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Family and Social Services Administration

Family and Social Services Administration

Aging Home > Medicaid HCBS Medicaid Waivers

Indiana Home and Community-Based Services Waivers

This program allows Indiana Medicaid programs to pay for services that are provided in a person’s home or other community setting rather than a Medicaid funded facility or institution. Persons must qualify for institutional care in order to be eligible for home and community-based services. Waiver refers to the waiving of certain federal requirements that otherwise apply to Medicaid program services. The Division of Aging oversees two waivers; they are the Aged and Disabled Waiver (A&D) and the Traumatic Brain Injury Waiver (TBI).

 

Aged and Disabled Waiver (A&D)

The A&D Waiver provides an alternative to nursing facility admission for adults and persons of all ages with a disability. The waiver is designed to provide services to supplement informal supports for people who would require care in a nursing facility if waiver or other supports were not available. Waiver services can be used to help people remain in their own homes, as well as assist people living in nursing facilities to return to community settings such as their own homes, apartments, assisted living or Adult Family Care.

Traumatic Brain Injury Waiver (TBI)

The TBI Waiver provides home and community-based services to individuals who, but for the provision of such services, would require institutional care. Through the use of the Traumatic Brain Injury Waiver (TBI), the Indiana Office of Medicaid Policy and Planning and the Indiana Division of Aging seek to increase availability and access to cost-effective traumatic brain injury waiver services to people who have suffered a traumatic brain injury. Indiana defines a traumatic brain injury as a trauma that has occurred as a closed or open head injury by an external event that results in damage to brain tissue, with or without injury to other body organs. Examples of external agents are: mechanical; or events that result in interference with vital functions. Traumatic brain injury means a sudden insult or damage to brain function, not of a degenerative or congenital nature. The insult of damage may produce an altered state of consciousness and may result in a decrease in cognitive, behavioral, emotional, or physical functioning resulting in partial or total disability not including birth trauma related injury.

Program of All-Inclusive Care for the Elderly (PACE®)

The Program of All-Inclusive Care for the Elderly (PACE®) model is centered on the belief that it is better for the well-being of seniors with chronic care needs and their families to be served in the community whenever possible. PACE serves individuals who: are ages 55 or older; certified by their state to need nursing home care; able to live safely in the community at the time of enrollment; and live in a PACE service area. While all PACE participants must be certified to need nursing home care to enroll in PACE, only about seven percent of PACE participants nationally reside in a nursing home. If a PACE enrollee needs nursing home care, the PACE program pays for it and continues to coordinate the enrollee's care.

Services

Delivering all needed medical and supportive services, a PACE program is able to provide the entire continuum of care and services to seniors with chronic care needs while maintaining their independence in their home for as long as possible. Services include the following:

  • adult day care that offers nursing, physical, occupational and recreational therapies, meals, nutritional counseling, social work, and personal care;
  • medical care provided by a PACE physician familiar with the history, needs, and preferences of each participant;
  • home health care and personal care;
  • all necessary prescription drugs; • social services; • medical specialties, such as audiology, dentistry, optometry, podiatry, and speech therapy;
  • respite care;
  • hospital and nursing home care when necessary; and
  • transportation.

The Franciscan Senior Health & Wellness PACE program currently provides services to older adults who live in the following ZIP codes in Indianapolis, Beech Grove, Greenwood, Franklin and Johnson County: 46201, 46219, 46229, 46203, 46107, 46237, 46239, 46227, 46259, 46142, 46143, 46184, and 46131. For more information, please contact Area 8, CICOA Aging & In-Home Solutions at 317-254-5465.

Where to begin to become a HCBS waiver provider

IMPORTANT NOTICE – Applicants for Assisted Living, Adult Day Service, Adult Family Care and Structured Day Program: The Centers for Medicare and Medicaid Services (CMS) issued new rules governing Home and Community-Based Services which became effective March 17, 2014. These rules require that states ensure that all Medicaid Waiver services are delivered in settings which do not have the characteristics of an institution and are truly “home and community-based”. At this time, the State is unable to approve service settings which are presumed to be institutional in nature and require “heightened scrutiny” under the rule. This includes the following:
  • Any service which is provided within a facility which also provides inpatient services or treatment, such as a nursing facility.
  • Any service which is on the grounds of, or adjacent to, a public (government owned or operated) institution.
  • Settings that have the effect of isolating individuals from the broader community. This includes any setting that provides a physical or operational barrier between the individual and the community, such as a memory care unit.

Settings which are already certified to provide services under the A&D and TBI Medicaid waivers may continue to operate and accept new participants. The DA is developing a transition plan which will establish a “heightened scrutiny” process to ensure that all waiver services are provided in an environment free from institutional characteristics and which allow the participant the same levels of opportunity to access the community and direct their own life as their non-disabled peers. Upon CMS approval of our transition plan, including our process for heightened scrutiny, applications will again be accepted for settings presumed institutional. They will then be subjected to the heightened scrutiny process, including submission to CMS. CMS approval of these settings will be required before they can be certified as a waiver provider.

Please contact the Division of Aging prior to submitting an application if you have any questions regarding the implementation of this rule. Details regarding the rule and the state’s implementation can be found at http://www.in.gov/fssa/4917.htm

After reviewing the information provided above you will need to complete an application for certification. A table indicating required documents for each waiver service is available for you to review. Any additional questions or inquiries may be submitted to the Waiver Provider Specialist by phone at 317-232-4650 or by email at daproviderapp@fssa.in.gov.

The basic Medicaid Waiver Provider application for certification is available to download here and the required W-9 maybe be downloaded here.

Please submit final application and all required documents at daproviderapp@fssa.in.gov and paper applications will continue to be accepted and may be mailed o the address below.

ATTN: Waiver/Provider Analyst
Family and Social Services Administration
Indiana Health Coverage Programs (IHCP)
DA Home and Community-Based Services Waivers
402 West Washington Street, Room W454, MS 21
P.O. Box 7083
Indianapolis, IN 46027

Once all documentation and forms are received by the Division of Aging, the Waiver Provider Analyst will review your Provider Application packet. There may be some follow-up questions or additional information needed. You may be contacted via email or telephone. It is important that you reply as soon possible in order to avoid any unnecessary delays in processing your application. If the necessary documentation is not submitted in a timely manner, the application may be returned to you with the request to resubmit.

  • If you are applying to be an Adult Family Care provider, Assisted Living provider, or an Adult Day Services Provider, you will also need to have an onsite survey conducted by the Division of Aging.
  • If you are applying to be an Assisted Living provider, you must complete a Disclosure for Housing with Services Establishments form, downloadable here.
  • If you are applying to be an Adult Family Care provider, you must complete a Certificate of Liability Insurance, downloadable here.
  • Upon completion of the application process through the Division of Aging, you will be notified by mail that your certification has been approved or denied. Information regarding the appeal process will also be included, in the event your application is denied.
  • If approved, you will then be directed to download your Indiana Health Coverage Programs Waiver Billing Provider Application and Profile Maintenance packet through HP. (See HCBS waiver manual, Section 1.  Helpful hints are also included). You will be notified by letter when the process is complete and your waiver billing number is assigned.
  • NOTE: YOU MUST SUBMIT YOUR APPLICATION TO HP WITHIN 90 DAYS OF RECEIPT OF YOUR WAIVER PROVIDER CERTIFICATION FROM THE DIVISION OF AGING
  • You may begin providing services when you receive you HP billing number, are activated in the waiver provider database and receive your Notice of Action.