§ 12-15-1.3-18 — Reimbursement rates for federal home and community based services program; direct care staff compensation; procedures; documentation

Indiana § 12-15-1.3-18

• Jurisdiction: Indiana
• Art. 15: MEDICAID
• Ch. 1.3: Medicaid Waivers and Plan Amendments

Text

(a) The definitions set forth in 460 IAC 6-3
as of January 1, 2021, apply to the terms that are used in this section.
(b) As used in this section, "benefits" means allowances and
services provided by employers to employees as compensation that is
in addition to salary and wages, including but not limited to paid time
off, health insurance, life insurance, worker's compensation, and
qualifying pensions.
(c) The office of the secretary shall increase the reimbursement rate
for services if the services are provided as follows:
(1) The services are provided to an individual who receives
services under a Medicaid waiver under the federal home and
community based services program.
(2) The individual is authorized under the Medicaid waiver
described in subdivision (1) to receive any of the following
services:
(A) Adult day services.
(B) Prevocational services.
(C) Residential habilitation and support.
(D) Respite.
(E) Extended services as defined in the family supports
Medicaid waiver and the community integration habilitation
Medicaid waiver.
(F) Day habilitation, as defined in the family supports Medicaid
waiver and the community integration habilitation Medicaid
waiver.
(G) Workplace assistance, as defined in the family supports
Medicaid waiver and the community integration habilitation
Medicaid waiver.
(H) Residential habilitation and support (RHS daily).
(I) Transportation services.
(J) Participant assistance and care, as defined in the family
supports Medicaid waiver.
(K) Facility based support, as defined in the family supports
Medicaid waiver and the community integration habilitation
Medicaid waiver.
(3) The services are delivered to the individual by a direct care
staff.
(d) The amount of the increase in the reimbursement rate described
in subsection (c) for a state fiscal year beginning July 1, 2021, or upon
approval of CMS, or thereafter is the reimbursement rate in effect as of
June 30, 2019, for the services listed in subsection (c)(2) multiplied by
fourteen percent (14%).
(e) An authorized service provider shall use at least ninety-five
percent (95%) of the amount of the increase in the reimbursement rate
to pay payroll tax liabilities and to increase the wages and benefits paid
to direct care staff in comparison to payroll tax liabilities, wages, and
benefits paid to direct care staff as of the provider's most recent fiscal
year ended on or before December 31, 2019, who:
(1) are employed by the authorized service provider to provide
services in Indiana;
(2) provide support services listed in subsection (c)(2); and
(3) are paid on an hourly basis.
(f) If a provider does not use at least ninety-five percent (95%) of
the increase to pay payroll tax liabilities and to increase wages and
benefits paid to direct care staff, the office shall recoup part or all of
the increase in the reimbursement rate that the provider receives as
provided in subsection (h).
(g) An authorized service provider providing services in Indiana
shall provide written and electronic notification of its plan to pay
payroll tax liabilities and to increase wages and benefits to:
(1) direct care staff described in subsection (e) who are employed
by the provider; and
(2) the office of the secretary;
within thirty (30) days after the office implements an increase in
reimbursement rates.
(h) The office may recoup the difference between ninety-five
percent (95%) of the amount received by a provider as a result of
increased reimbursement rates and the amount of the increase that is
actually used by the provider to pay payroll tax liabilities and to pay an
increase in wages and benefits to direct care staff. The remaining five
percent (5%) may be retained by the provider to cover administrative
and overhead costs.
(i) Providers shall maintain all books, documents, papers,
accounting records, and other evidence required to support the
reporting of payroll information for payment of payroll tax liabilities
and for increased wages and benefits to direct care staff. Wages are
defined as total compensation, including paid time off and training, less
overtime and shift differential for direct care staff providing services
to individuals receiving the services described in subsection (c)(2) as
reported on the provider's payroll records. Providers shall make these
materials available at their respective offices at all reasonable times
and for three (3) years from the date of final payment for the services
listed in subsection (c)(2) for inspection by the state or its authorized
designees. Providers shall furnish copies at no cost to the state if
requested.
(j) The office or its designee may recoup all or a part of the amount
paid using the increased reimbursement rates based upon an audit or
review of the supporting documentation required to be maintained
under subsection (i) if the provider cannot provide adequate
documentation to support the payment of payroll tax liabilities and the
payment of increased wages and benefits to direct care staff.
(k) If required, the office shall file Medicaid waiver amendments for
the family supports Medicaid waiver and the community integration
and habilitation Medicaid waiver related to rate increases and Medicaid
waiver caps only on or before October 1, 2021, with the earliest
possible effective date allowed by the federal Centers for Medicare and
Medicaid Services. If the federal Centers for Medicare and Medicaid
Services denies the Medicaid waiver amendments, the office may
modify the waiver amendment request. If a waiver amendment is not
approved, rate increases may not be granted under this section.
(l) This section may not be construed as creating an employment
relationship of any kind between office staff and direct care staff of an
authorized service provider.

Legislative History

As added by P.L.217-2017, SEC.78. Amended by P.L.165-2021, SEC.137.