2023 Indiana Code › Title 12. Human Services › Article 10. Aging Services › Chapter 11.5. Long Term Care Services › 12-10-11.5-8. Reimbursement for Certain Services; Home and Community Based Services; Limitations on Office Concerning Assisted Living Services; Rules

Sec. 8. (a) As used in this chapter, "assisted living services" refers to services covered under a waiver and provided in any of the following entities:
(1) A residential care facility licensed under IC 16-28.
(2) Any other housing with services establishment.
(b) As used in this section, "level of services" means a determination of the type of services an individual may receive under a Medicaid waiver based on the individual's impairment and dependence and the corresponding reimbursement rate for the determined level of care.
(c) 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).
(d) Under a Medicaid 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:
(1) Assisted living services.
(2) Integrated health care coordination.
(3) Transportation.
(e) 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.
(f) 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.
(g) 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 service 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.
(h) The division 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 (g)(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.
As added by P.L.224-2017, SEC.1. Amended by P.L.173-2018, SEC.3; P.L.10-2019, SEC.56; P.L.56-2023, SEC.89; P.L.149-2023, SEC.8.