§ 12-8-1.6-10 — Reimbursement for certain services; home and community based services; limitations concerning assisted living services; rules

Indiana § 12-8-1.6-10

• Jurisdiction: Indiana
• Art. 8: ADMINISTERING FAMILY AND SOCIAL
• Ch. 1.6: Medicaid Home and Community Based Services

Text

(a) This section applies to a home and
community based services waiver that included assisted living services
as an available service before July 1, 2025.
(b) As used in this section, "office" includes the following:
(1) The office of the secretary of family and social services.
(2) A managed care organization that has contracted with the
office of Medicaid policy and planning under IC 12-15.
(3) A person that has contracted with a managed care organization
described in subdivision (2).
(c) Under a home and community based services waiver that
provides services to an individual who is aged or disabled, the office
shall reimburse for the following services provided to the individual by
a provider of assisted living services, if included in the individual's
home and community based service plan:
(1) Assisted living services.
(2) Integrated health care coordination.
(3) Transportation.
(d) If the office approves an increase in the level of services for a
recipient of assisted living services, the office shall reimburse the
provider of assisted living services for the level of services for the
increase as of the date that the provider has documentation of providing
the increase in the level of services.
(e) The office may reimburse for any home and community based
services provided to a Medicaid recipient beginning on the date of the
individual's Medicaid application.
(f) The office may not do any of the following concerning assisted
living services provided in a home and community based services
program:
(1) Require the installation of a sink in the kitchenette within any
living unit of an entity that participated in the Medicaid home and
community based services program before July 1, 2018.
(2) Require all living units within a setting that provides assisted
living services to comply with physical plant requirements that
are applicable to individual units occupied by a Medicaid
recipient.
(3) Require a provider to offer only private rooms.
(4) Require a housing with services establishment provider to
provide housing when:
(A) the provider is unable to meet the health needs of a resident
without:
(i) undue financial or administrative burden; or
(ii) fundamentally altering the nature of the provider's
operations; and
(B) the resident is unable to arrange for services to meet the
resident's health needs.
(5) Require a housing with services establishment provider to
separate an agreement for housing from an agreement for
services.
(6) Prohibit a housing with services establishment provider from
offering studio apartments with only a single sink in the unit.
(7) Preclude the use of a shared bathroom between adjoining or
shared units if the participants consent to the use of a shared
bathroom.
(8) Reduce the scope of services that may be provided by a
provider of assisted living services under the aged and disabled
Medicaid waiver in effect on July 1, 2021.
(g) The office of the secretary may adopt rules under IC 4-22-2 that
establish the right, and an appeals process, for a resident to appeal a
provider's determination that the provider is unable to meet the health
needs of the resident as described in subsection (f)(4). The process:
(1) must require an objective third party to review the provider's
determination in a timely manner; and
(2) may not be required if the provider is licensed by the Indiana
department of health and the licensure requirements include an
appellate procedure for such a determination.

Legislative History

As added by P.L.174-2025, SEC.14.