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IN Level of Care Assessment Representative

The Indiana Family and Social Services Administration, in partnership with various entities, conducts federally required Level of Care (LOC) assessment and determination services and intake counseling for individuals in need of Nursing Facility Level of Care (NFLOC) for nursing facility (NF) admission or home- and community-based services (HCBS) waiver programs. The Indiana Level of Care Assessment Representative (LCAR) provides these services and assessments for Hoosiers receiving or seeking long-term care that help them navigate complex processes and ensure they get the appropriate supports they need.

Beginning July 1, 2025, the LCAR will provide:

  • Preadmission Screening and Resident Review (PASRR)
  • Level of Care (LOC) assessments, and renewals
  • LOC determination (outcome) recommendations and re-determinations
  • Intake counseling for the PathWays 60+ population

These services apply to the PathWays for Aging, Health & Wellness, and Traumatic Brain Injury Waivers. A downloadable one-pager about the changes can be found here.

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Fact Sheets

Resources

Frequently Asked Questions

  1. Program Overview
  2. General Member Information
  3. Waiting List and Waivers
  1. Pediatric Eligibility
  2. Provider Information

Program Overview

  • What is LCAR?
    • LCAR stands for Level of Care Assessment Representative. This is an entity responsible for evaluating Nursing Facility Level of Care (NFLOC) for Medicaid-eligible individuals entering Medicaid-certified nursing facilities (NF) or home- and community-based services (HCBS) waiver programs.
    • On July 1, 2024, the LCAR began Preadmission Screening and Resident Review (PASRR) and level of care assessments for individuals entering or residing in a skilled nursing facility.
    • Beginning July 1, 2025, the LCAR will provide:
    • PASRR
    • Level of Care (LOC) assessments and reassessments
    • LOC determination recommendations
    • Intake counseling for the Medicaid-eligible 60+ population
    • LCAR will conduct all Level of Care evaluations for HCBS waiver services on the Indiana PathWays for Aging, Health & Wellness, and Traumatic Brain Injury Waivers.
  • Who is the LCAR vendor?

    Maximus

  • When does LCAR launch?

    LCAR officially launched July 1, 2024, with the LCAR vendor conducting PASRR and level of care determinations for individuals entering or residing in a skilled nursing facility. The next phase of work launches July 1, 2025, with the LCAR conducting nursing facility level of care assessments for individuals for the PathWays, Health & Wellness, and Traumatic Brain Injury Waivers. Some qualifying individuals may also receive intake counseling.

  • Who does LCAR serve?

    Prior to July 1, 2025, LCAR has served individuals entering or residing in skilled nursing facilities. Starting July 1, 2025, LCAR will begin serving individuals seeking assessment for nursing facility level of care for home and community-based services such as the PathWays for Aging Waiver, Health and Wellness Waiver, or Traumatic Brain Injury Waiver.

  • What is meant by level of care (LOC) assessment?

    The term ‘level of care (LOC) assessment’ refers to an assessment provided upon request for Long-term Services and Supports (LTSS) to determine an individual’s functional eligibility.

  • What is the LCAR process?
    • For Medicaid-eligible individuals not currently enrolled in PathWays who are seeking nursing facility admission, the existing PASRR process will apply through December 2025. Approved entities (e.g., Hospitals, Nursing Facilities, Managed Care Entities) will assist in completing PASRR screening and LOC assessments and submitting the results to the LCAR for determination.
    • For Medicaid-eligible individuals who are not enrolled in PathWays and are seeking new HCBS, the individual or an assisting entity (e.g., Area Agency on Aging) can submit a request online or via phone for a LOC assessment from the LCAR. The individual will then undergo a LOC assessment by trained and qualified evaluators employed by Maximus.
    • The assessors will meet individuals virtually or in-person as needed to complete these assessments.
    • The assessors will use the age appropriate interRAI assessment tool to account for the applicant's physical, functional, and cognitive needs and determine whether the individual qualifies for nursing facility placement or home-and-community-based services.
    • The individual will receive a determination on the outcome of their assessment via mail. The determination will be issued within 11 calendar days of their request.
    • For individuals already enrolled in PathWays for Aging, the individual’s MCE will conduct the LOC assessment, and the LCAR will provide a determination recommendation based on MCE results to reduce duplication of assessments. This will be the same process for current Medicaid members that are in need of a reassessment or renewal.
    • For individuals receiving services through the H&W waiver, the individuals’ case manager will coordinate with the LCAR to ensure current members are reassessed annually and as needed based on health changes.
  • What is meant by the LCAR process for intake counseling?
    • During or following a LOC assessment, intake counseling helps individuals who may be eligible for Indiana PathWays for Aging or Program of All-Inclusive Care for the Elderly (PACE) to understand their settings and program options.
    • Intake counseling will be available through LCAR for individuals who are within one month of their 60th birthday month and older and who qualify for long-term NFLOC. Intake counseling should be completed via phone, but in-person options will be available on request. Maximus will use a person-centered approach in helping the individual explore setting options (whether nursing facilities or home-and-community based options) and program options (through PathWays or through PACE).
  • What is the LCAR process for warm handoffs to other resources?

    Maximus will provide a warm handoff to the appropriate entity or resource for individuals 60 or older on the PathWays Waiver or Medicaid-eligible individuals under age 60. For active individuals on the H&W waiver turning 60 years of age, their care manager will ensure a successful transition into the PathWays for Aging program.

  • How does this new LCAR process differ from what’s done today?
    • Area Agencies on Aging (AAA) and Independent Case Management (ICM) Agencies will no longer assess individuals for Nursing Facility Level of Care though they will continue to facilitate and coordinate service planning primarily for individuals on the H&W and TBI waivers to ensure the individual's needs are met. AAAs will also continue to provide case management, information, and referrals to various services for older adults and people with disabilities of any age.
    • Beginning July 1, 2025, the LCAR will provide NFLOC assessments and issue these determinations for individuals seeking HCBS Waiver programs with FSSA approval and oversight.
    • NFLOC criteria are not changing. These criteria are set forth in Administrative Code and in the CMS-approved waivers.
  • Why is the LCAR process changing?

    FSSA has been engaged in a multi-year reform of its LTSS programs. LCAR streamlines access to LTSS into a single point of entry. The transition to one statewide vendor will enhance efficiency and provide consistent and accurate NFLOC assessments for the PathWays, H&W and TBI Waivers.

  • I used to work with my AAA for my LOC assessments and now I will work with the LCAR. What is changing?
    • Maximus is responsible to assess NFLOC within 7 calendar days and issue LOC recommendations within 11 calendar days of receiving a LOC request unless they receive a completed assessment from a qualified entity.
    • AAA will be notified through Maximus’ AssessmentPro on any NFLOC decision.  When an individual meets NFLOC, the AAA will proceed with facilitating service planning and connecting to community resources to ensure the individual's needs are being met.
    • If you are seeking admission to a NF, Maximus will also conduct the PASRR process.
  • Contact LCAR

General Member Information

Waiting List and Waivers

  • Will anything change in terms of my length of stay or eligibility for the waiting list?

    The implementation of LCAR will not impact your waiting list status.

  • Is there an anticipated end date for the waiting list?
    • When the new waiver year began on July 1, 2024, FSSA began inviting a group of individuals from the H&W and PathWays Waiver waiting lists each month as long as capacity remained. Based on the number of available slots, the number of people on the waiting list FSSA increased the number of monthly invitations effective October 2024 and will continue to monitor the invitation process.
    • As approved by the federal government, 55,969 total slots are available between the two waivers during the timeframe July 1, 2024, through June 30, 2025. FSSA reached its federally approved capacity for the prior waiver year in April 2024 and implemented a waiting list.
    • Individuals on the PathWays Waiver and Health and Wellness Waiver waiting lists do not have a static place in line. The waiting list is fluid, as individuals are added on a daily basis with varying LOC criteria that impact how individuals are invited. If you have questions about your place on the waiting list, you can reach out to your local AAA. If after reaching out to your AAA you still have questions, you can reach out to FSSA at medicaid@fssa.in.gov. Please note that for the reasons outlined above, your AAA will not be able to tell you about your place on the waiting list (nor will FSSA) but can provide information regarding your original LOC date or priority category status.
  • What waivers and programs are impacted by this change?
    • PathWays for Aging (PathWays) Waiver
    • Health and Wellness (H&W) Waiver
    • Traumatic Brain Injury (TBI) Waiver
    • Pre-Admission Screening for nursing facility admission
  • Where can I learn more about the waitlist?

    FSSA Health & Wellness and PathWays for Aging Waiting List Information can be found here.

Pediatric Eligibility

Provider Information