish compliance with the requirements of this section.
(b) AFC providers are individuals who are willing to share their home and family life with up to three (3) eligible disabled or elderly persons.
(c) The provider cannot be the parent of:
(1) a minor child of;
(2) the spouse of; or
(3) another relative related by blood or marriage to;
the consumer.
(d) The provider must:
(1) be at least 21 years of age; and
(2) live in a setting that is suitable for the provider and the consumer or consumers.
(e) An AFC home provider must live in the home that is to be enrolled, unless another provider-contracted primary caregiver lives in the provider's home. If the primary caregiver is not the provider:
(1) the same qualifications are required for that caregiver as those required for the provider; and
(2) the provider remains responsible for liability insurance under 455 IAC 3-6-4 and safety provisions found in 455 IAC 3-5.
(f) Caregivers other than the provider must be subcontractors or employees of the provider, and it will be the responsibility of the provider to ensure the state that these caregivers meet the same eligibility requirements. Documentation that subcontractors or employees meet the minimum provider requirements must be:
(1) kept in a provider's file; and
(2) available to FSSA waiver services at any point in the certification and ongoing monitoring process of that home.
(g) An AFC home provider must have a statement from a physician or other qualified practitioner indicating the provider and any caregivers, if applicable, are free from tuberculosis and other communicable diseases. There must be documentation of annual physicals for all caregivers.
(h) The provider and other caregivers, if applicable, must be physically, cognitively, and emotionally capable of providing care to each consumer.
(i) The provider and other caregivers, if applicable:
(1) are required to pass a state criminal background check obtained from the Indiana state police central repository meeting the requirements of section 3(9) of this rule prior to opening the home to consumers or working in the home; and
(2) must notify the division if they are convicted of a crime after they are certified.
(j) The AFC provider must have the ability to provide services for consumers in a manner and in an environment that encourages maintenance or enhancement of each consumer's quality of life and promotes the consumer's:
(1) privacy;
(2) dignity;
(3) choice;
(4) independence;
(5) individuality; and
(6) decision-making ability.
(k) If the provider or other caregivers, if applicable, have a documented history or substantial evidence of substance abuse or mental illness, they must provide evidence satisfactory to FSSA waiver services of successful treatment and rehabilitation.
(l) An AFC provider must:
(1) be literate;
(2) demonstrate the:
(A) understanding of written and oral orders; and
(B) ability to communicate with:
(i) consumers;
(ii) physicians;
(iii) case managers; and
(iv) appropriate others;
(3) be able to respond appropriately to emergency situations at all times;
(4) have a clear understanding of job responsibilities;
(5) have knowledge of consumer's care plans; and
(6) be able to provide or obtain the care specified for each consumer's needs.
(m) The provider must do the following:
(1) Provide assurances to FSSA waiver services of reliable backup for those times when the primary caregiver:
(A) must be absent from the home; or
(B) otherwise cannot provide the necessary level of care.
(2) Designate specific substitute caregivers who:
(A) meet caregiver qualifications; and
(B) will be available for any such absences.
The enrollment application must include a written plan on coverage during absence of the primary caregiver. The use of substitute caregivers must include assurances that the substitutes meet eligibility requirements of a provider in this rule.
(n) FSSA waiver services may deny an application for noncompliance with any requirements in this rule.
(Division of Aging; 455 IAC 3-4-1)
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 2. Enrollment application forms will be available from the division.
(Division of Aging; 455 IAC 3-4-2)
455 IAC 3-4-3 Provider enrollment; application requirements
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 3. The enrollment application for providers of AFC services must include the following information to be submitted by the provider applicant:
(1) The:
(A) maximum consumer capacity requested; and
(B) number of any other occupants, which is not to exceed three (3) consumers.
(2) The service level classification being requested with information and supporting documentation regarding the following:
(A) Qualifications.
(B) Relevant work experience.
(C) Training all caregivers as required by FSSA waiver services.
(3) A floor plan of the house showing the following:
(A) The location and size of rooms.
(B) Exits and directions for vacating the premises.
(C) Wheelchair ramps, if applicable.
(D) Smoke detectors.
(E) Fire extinguishers.
(4) A list of three (3) reliable references, all of whom must be unrelated to the provider, that have current knowledge of the provider-applicant's character and capabilities for providing care services.
(5) A written plan describing the planned operation of the AFC home, including the use of primary caregivers other than the provider and substitute caregivers.
(7) CPR and first aid certificates.
(8) A TB test and evidence of an annual physical by a physician or designee.
(9) A criminal background check that does not have any evidence of the following:
(B) Neglect, battery, or exploitation of an endangered adult (IC 35-46-1-12).
(D) Failure to report battery, neglect, or exploitation of an endangered adult or dependent (IC 35-46-1-13).
(Division of Aging; 455 IAC 3-4-3)
Rule 5. Certification of AFC Provider Home
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 1. An on-site review of the home will be completed in order to assess the provider's ability to safely and successfully provide AFC care of the consumer. FSSA waiver services will certify that the criteria set forth in this article are met during this initial certification inspection.
(Division of Aging; 455 IAC 3-5-1)
455 IAC 3-5-2 Home certification requirements; general requirements
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 2. (a) On-site provider files that document that all provider requirements set forth in this article are met must be present and made available for review by an inspector designated by FSSA waiver services.
(b) The division or a designee will conduct a home inspection to assure that all required standards as provided in this article are met in the physical home. The provider must provide documentary evidence to verify standards are met for criteria not visible to the inspector.
(c) Each AFC home must meet all applicable local zoning, building, and housing codes and state and local fire and safety regulations for a single family residence. The building and furnishings must be clean and in good repair. Grounds must be well-maintained. Walls, ceilings, and floors must be of such character to permit frequent washing, cleaning, or painting. There must be no accumulation of garbage, debris, rubbish, or offensive odors.
(d) AFC homes must meet all applicable state and local building, mechanical, and housing codes for private residence fire and life safety. At least one (1) working fire extinguisher must be:
(1) in a visible and readily accessible location on each floor, including basements; and
(2) inspected at least once a year.
Fire extinguishers must be tagged, with a signature and date of inspection.
(e) All consumers must have unobstructed passageways throughout the house.
(f) Interior and exterior stairways must be provided with handrails. Adequate lighting, based on the needs of the individual, must be provided in each room, stairway, and exit way. Light bulbs must be protected with appropriate covers. Yard approved exits and exterior steps must be accessible and appropriate to the condition and needs of the consumers.
(g) All exit doors and interior doors must have simple hardware that cannot be locked against exit without an obvious method of operation.
(h) The heating and cooling systems must be in working order. Areas of the home used by consumers must be properly ventilated and maintained at a safe and comfortable temperature. Heating and electrical equipment, including wood and alternative fuel stoves, must be installed in accordance with all manufacturer's specifications and applicable private residence fire and life safety codes. Such equipment must be:
(1) used and maintained properly; and
(2) in good repair.
(i) All common use areas of the house and exits must be barrier free, and corridors and hallways must be wide enough to accommodate a walker or wheelchair. Any bedroom window identified as an exit must be free of any obstacles at least the width of the window that would interfere with its being an exit. There must be a wheelchair ramp from a minimum of one (1) exterior door if nonambulatory persons are in residence. Wheelchair ramps must meet the standards of the Americans with Disabilities Act. Providers must bring existing ramps into revised compliance if necessary to meet the needs of new consumers or current consumers with increased care needs. Throw and scatter rugs are prohibited to avoid falls. There must be grab bars in the bathtub or shower. Each consumer must have their own bedroom with linens, a closet, and drawer space.
(j) There must be current readily available basic first aid supplies and a first aid manual.
(k) A public water supply must be utilized if available. If a nonmunicipal water source is used, minimum water quality standards must be met.
(l) Septic tanks or other nonmunicipal sewage disposal systems must be in good working order. Commodes must be emptied frequently, and incontinence garments will be disposed of in closed containers.
(m) Garbage and refuse must be suitably stored in clean, rodent-proof, covered containers, pending weekly removal.
(n) Prior to laundering, soiled linens and clothing must be stored in closed containers in an area separate from resident bedrooms and food storage, kitchen, and dining areas. Special prewash attention must be given to soiled and wet bed linens.
(o) Sanitation for household pets and other domestic animals must be adequate to prevent health hazards. Proof of rabies and other vaccinations required by a certified veterinarian must be maintained on the premises for household pets. Pets not confined in enclosures must:
(1) be under control; and
(2) not present a danger to consumers or guests.
(p) There must be adequate control of insects and rodents including screens on doors and windows that are used for ventilation.
(q) Universal precautions for infection control should be followed in consumer care. Hands and other skin surfaces must be washed immediately and thoroughly prior to and following the provision of assistance for a consumer.
(r) The AFC services provider must have readily available a copy of the address and telephone number of the:
(1) local or state long term care ombudsman program; and
(2) local AAA.
(s) The following must be posted or made readily available to the consumer and others:
(1) The FSSA provider agreement, with attached conditions to the agreement if applicable.
(2) A statement of consumer rights as stated in 455 IAC 3-14.
(3) The floor plan that indicates the fire evacuation route of the home.
(4) The house rules.
(5) The FSSA waiver services inspection form.
(6) The ombudsman poster.
(7) The division's designated procedures for making complaints.
(Division of Aging; 455 IAC 3-5-2)
455 IAC 3-5-3 Home certification requirements; bathroom specifications
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 3. (a) Consumers may share a bathroom; however, the bathroom must provide individual privacy and have the following:
(1) A finished interior with a mirror.
(2) A functioning window or other means of ventilation.
(3) A window covering.
(4) Tubs or showers.
(5) Toilets and sinks in good repair.
The rooms must be clean and free of objectionable odors.
(b) Bathrooms must have hot and cold water at each tub, shower, and sink in sufficient supply to meet the needs of the consumers. The hot water temperature in bathing areas must be supervised for persons unable to regulate water temperature. Shower curtains and doors must be clean and in good condition. Nonslip floor surfaces must be provided in tubs and showers.
(c) There must be safe and secure grab bars for toilets, tubs, or showers for consumer's safety. Bathrooms must have adequate supplies of toilet paper and soap. Consumers will be provided with individual towels and washcloths, which are laundered in hot water at least weekly or more often if necessary. There will be appropriate racks or hooks for drying bath linens.
(Division of Aging; 455 IAC 3-5-3)
455 IAC 3-5-4 Home certification requirements; bedroom specifications
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 4. (a) Providers, caregivers, or their family members must not share bedrooms with consumers. All consumers will have a private room unless the consumer insists on another arrangement. Each will be provided an individual bed that consists of a mattress and springs, or equivalent, in good condition. The following may not be used for consumers:
(1) Cots.
(2) Rollaway mattresses.
(3) Bunks.
(4) Trundles.
(5) Day beds with restricted access.
(6) Couches.
(7) Folding beds.
Day beds with good access may be used if this is the consumer's choice.
(b) Each consumer's bed must have clean bedding in good condition consisting of the following:
(1) A bedspread.
(2) A mattress pad.
(3) Two (2) sheets.
(4) A pillow with a pillowcase.
(5) Blankets adequate for the weather.
(c) Sheets and pillowcases must be laundered at least weekly and more often if soiled. Waterproof mattress covers must be used for incontinent consumers.
(d) Each bedroom must have sufficient space for each consumer's clothing and personal effects including hygiene and grooming supplies, and consumers will be allowed to:
(1) keep and use reasonable amounts of personal belongings; and
(2) have private, secure storage space.
(e) Drapes or shades for windows must:
(1) be in good condition; and
(2) allow privacy for consumers.
(f) Bedrooms must be on ground level for consumers who:
(1) are nonambulatory;
(2) have impaired mobility; or
(3) are cognitively impaired.
Consumers on the second floor or in the basement must demonstrate their self-preservation capability to self-exit or barricade, that is, close the door or stop smoke from coming under the door.
(g) Bedrooms will have at least one (1) window or exterior door that:
(1) can be readily opened from the inside without special tools; and
(2) provides a clear opening.
(Division of Aging; 455 IAC 3-5-4)
455 IAC 3-5-5 Home certification requirements; meal specifications
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 5. (a) Three (3) regularly scheduled nutritious meals must be offered daily. Nutritious snacks and liquids should be available and offered to fulfill each consumer's nutritional requirements. Special consideration must be given to consumers with chewing difficulties and other eating limitations.
(b) Food must not be used as an inducement to control the behavior of a consumer.
(c) Special diets are to be provided as prescribed in writing by the consumer's physician or nurse practitioner.
(d) Food should be stored and maintained at the correct temperature.
(e) Utensils, dishes, and glassware must be washed by dishwasher or by hand in hot soapy water, rinsed, and stored to prevent contamination.
(Division of Aging; 455 IAC 3-5-5)
455 IAC 3-5-6 Home certification requirements; communication
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 6. (a) A telephone should be provided in the home and made available and accessible for consumers' use in a location that allows for privacy for incoming and outgoing calls.
(b) Consumers with hearing impairments (to the extent that they cannot hear over a normal phone) will be provided with a telephone that is:
(1) amplified with a volume control; or
(2) hearing aid compatible.
(c) The telephone number for phones provided must be a listed number.
(d) Emergency telephone numbers must be posted by the telephone including an emergency number to reach a provider who does not live in the home. Telephone numbers for the state and local long term care ombudsman must also be posted.
(Division of Aging; 455 IAC 3-5-6)
455 IAC 3-5-8 Home certification requirements; smoke detectors
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 8. (a) Smoke detectors must be installed in accordance with the manufacturer's listing and be installed in the following areas:
(1) Each bedroom.
(2) In hallways or access areas that adjoin bedrooms.
(3) The family room or main living area where consumers congregate.
(4) The kitchen.
(5) Any interior designated smoking area.
(6) Basements.
In addition, in two (2) story houses, smoke detectors must be installed at the top of the stairway to the second floor. Ceiling placement of smoke detectors is recommended.
(b) Detectors must be equipped with a device that warns of low battery when battery operated or with a battery backup if hard wired. All smoke detectors are to be maintained in functional condition. Battery-operated smoke detectors must be tested monthly and batteries changed as appropriate, but at a minimum of at least once per year.
(c) Bedrooms used by hearing-impaired occupants who cannot hear a regular smoke alarm must be equipped with a visual/audio or vibration alerting smoke alarm as appropriate.
(d) All smoke detectors must:
(1) contain a sounding device; or
(2) be interconnected to other detectors;
to provide, when actuated, an alarm that is audible in all sleeping rooms.
(Division of Aging; 455 IAC 3-5-8)
455 IAC 3-5-9 Home certification requirements; hazardous materials
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 9. (a) Flammable and combustible liquids and hazardous materials must be safely and properly:
(1) stored in original, properly labeled containers or safety containers; and
(2) secured in areas to prevent tampering by consumers or vandals.
(b) Cleaning supplies, medical sharps containers, poisons, and insecticides must be properly stored in original, properly labeled containers in a safe area away from food preparation and storage areas, dining areas, and medications.
(c) Any firearms owned by the primary caregiver must be stored, unloaded, in a locked cabinet. The firearms cabinet must be located in an area of the home that is not accessible to consumers. Consumers are not allowed to bring firearms into the home. When firearms are present, this fact should always be addressed in the consumer risk contract for the benefit of consumer awareness. Any firearm accidents that would occur would be the responsibility of the provider.
(Division of Aging; 455 IAC 3-5-9)
455 IAC 3-5-10 Home certification requirements; fire evacuation
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 10. (a) An emergency evacuation plan must be developed, posted, and rehearsed with occupants at least quarterly.
(b) All caregivers must be required to demonstrate the ability to quickly evacuate all consumers from the home to the closest point of safety that is exterior to and away from the structure. If there are problems in demonstrating this evacuation time, conditions may be applied to the HCBS Medicaid waiver provider agreement that include, but are not limited to:
(1) reduction of consumers under care; or
(2) increased fire protection.
(c) Within twenty-four (24) hours of arrival, any new consumer or caregiver will:
(1) be shown how to:
(A) respond to a fire alarm; and
(B) evacuate from the home in an emergency; and
(2) receive an orientation to basic fire safety.
(d) The provider will provide, keep updated, and post a floor plan containing the following:
(1) Room sizes.
(2) The location of each consumer bedroom.
(3) Fire exits.
(4) The caregiver's sleeping room.
(5) Smoke detectors.
(6) Fire extinguishers.
A copy of this drawing will be submitted with the application and updated to reflect any change.
(e) There must be a second safe means of egress. Providers whose sleeping rooms are above the first floor may be required to demonstrate a fire exit drill from that room, using the secondary egress, at the time of enrollment, renewal, or inspection.
(f) There will be at least one (1) plug-in rechargeable flashlight available on each floor for emergency lighting that is checked on a monthly basis.
(g) Smoking regulations will be adopted to allow smoking only in designated areas. Smoking will be prohibited in:
(1) sleeping rooms;
(2) homes where oxygen is used; or
(3) garages where flammable materials are stored.
Ashtrays of noncombustible material and safe design must be provided in areas where smoking is permitted.
(Division of Aging; 455 IAC 3-5-10)
Rule 6. Record Keeping and Documentation
455 IAC 3-6-1 Provider enrollment and certification documentation
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 1. (a) The provider must maintain a file that includes copies of all the documentation required for the provider enrollment and certification process, as well as the documentation to substantiate that these requirements are maintained. These will include, but are not limited to, the following:
(1) Emergency plans and contact numbers.
(2) Training certifications for all caregivers.
(3) The provider's Medicaid provider agreement.
(4) Insurance documentation.
(5) Required health and safety records.
(b) In addition, the provider will maintain current and comprehensive consumer files.
(Division of Aging; 455 IAC 3-6-1)
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 2. (a) The provider must create and maintain a personal file for each consumer. This file must include all prudent, personal information about the consumer, including, but not limited to, the following:
(1) Name.
(2) Date of birth.
(3) Social Security number.
(4) Family contact.
(5) Medical information.
(6) Current plan of care.
(7) Documentation of all reported incidents involving the health and safety of the consumer.
(b) The provider is to be aware of and understand all privacy and Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations concerning the consumer's records and information.
(c) This file must also contain documentation that indicates whether or not a consumer has any of the following:
(1) Advance directives.
(2) A living will.
(3) A power of attorney.
(4) A health care representative.
(5) A do not resuscitate (DNR) order.
(6) A letter of guardianship.
If these documents exist, copies must be present in the file.
(d) The provider is required to document a consumer progress or status note at least once every seven (7) days.
(e) The provider must place a copy of the individual plan of care in the consumer's file.
(f) Consumer files for HCBS Medicaid waiver program consumers maintained by the provider must be readily available at the AFC home for all caregivers and to:
(1) representatives of FSSA waiver services conducting inspections or investigations;
(2) consumers;
(3) their authorized representative; or
(4) other legally authorized persons.
The ombudsman has access to all consumer and home files with consumer oral or written consent, and within the guidelines federal and state laws.
(g) Information related to a consumer must be kept confidential, except as may be necessary in the planning or provision of care or medical treatment, or related to an investigation or sanction action under these standards.
(Division of Aging; 455 IAC 3-6-2)
455 IAC 3-6-3 Consumer financial records
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 3. (a) If the provider manages or handles a consumer's money, a separate account record must be maintained in the consumer's name. The provider must not under any circumstances:
(1) commingle;
(2) borrow from; or
(3) pledge;
any funds of a consumer.
(b) The personal needs allowance for an HCBS Medicaid waiver consumer is to be used at the discretion of the consumer.
(c) Providers or caregivers must not influence, solicit from, or suggest to any consumer that they or their family give the caregiver or the caregiver's family money or property for any purpose. The provider or caregiver or the caregiver's family must not accept gifts or loans from the consumer or the consumer's family.
(d) Providers must maintain the following financial records on the premises with the consumer records:
(1) Agreements with:
(A) FSSA waiver services;
(B) the consumer;
(C) the consumer's relatives; or
(D) the person or persons paying for care;
along with any financial planning sheets if pertinent.
(2) A consumer account record of expenditures if the provider manages or handles a consumer's money. This record must show amounts and sources of funds received and issued to, or on behalf of, the consumer. Any purchases made on behalf of a consumer must be documented by receipts.
(Division of Aging; 455 IAC 3-6-3)
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 4. The provider must maintain liability insurance of at least one hundred thousand dollars ($100,000), as described in 460 IAC 1.2-12-1(4), to cover damage or loss of the consumer's property due to negligence of the insured or injury or harm to the consumer resulting from the provision of services or failure to provide needed services and incidents occurring in the AFC home or on the home's premises.
(Division of Aging; 455 IAC 3-6-4)
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 5. (a) Prior to admission, the AFC services provider must complete a consumer contract with each potential consumer or his or her designated representative. The contract must cover the following:
(1) The name of the provider.
(2) The street address.
(3) The mailing address of the AFC home.
(4) The term of the contract.
(5) A description of the following:
(A) Services to be provided to the consumer.
(B) Additional services provided outside of the waiver program, but for which the provider may assist by arrangement of appointments or provision of transportation.
(C) The process through which the contract may be modified, amended, or terminated.
(D) The complaint resolution process available to the consumers.
(6) The name of the consumer's designated representative, if applicable.
(7) Any specific information related to any house rules, which must not be in conflict with the:
(A) consumer rights as defined in this article; or
(B) family atmosphere of the home.
House rules are subject to review and approval by FSSA waiver services prior to HCBS Medicaid waiver program enrollment.
(b) The consumer contract is to be reviewed annually by the:
(1) case manager;
(2) provider;
(3) caregiver; and
(4) consumer or consumer's family members.
(c) Consumers must not be liable for damages considered normal wear and tear. The AFC provider:
(1) will not include any provision in a consumer agreement or disclosure statement that is in conflict with this article or other applicable law;
(2) must not ask or require a consumer to waive any of the consumer rights or the facility's liability for negligence;
(3) must retain a copy of the signed and dated consumer agreement; and
(4) must provide copies to:
(A) the consumer or to his or her designated representative; and
(B) FSSA waiver services;
upon request.
(d) The consumer contract will include a statement of the consumer rights listed in 455 IAC 3-14, to be signed by the provider and consumer. The AFC service provider must provide a copy of the consumer rights:
(1) prior to execution of the consumer contract; and
(2) to anyone requesting a copy.
(Division of Aging; 455 IAC 3-6-5)
Rule 7. Primary and Substitute Caregiver Requirements
455 IAC 3-7-1 AFC provider's responsibility
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 1. (a) It is the AFC provider's responsibility to provide assurances to the state that any subcontractors or employees that are employed in order to provide AFC services meet all caregiver requirements.
(b) When the primary caregiver is not the actual provider with whom the waiver provider agreement is signed, the provider must maintain in the provider file all necessary documentation in accordance with this article.
(c) The requirements of all caregivers, including primary and substitute caregivers, will be the same as those for the provider, other than the necessity to provide proof of financial stability, homeownership and liability insurance, and complying with home inspection requirements.
(d) The requirements for the safety of the physical dwelling that is the AFC home falls under the responsibilities of the homeowner, who must be the provider.
(Division of Aging; 455 IAC 3-7-1)
455 IAC 3-7-2 Primary and substitute caregiver requirements
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 2. (a) The primary caregiver will reside in the home owned by the provider or in any home in which the provider does not reside. The caregiver's family unit may reside in the home along with the caregiver and the consumers. Just as with the provider, all caregivers must be twenty-one (21) years of age or older and meet all applicable provider requirements. The provider must ensure that a qualified caregiver is present and available at the home at all times when consumers are in the home. A consumer must not be left in charge in lieu of a caregiver.
(b) Substitute caregivers, persons other than the provider or primary caregiver, must meet all applicable standards and requirements of this article.
(c) Substitute caregivers must:
(1) have a clear understanding of job responsibilities;
(2) have knowledge of the consumer's care plans; and
(3) be able to provide the care specified for each consumer's needs.
(Division of Aging; 455 IAC 3-7-2)
Rule 8. Training Requirements for All Caregivers
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 1. (a) The provider will keep documentation of the training and orientation of primary and substitute caregivers. A provider is responsible for the supervision, training, and overall conduct of caregivers when:
(1) acting within the scope of their role in AFC service provision; or
(2) present in the home.
(b) Prior to admission of the first HCBS Medicaid waiver consumer to the AFC home, and annually thereafter, the provider, primary caregiver, and any substitute caregivers must complete both a basic first aid course and cardiopulmonary resuscitation (CPR) course. Documentation of the training must be kept in the facility's records including the following:
(1) The date of the training.
(2) The subject matter.
(3) The name of the agency or organization providing the training.
(4) The number of classroom hours.
(c) FSSA waiver services may grant an exception to the training requirements established in this article for a substitute caregiver who holds a current Indiana license as a health care professional, such as a:
(1) physician;
(2) registered nurse; or
(3) licensed practical nurse.
The requirement for an annual CPR course training must not be waived.
(d) The provider must orient any substitute caregiver to the home and to the consumers, to include at least the following:
(1) A demonstration of evacuation procedures.
(2) The locations of the following:
(A) Fire extinguishers.
(B) The consumer's records.
(C) Telephone numbers for the following:
(i) The consumer's physicians.
(ii) The provider.
(iii) Other emergency contacts.
(D) Medications and key for the medication cabinet.
(3) Introduction to consumers.
(4) Instructions for caring for each consumer, including health care and consumer preferences in:
(A) food;
(B) daily routine; and
(C) other issues that are important to that individual's quality of life.
(Division of Aging; 455 IAC 3-8-1)
Rule 9. Level of Service and Payment
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 1. (a) AFC service will be provided and paid according to three (3) levels of service, with:
(1) level 1 being the least impaired; and
(2) level 3 the most impaired or dependent.
(b) The level of service assessment tool for AFC service will be based on and utilize the point system definitions as defined in section 3 of this rule.
(Division of Aging; 455 IAC 3-9-1)
455 IAC 3-9-2 Initial enrollment levels of care; provision of higher level services
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 2. (a) AFC providers will provide in-home services to those consumers:
(1) who are determined to meet any of the three (3) care levels; and
(2) whose needs can be met in an AFC setting.
They can choose to serve one (1) level or any combination of levels as long as the provider can meet the individual's needs.
(b) Safeguards must be in place to ensure that the provider can handle the increased medical issues. The provider must have the ability to provide the higher level of care that the individual consumer requires through:
(1) professional licensure;
(2) previous experience working with individuals with a similar level of care; or
(3) other means appropriate to the consumer.
(c) Providers may admit or continue to care only for consumers whose impairment levels are within the classification level of the home.
(d) A provider may request a change in service level at any time during the year. The request must specify the:
(1) requested change; and
(2) reason it is desired;
in writing. An assessment will be completed when there have been significant changes in condition.
(Division of Aging; 455 IAC 3-9-2)
455 IAC 3-9-3 AFC level of service assessment tool
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 3. (a) The AFC level of service assessment tool is used to determine level of service eligibility. Some items may become disqualifiers for admission, including either of the following:
(1) If a physician determines that it is unsafe for the consumer.
(2) If the provider determines that the consumer will not be a good match for the home.
(b) The AFC assessment tool will assess consumer's level of service needs based on a point system as follows:
Level 1-Total points 36 or fewer
Level 2-Total points 37-60
Level 3-Total points 61-75
(c) Following approval of AFC services and admission to an AFC home, the case manager must conduct and document a review of the consumer's status on site at least once every ninety (90) days. Reassessment may occur more frequently if needed as determined by the case manager, caregiver, or provider. The level of service assessment will be completed and documented:
(1) as often as necessary; and
(2) at a minimum, as part of the annual level of care eligibility redetermination process.
Providers are encouraged to support a consumer's choice to remain in his or her living environment as long as possible.
(Division of Aging; 455 IAC 3-9-3)
455 IAC 3-9-4 Base rate; payments based on level of service
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 4. (a) An all-inclusive daily base rate for each of the three (3) service levels will be:
(1) established by OMPP; and
(2) paid to the provider for each approved HCBS Medicaid waiver consumer.
Provider payment rates will be based on the level of service a consumer requires. The service payments are for the consumer's care by the provider only and exclude room and board.
(b) This AFC service rate will include the following:
(1) Personal care and services.
(2) Homemaker, chore, attendant care, and companion services.
(3) Medication oversight, to the extent permitted under state law.
(4) Transportation.
(c) The rate will be considered payment in full for all services provided, except room and board. Separate payment will not be made for:
(1) homemaker or chore services furnished to an individual receiving AFC services; or
(2) transportation services;
since these services are integral to and inherent in the provision of AFC services. For those consumers receiving AFC as a waiver service, the only other waiver service allowed is case management. Consumers will still be eligible to use nonwaiver Medicaid prior authorization services while receiving the AFC service.
(Division of Aging; 455 IAC 3-9-4)
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 5. The consumer is responsible for his or her room and board. These amounts are defined and updated according to the room and board definition and amounts prescribed by the Social Security Administration. This payment is to be paid directly to the provider by the consumer or his or her guardian. AFC providers must be willing to accept:
(1) the current SSI rate (minus the consumer's personal needs allowance); or
(2) a Section 8 housing voucher;
as payment for the consumer's monthly room and board.
(Division of Aging; 455 IAC 3-9-5)
Rule 10. Care and Service Standards
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 1. Any services performed under the HCBS Medicaid waiver programs for persons who are aged or medically disabled must comply with the prohibitions regarding the practice of medicine under IC 25-22.5-1.
(Division of Aging; 455 IAC 3-10-1)
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 2. Providers, with the assistance of the case manager and consumer, must create and make readily accessible to the consumer and caregiver a calendar for the consumer that will include:
(1) scheduled activities;
(2) all medical appointments and other services; and
(3) medication chart, if indicated.
(Division of Aging; 455 IAC 3-10-2)
455 IAC 3-10-3 Services that must be provided
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 3. The AFC service will include the provision of the following:
(1) Personal care and services.
(2) Homemaker, chore, attendant care, and companion services.
(3) Medication oversight, to the extent permitted under state law.
(Division of Aging; 455 IAC 3-10-3)
455 IAC 3-10-4 Services allowed to be provided
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 4. (a) The following and similar activities are allowed to be provided:
(1) Homemaker activities essential to the consumer's health care needs to prevent or postpone institutionalization when provided during the provision of other attendant care services.
(2) Assistance, as defined in the plan of care, which may include the following:
(A) Personal care, including:
(i) bathing;
(ii) partial bathing;
(iii) oral hygiene;
(iv) hair care;
(v) shaving;
(vi) hand and foot care;
(vii) dressing;
(viii) clipping hair; and
(ix) application of cosmetics.
(B) Mobility, including:
(i) proper body mechanics;
(ii) transfer between bed and chair; and
(iii) ambulation that does not include assistive devices.
(C) Elimination, including:
(i) assists with bedpan, bedside commode, and toilet;
(ii) incontinent or involuntary care; and
(iii) emptying urine collection and colostomy bags.
(D) Nutrition, including meal planning in accordance with special diets, preparation, and cleanup.
(E) Safety, including:
(i) the use of principles of health and safety in relation to self and consumer;
(ii) identifying and eliminating safety hazards;
(iii) practicing health protection and cleanliness by appropriate techniques of hand washing; and
(iv) waste disposal and household tasks.
(F) Assistance with correspondence and bill paying.
(G) Escorting individuals to doctor appointments and community activities that:
(i) are therapeutic in nature; or
(ii) assist with developing or maintaining natural supports.
(b) Attendant care services must follow a written plan of care addressing specific needs determined by the consumer's assessment. Attendant care services will not be provided to medically unstable consumers as a substitute for care provided by:
(1) a registered nurse;
(2) a licensed practical nurse;
(3) a licensed physician; or
(4) another health professional.
(Division of Aging; 455 IAC 3-10-4)
455 IAC 3-10-5 Additional services that may be provided
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 5. In addition to the services in sections 3 and 4 of this rule, and to the extent not already covered under those sections, the consumer may require assistance in the following areas:
(1) Social and recreational programming.
(2) Eating.
(3) Dressing.
(4) Grooming and personal hygiene.
(5) Bowel and bladder care (incontinence).
(6) Walking.
(7) Getting in and out of bed.
(8) Getting in and out of seating.
(9) Medical appointments.
(10) Transportation.
(Division of Aging; 455 IAC 3-10-5)
455 IAC 3-10-6 Transportation service provision
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 6. Providers must be able to provide or arrange for appropriate, safe, and reasonable consumer transportation requests for community and social activities that are therapeutic in nature or that assist in maintaining or developing natural supports. Providers will see that consumers have appropriate, safe, and reasonable transportation for all medical appointments. There is no reimbursement for travel, as this is a part of AFC service provision. If transportation requests from the consumer or consumer's family exceed what the caregiver or provider deems appropriate, this issue may:
(1) be discussed with the waiver service case manager; and
(2) need to be addressed in the consumer agreement.
(Division of Aging; 455 IAC 3-10-6)
455 IAC 3-10-7 Medications, treatments and therapies
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 7. (a) Provision of medication management services must be at the direction of a consumer who is competent, but otherwise unable to accomplish the task himself or herself due to an impairment or physical infirmity. In the event a consumer is not competent, or in instances where competence is in question, a competent individual who is responsible for the health and care of the consumer may direct the appropriate assistance for the consumer.
(b) The provider and caregivers must demonstrate an understanding of each consumer's medication regimen, including the following:
(1) The reason for which the medication is used.
(2) Medication actions.
(3) Specific instructions.
(4) Common side effects.
(c) The provider must obtain and place a written, signed order in the consumer's record for any medications that have been prescribed by the physician or nurse practitioner. Orders must be carried out as prescribed unless the consumer or the consumer's legal representative refuses to consent. The physician or nurse practitioner must be notified if a consumer refuses to consent to an order.
(d) Changes to an order may not be made without a physician or nurse practitioner's order. Order changes obtained by telephone must be documented by filing the pharmacy receipt detailing specifics regarding the prescription.
(e) Over-the-counter medication requested by the consumer must be:
(1) addressed in the plan of care; and
(2) reviewed by the consumer's:
(A) physician;
(B) nurse practitioner; or
(C) pharmacist;
as part of developing the care plan and at the time of care plan review.
(f) Prescription medications ordered to be given "as needed" or "p.r.n." must have additional directions that show what the medication is for and specifically when, how much, and how often it may be administered. These written directions may be given by any of the following:
(1) A physician.
(2) A nurse practitioner.
(3) A registered nurse.
(4) A pharmacist.
(g) Consumers must have a physician's or nurse practitioner's written order of approval to self-medicate. Persons able to handle their own medical regimen will keep medications in their own room in a small storage area that can be locked. The provider will notify the physician or nurse practitioner should the consumer show signs of no longer being able to self-medicate safely. Each consumer's medication container:
(1) will be:
(A) clearly labeled with the pharmacist's label; or
(B) in the original labeled container or bubble pack; and
(2) must be kept by the:
(A) consumer; or
(B) primary caregiver;
depending on the individual's need and abilities.
If consumers manage their own medicine regimen, caregivers must be well informed of medication management to assure that assistance, when needed, is provided.
(h) Both caregiver and consumer must have ready access to the consumer's medications, but consumers must not have access to medications of the provider or other household members. Individuals, other than the caregiver, may not have access to each consumer's locked medication. Over-the-counter medications in stock bottles, with original labels, may be used in the home. Unused, outdated, or discontinued medications must:
(1) not be kept in the home; and
(2) be disposed of according to the pharmacist's recommendations.
Disposal of medications will be documented on the medication administration record or in the consumer's record.
(i) For some consumers, it may be necessary that the provider oversees the consumer's medicine intake. The provider may set up each consumer's medications for up to seven (7) days in advance (excluding p.r.n. medications) by using a closed container manufactured for that purpose. If such a container is used, each consumer will have her or his own container with compartments for the days and times of the day the medications are to be given. The container must be clearly labeled with the following:
(1) The consumer's name.
(2) The name of each medication.
(3) The time to be given.
(4) The dosage or amount.
(5) The route (if other than oral).
(6) A description of each medication.
(j) With consumers who require the level of assistance with their medication noted in subsection (i), a current, written medication administration record must be kept for each consumer and must identify all of the medications consumed by the consumer, including over-the-counter medications and prescribed dietary supplements. The document record will indicate the following:
(1) The medication name.
(2) The dosage.
(3) The route (if other than oral).
(4) The date and time to be given.
(5) The signature of the caregiver providing assistance.
FSSA waiver services provides a suggested format for this record.
(k) A discontinued or changed medication order will be marked and dated on the medication administration record as discontinued. The new order will be written on a new line showing the date of the order. If a consumer misses or refuses a medication, treatment, or therapy, the initials must be circled, and a brief but complete explanation must be recorded on the back of the medication record. As needed (p.r.n.) medication must be documented with the following:
(1) The time.
(2) The dose.
(3) The reason the medication was given.
(4) The outcome.
(Division of Aging; 455 IAC 3-10-7)
455 IAC 3-10-8 Standards for psychoactive medications
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 8. (a) Providers will not request a psychoactive medication to treat a consumer's behavioral symptoms without a consultation from the:
(1) physician;
(2) nurse practitioner;
(3) registered nurse; or
(4) mental health professional.
The consultation will include a discussion of alternative measures to medication use including behavioral interventions.
(b) These medications may be used only:
(1) after documenting all other alternative considerations; and
(2) when required to:
(A) treat a consumer's medical symptoms; or
(B) maximize a consumer's physical functioning.
(c) Psychoactive medications must never be given:
(1) to discipline a consumer; or
(2) for the convenience of the AFC home.
Psychoactive medications as defined in this article may be used only pursuant to a prescription that specifies the circumstances, dosage, and duration of use.
(d) The provider and all caregivers must know the following for each psychoactive medication used:
(1) Specific reasons for the use of the psychoactive medication for an individual consumer.
(2) The common side effects.
(3) When to contact the physician, nurse practitioner, or mental health professional regarding those side effects.
(e) All caregivers must also know the behavioral interventions to be used along with the medication.
(f) The individual completing the initial assessment must determine the frequency of the reassessment of the psychoactive medication use. The medication usage:
(1) is included as part of that consumer's individual plan of care; and
(2) includes other environmental and behavioral strategies or modifications to address any behavioral symptoms for which the psychopharmacological medication has been prescribed.
(g) Prior to making a request to prescribe or increase psychoactive drugs, other accepted interventions must be attempted, if possible, and documented. Information regarding resources is available from the ombudsman. Any change in medication will only occur when the prescribing physician determines it is medically warranted for the consumer.
(Division of Aging; 455 IAC 3-10-8)
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 9. (a) The consumer must be free from chemical restraint at all times.
(b) Involuntary seclusion can only be used to prevent the spread of infection as ordered by a physician for a medical diagnosis.
(c) Physical restraint is not allowed in an AFC home. If consumer loss of control warrants this level of restraint, the caregiver should call for emergency assistance.
(Division of Aging; 455 IAC 3-10-9)
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 10. Care and supervision of consumer will be in a home-like atmosphere and will be appropriate to the:
(1) needs;
(2) preferences;
(3) age; and
(4) condition;
of the individual consumer.
(Division of Aging; 455 IAC 3-10-10)
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 11. The training of the provider and staff will be appropriate to the:
(1) age;
(2) care needs; and
(3) condition;
of the consumers. If a consumer has a medical regimen or personal care plan prescribed by a licensed health care professional, the provider must cooperate with the plan and ensure that it is implemented as instructed.
(Division of Aging; 455 IAC 3-10-11)
455 IAC 3-10-12 Notice of health status changes
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 12. The provider is responsible for promptly informing the consumer's:
(1) physician or nurse practitioner;
(2) family;
(3) legal representative; and
(4) case manager;
of changes in the health status of the individual. Changes in the consumer's condition must be documented and appropriate medical assistance obtained.
(Division of Aging; 455 IAC 3-10-12)
455 IAC 3-10-13 Serious medical emergency requirements
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 13. In the event of a serious medical emergency, the caregiver will call 911 or the appropriate emergency number for their community. The physician or nurse practitioner, family or consumer representative, and the case manager (when applicable) must also be called. The provider will have copies of any:
(1) advance directives;
(2) do not resuscitate (DNR) orders; and
(3) pertinent medical information;
available when emergency personnel arrive.
(Division of Aging; 455 IAC 3-10-13)
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 14. Providers must make available activities each week that are of interest to the consumers. Activities must be oriented to individual preferences as indicated in the consumer's care plan. Documentation of consumer activity participation should be recorded in the weekly status update in the consumer's file. Consumer expectations may need to be addressed in the consumer contract on a case-by-case basis.
(Division of Aging; 455 IAC 3-10-14)
455 IAC 3-10-15 Consumer moves, transfers, and discharges; notice; exceptions
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 15. (a) A consumer may not be involuntarily:
(1) moved:
(A) from the AFC home; or
(B) to another room within the home; or
(2) transferred to another AFC home for a temporary stay;
without thirty (30) days written notice to the consumer regarding the consumer move, transfer, or discharge.
(b) The notification must state the reasons for the move or transfer and the consumer's right to object to the move or transfer. The notification is to be provided to the following:
(1) The HCBS Medicaid waiver case manager.
(2) The consumer's legal representative, if any.
(3) The consumer's guardian, if any.
(4) The ombudsman.
(5) The division.
(c) Exceptions to the requirements in subsections (a) and (b):
(1) include situations in which undue delay might jeopardize the health, safety, or well-being of the consumer or others; and
(2) are outlined in 460 IAC 1.2 and the FSSA DA provider agreement.
(d) Consumers may be moved or transferred involuntarily without the thirty (30) day notice from the provider for only the following reasons:
(1) Medical emergencies.
(2) Behavior that poses an imminent danger or harm to self, others, or caregivers.
(3) Loss of eligibility for the HCBS Medicaid waiver program.
(4) The consumer's care needs exceed the ability (taking into account the provider's own health) or classification of the provider.
(5) The provider has had its HCBS Medicaid waiver provider agreement revoked or not renewed.
(e) If the consumer:
(1) has a medical emergency; or
(2) needs to be admitted to a hospital;
the provider must notify the consumer's physician and case manager as soon as reasonable in order to make the necessary arrangements for the provision of ongoing care.
(f) A consumer that is:
(1) to be involuntarily transferred; or
(2) refused the right of return or readmission;
(Division of Aging; 455 IAC 3-10-15)
Rule 11. Admission Requirements
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 1. Prior to placement, the provider, with the assistance of the case manager, will meet with potential consumers who are interested in residing in this AFC home. The provider or primary caregiver makes the final decision on who may live in their home.
(Division of Aging; 455 IAC 3-11-1)
455 IAC 3-11-2 Obtaining consumer information
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 2. (a) The provider must obtain and document general information regarding the consumer after they have chosen to live there. The information must include the following:
(1) The names, addresses, and telephone numbers of relatives.
(2) Case managers.
(3) Medical and mental health care providers.
(4) The date of admission.
(5) The consumer's:
(A) Social Security number;
(B) medical insurance number;
(C) birth date;
(D) most recent prior residence;
(E) hospital preference (if known); and
(F) mortuary (if known).
(b) The provider must also obtain and place in the record any medical information available including a history of any of the following that may be pertinent to the consumer's care:
(1) Accidents.
(2) Illnesses.
(3) Impairments.
(4) Mental status.
(Division of Aging; 455 IAC 3-11-2)
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 3. (a) The provider must ask for copies of the following documents and document whether or not the consumer has them:
(1) An advance directive.
(2) A living will.
(3) A power of attorney.
(4) A health care representative.
(5) A do not resuscitate (DNR) order.
(6) Letters of guardianship.
(b) Any copies collected must be:
(1) placed in a prominent place in the consumer file; and
(2) sent with the consumer when transferred for medical care.
(Division of Aging; 455 IAC 3-11-3)
455 IAC 3-11-4 House rules and consumer rights
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 4. The provider must discuss with the consumer and his or her representative, if any, the consumer rights set forth in 455 IAC 3-14 and written house rules. The discussion must be documented by having the consumer sign and date or acknowledge in writing the house rules and the consumer rights on a provider created form, and this form will be filed in the consumer's file.
(Division of Aging; 455 IAC 3-11-4)
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 5. (a) During the initial phase following the consumer's admission to the home, the provider must continue the assessment process, which includes documenting the consumer's expressed preferences and care needs. This information should be presented to the case manager at the ninety (90) day review.
(b) The assessment must include observations of the consumer and the review of information obtained from the screening assessment process.
(c) The provider must promptly report significant changes in the consumer's condition to the following:
(1) The HCBS Medicaid waiver case manager.
(2) The physician.
(3) The consumer or family member, or both, as appropriate.
(Division of Aging; 455 IAC 3-11-5)
455 IAC 3-11-6 Prohibition of certain restrictions
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 6. (a) The provider must not restrict the ability of a consumer to engage in activities away from the AFC services provider. Ability to handle independent activities, such as going for walks:
(1) may vary from one (1) consumer to another; and
(2) should be addressed in the consumer contract.
(b) Except to protect the rights and activities of other consumers and residents, the AFC services provider may not restrict the ability of the consumer to:
(1) have visitors; and
(2) receive family members and guests.
(c) The AFC service provider may not:
(1) restrict the ability of a consumer to use a:
(A) home health agency;
(B) home health provider; or
(C) case management service of the consumer's choice; or
(2) require a consumer to use home health services.
(Division of Aging; 455 IAC 3-11-6)
455 IAC 3-11-7 Notification of caregiver changes
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 7. The provider must:
(1) notify FSSA waiver services immediately of any primary caregiver changes or issues; and
(2) work with the case manager and FSSA waiver services to assure that the consumer will continue to receive the necessary care.
(Division of Aging; 455 IAC 3-11-7)
455 IAC 3-11-8 Adaptation to meet consumer's needs
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 8. The provider must provide the range of services required to meet the increasing or changing needs of consumers as they age in place to the maximum extent permitted by these standards.
(Division of Aging; 455 IAC 3-11-8)
Rule 12. Provider Capacity
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 1. (a) The individuals residing in an AFC home may include the following:
(1) AFC consumers.
(2) The primary caregiver.
(3) Those individuals who are related to and considered to be the family unit of the primary caregiver.
(b) The number of consumers permitted to reside in a home will be determined by the ability of the caregivers to meet the care needs of the consumers living in that home. Determination of capacity must include consideration of total household composition, including children and relatives requiring care and supervision. The number of caregiver family members will be reviewed by FSSA waiver services for the appropriateness of match with the individual consumer's needs. These determinations will be made on a case-by-case basis.
(c) There must be not more than four (4) AFC consumers placed in an AFC home, including private pay consumers and Medicaid waiver consumers.
(Division of Aging; 455 IAC 3-12-1)
Rule 13. Consumer Eligibility Requirements
455 IAC 3-13-1 Medical and financial eligibility
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 1. (a) For purposes of this rule, "nursing facility level of care" means care for patients:
(1) with long term illnesses or disabilities that are relatively stable; or
(2) nearing recovery and discharge who continue to require some professional medical or nursing supervision and attention.
(b) The FSSA waiver services will determine consumer eligibility based on the determination that the consumer meets nursing facility level of care and Medicaid requirements. Consumers who are:
(1) eighteen (18) years of age or older; and
(2) eligible and approved for the A & D waiver;
may be eligible for this service.
(Division of Aging; 455 IAC 3-13-1)
455 IAC 3-13-2 Assessment tool for consumer screening
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 2. (a) Consumers who seek AFC as a service through the FSSA waiver services Medicaid waiver program must contact the local AAA to complete the waiver application. A case manager will:
(1) be assigned; and
(2) complete an eligibility assessment;
which will determine if the consumer requires a level of care provided by a nursing facility as described in 405 IAC 1-3-1 and 405 IAC 1-3-2. The nursing facility level of care eligibility assessment must be conducted prior to the start of the HCBS Medicaid waiver and at least annually thereafter.
(b) Prior to the start of AFC services, the case manager will complete an AFC level of service assessment. The level of service assessment tool must assess the consumer's needs in multiple areas, including the following:
(1) Expressive and receptive communication.
(2) Orientation.
(3) Adaptation to change.
(4) Judgment.
(5) Memory.
(6) Awareness of own needs.
(7) Behavior.
(8) Wandering.
(9) Night needs.
(10) Feeding and nutrition.
(11) Transferring.
(12) Dressing and undressing.
(13) Bathing.
(14) Personal hygiene.
(15) Toileting.
(16) Bladder and bowel control.
(17) Mobility.
(18) Medication treatment procedures.
(c) The level of service assessment will include interviews with the following:
(1) The prospective consumer.
(2) His or her family.
(3) Prior care providers, as appropriate.
(d) The interviews should also include any:
(1) physician;
(2) nurse practitioner;
(3) registered nurse;
(4) pharmacist;
(5) therapist; or
(6) other health or mental health professional;
involved in the care of the consumer.
(e) Once complete, a copy of the level of service assessment document will be:
(1) given to the prospective consumer or his or her representative; and
(2) placed in the consumer file should the prospective consumer become a resident in the home.
(f) The level of service assessment and individual plan of care must be completed prior to the consumer's admission into an AFC home.
(Division of Aging; 455 IAC 3-13-2)
Rule 14. Consumer Rights
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 1. (a) The fundamental rights of individuals are not diminished by virtue of residence in an AFC home. The consumer maintains all citizen rights afforded under state and federal law. The AFC service provider must respect all rights recognized by law with respect to the following:
(1) Discrimination.
(2) Service decisions (including the right to refuse services).
(3) Freedom from abuse and neglect.
(4) Privacy.
(5) Association.
(6) Other areas of fundamental rights, including, but not limited to, the right to the following:
(A) Participating in the planning of his or her care and treatment or changes in care and treatment.
(B) Privacy and confidentiality of personal and medical records.
(C) Privacy in visits and written and oral communication.
(D) Sending and receiving mail unopened.
(E) Receiving any literature or statement of service that accompanies Medicaid payment for their care.
(F) Choosing activities, schedules, and health care consistent with his or her interests.
(G) Being free from physical or chemical restraints not required to treat his or her medical symptoms.
(H) Accessing his or her medical records.
(I) Handling his or her own funds or determining who will handle those funds.
(J) Having immediate access to his or her personal funds if the consumer has given authority to the provider to handle the funds.
(b) Every consumer receiving services in the AFC setting may contact their local or state ombudsman if they have concerns about the provision of this service. The provider is obligated to make available to the consumer the contact information, including phone number, for the ombudsman, as well as for other entities that may assist in ensuring the ongoing rights of the client are upheld. These may include, but are not limited to, the following:
(1) The police.
(2) The local AAA office.
(3) APS.
(4) Legal services.
(c) AFC providers must accord the consumers living with them the basic rights enjoyed by all individuals in this state, including, but not limited to, the following:
(1) Freedom from:
(A) verbal;
(B) sexual;
(C) physical;
(D) emotional;
(E) financial; and
(F) mental;
abuse.
(2) Freedom from physical or chemical restraints for the purposes of discipline or convenience, and not required to treat the consumer's medical symptoms.
(3) Freedom to have:
(A) records kept confidential and released only with a consumer's consent consistent with state law; and
(B) a service animal, consistent with the reasonable accommodations clause of the Fair Housing Act.
(Division of Aging; 455 IAC 3-14-1)
Rule 15. Case Management Responsibilities
455 IAC 3-15-1 Components of case management
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 1. (a) The components of case management are the following:
(1) Level of care assessment.
(2) Plan of care development.
(3) Monitoring.
(4) Advocacy on behalf of the consumer.
(b) Case management services for persons who are on a Medicaid waiver are provided by the FSSA division certified case managers. The sixteen (16) local AAAs serve as the single point of entry for the Medicaid waivers that require a nursing facility level of care. A case manager from the AAA will be assigned to an applicant. After an applicant has been determined to meet eligibility criteria and approved to receive Medicaid HCBS waiver services, he or she may choose:
(1) to retain their current AAA case manager; or
(2) a non-AAA or independent case manager;
for ongoing case management services.
(Division of Aging; 455 IAC 3-15-1)
455 IAC 3-15-2 Level of care determination; physician certification
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 2. (a) The case manager will make level of care determinations for all applicants for this service. This process will utilize the current case management database system.
(b) The 450B physician certification for long term care services must be completed for new Medicaid waiver consumers. The physician must indicate that a placement in an AFC home would be a safe and feasible placement for the consumer.
(Division of Aging; 455 IAC 3-15-2)
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 3. (a) An individual plan of care will be developed by the case manager in full cooperation with the consumer or guardian and the provider. This plan of care will describe:
(1) the medical and other services (regardless of funding source) to be furnished;
(2) their frequency; and
(3) the type of provider who will furnish each.
(b) All services will be furnished pursuant to a written plan of care and cost comparison budget. The plan of care and cost comparison budget will be subject to the approval of the FSSA waiver services waiver specialists.
(c) Based on the:
(1) assessment; and
(2) authorized plan of care;
the individual plan of care will be completed and documented within the initial fourteen (14) day period.
(d) The individual plan of care must do the following:
(1) Support the principles of dignity, privacy, and choice in:
(A) decision-making;
(B) individuality; and
(C) independence.
(2) Describe the consumer's:
(A) capabilities;
(B) needs; and
(C) preferences.
(3) Define the division of responsibility in the implementation of services.
(4) Address, at a minimum, the following elements:
(A) Assessed health care needs.
(B) Social needs and preferences.
(C) Personal care tasks.
(D) If applicable, limited nursing and medication services, including the following:
(i) Frequency of service.
(ii) Level of assistance.
(Division of Aging; 455 IAC 3-15-3)
455 IAC 3-15-4 Review and update of plan of care
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 4. (a) The individual plan of care must be:
(1) reviewed by the:
(A) provider;
(B) consumer or the consumer's representative; and
(C) HCBS Medicaid waiver case manager; and
(2) updated at least every ninety (90) days, or more often as:
(A) the consumer's condition changes; or
(B) determined by the:
(i) case manager;
(ii) provider; or
(iii) consumer.
(b) A review note with the date and reviewer's signature must be documented in the record at the time of the review.
(c) If the individual plan of care:
(1) contains many changes; and
(2) becomes less legible;
a new individual plan of care must be written.
(d) The provider must:
(1) provide the:
(A) consumer;
(B) HCBS Medicaid waiver case manager; and
(C) AAA;
with a copy of the individual plan of care; and
(2) place a copy in the consumer file.
(e) The plan of care for the consumer must be cost neutral. Medicaid waivers in general require that the plan of care must not exceed the cost of care if provided through a nursing facility. This is also explained in the A & D waiver. The initial AFC level of service assessment will be performed by the AAA waiver case manager with input from the applicant or guardian.
(f) Periodic reviews will take place to determine the appropriateness and adequacy of the services with regard to the consumer's needs. The consumer's case manager along with other interested persons, as appropriate, will conduct an on-site face-to-face review of the level of services assessment and the delivery of services under the plan of care at least every ninety (90) days. This visit will:
(1) occur in the home setting; and
(2) include a general consumer status review that will be completed by the case manager, with input from the consumer, guardian, and provider.
The form will review indicators of health and safety, and any issues identified as problems will be immediately reported to the BQIS. A consumer may move from one (1) level of service to another level (as determined by the AFC level of service assessment) with the same provider, as long as the provider is approved for that level of service. When there is need to change the level of service or a provider, an updated plan of care and cost comparison budget will be submitted. It is the case manager's responsibility to assure the plan of care and comparison budget reflects the appropriate level of service that meets the needs of the consumer in an efficient and effective manner.
(Division of Aging; 455 IAC 3-15-4)
455 IAC 3-15-5 Annual reassessments of annual plan of care and cost comparison budget
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 5. (a) Each consumer's plan of care and cost comparison budget will remain in effect for a period not to exceed twelve (12) months.
(b) The plan of care and cost comparison budget must be submitted via the current state-approved electronic database, to the state waiver unit for review at least six (6) weeks prior to expiration of the current plan but not earlier than two (2) months prior to expiration of the current plan. A new level of care assessment must be completed as well as new levels of service assessment.
(Division of Aging; 455 IAC 3-15-5)
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 6. All documentation by a case manager must be entered in the current state-approved electronic database within the required time frames.
(Division of Aging; 455 IAC 3-15-6)
455 IAC 3-15-7 Choice of providers required
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 7. The case manager must assure that each consumer is given the free choice of all qualified providers, including case managers. The consumer must sign the freedom of choice form. This must be documented in the state-approved electronic database.
(Division of Aging; 455 IAC 3-15-7)
Rule 16. Quality Assessment and Provider Compliance
455 IAC 3-16-1 Monitoring for quality assurance; inspections
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 1. (a) FSSA waiver services:
(1) must conduct an inspection of the AFC home prior to issuance of a HCBS Medicaid waiver provider agreement; and
(2) will conduct an announced or unannounced inspection annually.
(b) Inspection may also take place upon either of the following conditions:
(1) Receipt of an oral or written complaint of violations that threaten the health, safety, or welfare of consumers.
(2) Anytime FSSA waiver services has reason to believe a home:
(A) has violated a condition of the Medicaid waiver provider agreement or a provision of this article; or
(B) is operating without an HCBS Medicaid waiver provider agreement.
(c) Inspections may also take place for the purpose of routine monitoring of the consumer's care.
(d) Once an on-site review has taken place, another inspection may be necessary to determine if cited deficiencies have been corrected.
(e) Mini inspections will also be completed during case manager visits, with completion of a health and safety indicator checklist to identify any concerns.
(f) Inspectors will respect the private possessions of consumers and other consumers, providers, and staff while conducting an inspection.
(Division of Aging; 455 IAC 3-16-1)
455 IAC 3-16-2 Monitoring for quality assurance; access to records
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 2. Representatives of FSSA waiver services must have full access and authority to examine and copy AFC home and consumer records required to be maintained by the provider. The provider will be responsible for making any copies requested. Copying of records will be done in a manner that is compliant with HIPAA rules.
(Division of Aging; 455 IAC 3-16-2)
455 IAC 3-16-3 Monitoring for quality assurance; access to premises and equipment
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 3. Representatives of FSSA waiver services must have access to inspect the physical premises, including:
(1) the buildings;
(2) the grounds;
(3) the equipment; and
(4) any vehicles;
relating to HCBS Medicaid waiver program participation and complaint investigations in the AFC home.
(Division of Aging; 455 IAC 3-16-3)
455 IAC 3-16-4 Monitoring for quality assurance; authority to interview
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 4. Representatives of FSSA waiver services must have authority to interview the following:
(1) The provider.
(2) The primary caregiver.
(3) Substitute caregivers.
(4) Consumers.
Interviews must be confidential and conducted privately.
(Division of Aging; 455 IAC 3-16-4)
455 IAC 3-16-5 Monitoring for quality assurance; authorized entrance
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 5. Providers must authorize caregivers to permit entrance by the FSSA waiver services for the purpose of:
(1) inspection;
(2) investigation; and
(3) other duties within the scope of their authority.
(Division of Aging; 455 IAC 3-16-5)
455 IAC 3-16-6 Monitoring for quality assurance; advance notice not required
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 6. Representatives of FSSA waiver services must have authority to conduct inspections with or without advance notice to the provider, staff, or a consumer of the home. FSSA waiver services may, in their discretion, determine to not give advance notice of any inspection if they believe that notice might obstruct or diminish the:
(1) effectiveness of the inspection; or
(2) enforcement of the provisions of this article.
(Division of Aging; 455 IAC 3-16-6)
455 IAC 3-16-7 Monitoring for quality assurance; entrance by ombudsman
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 7. The ombudsman has the right to enter the home at the request of the consumer, providing any additional quality oversight.
(Division of Aging; 455 IAC 3-16-7)
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 8. In accordance with 460 IAC 1.2, any unusual occurrence including, but not limited to, alleged, suspected, or actual abuse, neglect, or exploitation of an individual, will require an incident report to be completed by the provider or the case manager, or both.
(Division of Aging; 455 IAC 3-16-8)
455 IAC 3-16-9 Process for filing incident report
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 9. The process for filing an incident report includes the following steps:
(1) The incident is identified.
(2) The reporting entity reports the incident using the prescribed process. The report will include a detailed explanation as to the following:
(A) What happened.
(B) When it happened.
(C) How it happened.
(D) Action taken after the incident.
(E) Necessary follow-up.
(F) Any additional information necessary.
(3) BQIS will do the following:
(A) Review the incident and assign the appropriate coding.
(B) E-mail the incident report information to the case manager.
(4) The case manager will follow up:
(A) to ensure the health and safety is in place for the individual; and
(B) every seven (7) days until the incident is resolved.
(Division of Aging; 455 IAC 3-16-9)
455 IAC 3-16-10 Suspected abuse or exploitation investigation
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 10. FSSA waiver services, BQIS, or a designee will work with the ombudsman and adult protective services to investigate and act on suspected abuse or exploitation immediately and to follow up on other complaints or concerns as quickly as possible. The primary purpose of the prompt response is to protect the consumer and correct the situation. Investigations of complaints alleging injury, abuse, or neglect must be completed:
(1) as soon as possible; and
(2) in accordance with complaint standards utilized by the ombudsman program and adult protective services.
(Division of Aging; 455 IAC 3-16-10)
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 11. The AFC home provider and any caregivers must:
(1) not retaliate in any way against any consumer after the consumer or someone acting on his or her behalf has:
(A) filed a complaint;
(B) been interviewed; or
(C) served as a witness; and
(2) ensure that all caregivers follow the incident reporting procedures.
(Division of Aging; 455 IAC 3-16-11)
455 IAC 3-16-12 Procedures for corrections of violations
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 12. (a) If, as a result of an inspection or investigation, FSSA waiver services determine that abuse, exploitation, or neglect has occurred, the provider must be notified verbally to immediately cease the abusive act. The incident will be reported:
(1) through the provisions of this rule; and
(2) to adult protective services.
Arrangements will be made for immediate relocation of the consumer, and the provider's enrollment in the HCBS Medicaid waiver program will be terminated.
(b) If an inspection or investigation indicates a violation of this article or the provider agreement other than abuse, FSSA waiver services must notify the provider in writing of such violations.
(c) Except as provided under subsection (a), FSSA waiver services may require the provider to develop a corrective action plan that will be approved by BQIS and the division.
(d) The provider must notify BQIS and the division of the correction of violations not later than the date specified in the notice of violation.
(e) FSSA waiver services must conduct a reinspection of the home after the date:
(1) that the FSSA waiver services receives the report of compliance; or
(2) by which violations must be corrected as specified in the notice of violation.
(f) For violations that present an imminent danger to the health, safety, or welfare of consumers, the HCBS Medicaid waiver provider agreement may be immediately suspended and arrangements made to move the consumers.
(g) If:
(1) after inspection of a home, the violations have not been corrected by the date specified in the notice of violation; or
(2) FSSA waiver services, BQIS, or a designee has not received a report of compliance from the provider;
FSSA waiver services may terminate the HCBS Medicaid waiver provider agreement.
(h) Providers may appeal any decision by following the appeals process as described in 460 IAC 1.2-7-1.
(Division of Aging; 455 IAC 3-16-12)
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 13. (a) FSSA waiver services must deny, suspend, or revoke HCBS Medicaid waiver program enrollment if a provider, caregiver, or another person who has unsupervised access to consumers in the AFC home has done any of the following:
(1) Been convicted of a crime:
(A) against a person; or
(B) relating to financial exploitation.
(2) Been found by a court in a protection proceeding to have abused or financially exploited a vulnerable adult.
(3) Obtained or attempted to obtain HCBS Medicaid waiver program enrollment by fraudulent means or misrepresentation.
(4) Permitted, aided, or abetted the commission of any illegal act on the AFC home premises.
(5) A criminal background check that does not fully comply with 455 IAC 3-4-3(9).
(6) Been convicted of:
(A) the illegal use of drugs or an alcohol-related offense within the past five (5) years without evidence of rehabilitation including a discharge summary from a rehabilitation program;
(B) the illegal selling or distribution of drugs; or
(C) any crime involving a firearm used in:
(i) the commission of a felony; or
(ii) an act of violence against a person.
(7) Refused to permit authorized division representatives to:
(A) interview consumers; or
(B) have access to consumer records under section 5 of this rule.
(8) Interfered with any of the following:
(A) An ombudsman.
(B) An adult protective services investigator.
(C) Representatives of a money management program recognized by the division.
(D) An HCBS Medicaid waiver case manager.
(E) Any person or entity from an AAA or the division in the performance of quality assurance and consumer protection activities on behalf of a citizen in the performance of official duties.
(9) Been found by a court in a proceeding to have committed an act of domestic violence toward a family or household member.
(b) Failure of a provider to:
(1) follow a consumer's plan of care or any provisions of this article; or
(2) comply with the consumer rights established under any of the HCBS Medicaid waiver programs;
is considered a willful violation of the HCBS Medicaid waiver programs and subject to disenrollment.
(c) FSSA waiver services must deny, revoke, or refuse to renew the HCBS Medicaid waiver provider agreement where:
(1) it finds there has been substantial noncompliance with these standards; or
(2) there is substantial noncompliance with local codes and ordinances or any other state or federal law or rule applicable to the health and safety of caring for consumers in an AFC home.
(Division of Aging; 455 IAC 3-16-13)
Authority:
IC 12-8-8-4;
IC 12-9.1-2-3
Sec. 14. A provider whose:
(1) HCBS Medicaid waiver provider agreement has been:
(A) revoked; or
(B) voluntarily surrendered during a pending revocation or nonrenewal process; or
(2) application has been denied;
must not be permitted to apply to reenroll in the HCBS Medicaid waiver program for one (1) year from the date the revocation, surrender, or denial is final or for a longer period if specified in the order revoking or denying the enrollment.
(Division of Aging; 455 IAC 3-16-14)
Posted: 05/09/2007 by Legislative Services Agency
DIN: 20070509-IR-455060129PRA
Composed: Apr 29,2024 5:13:26PM EDT
A
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