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).
Directory of Medicaid Waiver Provider Assisted Living Facilities
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 foster care.
Adult Day Services (ADS), Adult Foster Care (AFC), Assisted Living (AL), Attendant Care, Case Management, Community Transition Services, Environmental Modifications, Health Care Coordination, Homemaker, Home Delivered Meals, Nutritional Supplements, Personal Emergency Response Systems (PERS), Pest Control, Respite, Specialized Medical Equipment & Supplies, Transportation, Vehicle Modifications
Adult Day Services (ADS) - Adult Day Services are community-based group programs designed to meet the needs of adults with impairments through individual plans of care. These structured, comprehensive, non-residential programs provide health, social, recreational, and therapeutic activities, supervision, support services, and personal care. These services must be provided in a congregate, protective setting and meals and/or nutritious snacks are required.
Adult Foster Care (AFC) - Adult Foster Care is a comprehensive service in which the participant of services resides with an unrelated caregiver in order for the participant to receive personal assistance designed to provide options for alternative long term care to individuals who meet nursing facility level of care and whose needs can be met in a home-like environment. The participant and up to three (3) other participants who are elderly or have physical and/or cognitive disabilities who are not members of the provider's or primary caregiver's family, reside in a home that is owned, rented, or managed by the adult foster care provider. Participants selecting the AFC service may also receive Case Management Services, Adult Day Services, Specialized Medical Equipment and Supplies and Health Care Coordination through the waiver.
Assisted Living (AL) - Assisted Living service is defined as personal care, homemaker, chore, attendant care and companion services, medication oversight (to the extent permitted under State law), therapeutic social and recreational programming, provided in a home-like environment in a residential facility which is licensed by the Indiana State Department of Health, in conjunction with residing in the facility. This service includes 24 hour on-site response staff to meet scheduled or unpredictable needs in a way that promotes maximum dignity and independence, and to provide supervision, safety and security. Participants may also receive Case Management Services, Specialized Medical Equipment and Supplies and Health Care Coordination through the waiver.
Attendant Care - Attendant Care services primarily involve hands-on assistance for aging adults and persons with disabilities. These services are provided in order to allow older adults or persons with disabilities to remain in their own homes and to carry out functions of daily living, self-care, and mobility. Attendant Care services are limited to 40 hours a week.
Case Management - Case Management is a comprehensive service comprised of a variety of specific tasks and activities designed to coordinate and integrate all other services required in the individual's care plan. Case Management is required in conjunction with the provision of any home and community-based service.
Community Transition Services - Community Transition Services include reasonable, set-up expenses for individuals who make the transition from an institution to their own home where the person is directly responsible for his or her own living expenses in the community and will not be reimbursable on any subsequent move. Reimbursement is limited to a lifetime cap for set up expenses up to $1,500.
Environmental Modifications - Environmental Modifications are minor physical adaptations to the home, as required by the individual's Plan of Care/Cost Comparison Budget. The modifications must be necessary to ensure the health, welfare and safety of the individual and enable the individual to function with greater independence in the home, and without which the individual would require institutionalization. Maintenance is limited to $500 annually for the repair and service of environmental modifications that have been provided through the waiver. There is also a lifetime cap of $15,000.
Health Care Coordination - Health Care Coordination includes medical coordination provided by a Registered Nurse to manage the health care of the individual including physician consults, medication ordering, and development and nursing oversight of a healthcare support plan. Skilled nursing services are provided within the scope of the Indiana State Nurse Practice Act. The purpose of Health Care Coordination is stabilization; prevention of deteriorating health; management of chronic conditions; and/or improved health status.
Homemaker - Homemaker services offer direct and practical assistance consisting of household tasks and related activities. The services assist the individual to remain in a clean, safe, healthy home environment and are provided when the individual is unable to meet these needs or when an informal caregiver is unable to meet these needs for the individual. Homemaker services are limited to 10 hours a week.
Home Delivered Meals - Home Delivered Meals are nutritionally balanced meals that help prevent institutionalization because the absence of nutrition in individuals with frail and disabling conditions presents a severe risk to health. No more than two meals per day will be reimbursed under the waiver.
Nutritional Supplements - Nutritional Supplements include liquid supplements, such as “Boost” or “Ensure” to maintain an individual’s health in order to remain in the community. Supplements should be ordered by a physician based on specific life stage, gender, and/ or lifestyle. There is an annual cap of $1,200.
Personal Emergency Response Systems (PERS) - Personal Emergency Response Systems (PERS) are electronic devices which enable certain individuals at high risk of institutionalization to secure help in an emergency. The individual may also wear a portable help button to allow for mobility. The system is connected to the person's phone and programmed to signal a response center once a "help" button is activated. The response center is staffed 24 hours daily/ 7 days per week by trained professionals.
Pest Control - Pest Control services are designed to prevent, suppress, or eradicate anything that competes with humans for food and water, injures humans, spreads disease and/or annoys humans and is causing or is expected to cause more harm than is reasonable to accept. Pests include insects such as roaches, mosquitoes, and fleas; insect-like organisms, such as mites and ticks; and vertebrates, such as rats and mice. There is an annual cap of $600.
Respite - Respite services are those services that are provided temporarily or periodically in the absence of the usual caregiver. Respite service is not to exceed 60 hours per month. Service may be provided in an individual’s home; the private home of the caregiver, an adult foster care home, or in a Medicaid certified nursing facility. For those individuals receiving the service of Adult Foster Care, funding for respite is already included in the per diem amount and the actual service of respite may not be billed. The level of professional care provided under respite services depends on the needs of the individual. An individual requiring assistance with bathing, meal preparation and planning, specialized feeding, such as an individual who has difficulty swallowing, refuses to eat, or does not eat enough; dressing or undressing; hair and oral care; and weight bearing transfer assistance should be considered for respite home health aide under the supervision of a registered nurse. An individual requiring infusion therapy; venipuncture; injection; oral medication; Hoyer lift; wound care for surgical, decubitus, incision, and so forth; ostomy care; and tube feedings should be considered for respite nursing services.
Specialized Medical Equipment & Supplies - Specialized Medical Equipment and Supplies are medically prescribed items required by the individual's Plan of Care/Cost Comparison Budget, which are necessary to assure the health, welfare and safety of the individual, which enable the individual to function with greater independence in the home, and without which the individual would require institutionalization. Individuals requesting authorization for this service through the waiver must first exhaust eligibility of the equipment or supplies through the Indiana Medicaid State Plan. There should be no duplication of services. Maintenance is limited to $500 annually for the repair and service of items that have been provided though the waiver.
Transportation - Transportation services enable individuals served under the waiver to gain access to waiver and other community services, activities and resources, specified by the plan of care. Transportation services under the waiver shall be offered in accordance with an individual's plan of care and whenever possible, family, neighbors, friends, or community agencies which can provide this service without charge will be utilized. This service is offered in addition to medical transportation required under 42 CFR 431.53 and transportation services under the State plan, if applicable, and shall not replace them.
Vehicle Modifications - Vehicle Modifications are the addition of adaptive equipment or structural changes to a motor vehicle that permit an individual with a disability to be safely transported in a motor vehicle. Vehicle modifications, as specified in the Plan of Care/Cost Comparison Budget, may be authorized when necessary to increase an individual’s ability to function in a home and community based setting to ensure accessibility of the individual with mobility impairments. These services must be necessary to prevent or delay institutionalization. The necessity of such items must be documented in the plan of care by a physician’s order. Vehicles necessary for an individual to attend post secondary education or job related services should be referred to Vocational Rehabilitation Services. Maintenance is limited to $500 annually for repair and services of items that have been funded though the waiver and there is a $15,000 lifetime cap.
Traumatic Brain Injury Waiver (TBI)
This waiver is requested in order to provide 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.Adult Day Services (ADS) , Attendant Care, Behavior Management/ Behavior Program and Counseling, Case Management, Environmental Modifications, Health Care Coordination, Homemaker, Occupational Therapy, Personal Emergency Response Systems (PERS), Physical Therapy, Residential Based Habilitation, Respite Care, Specialized Medical Equipment & Supplies, Speech/Language Therapy, Structured Day Program, Supported Employment, Transportation, Vehicle Modifications
Adult Day Services (ADS) - Adult Day Services are community-based group programs designed to meet the needs of adults with impairments through individual plans of care. These structured, comprehensive, non-residential programs provide health, social, recreational, and therapeutic activities, as well as supervision, support services, and personal care. These services must be provided in a congregate, protective setting. Meals and/or nutritious snacks are required.
Attendant Care - Attendant Care services primarily involve hands-on assistance for older adults and persons with disabilities who have physical needs. These services are provided in order to allow older adults or persons with disabilities to remain in their own homes and to carry out functions of daily living, self-care, and mobility.
Behavior Management/ Behavior Program and Counseling - Behavior Management includes training, supervision, or assistance in appropriate expression of emotions and desires, assertiveness, acquisition of socially appropriate behaviors, and the reduction of inappropriate behaviors.
Case Management - Case Management is a comprehensive service comprised of a variety of specific tasks and activities designed to coordinate and integrate all other services required in the individual's care plan. Case Management is required in conjunction with the provision of any home and community-based service.
Environmental Modifications – Environmental Modifications are physical adaptations to the home, required by the individual’s plan of care, which are necessary to ensure the health, welfare and safety of the individual, or enable the individual to function with greater independence in the home, and without which the individual would require institutionalization. Maintenance is limited to $500 annually for the repair and service of environmental modifications that have been provided through the waiver. There is also a lifetime cap of $15,000.
Health Care Coordination - Health Care Coordination includes medical coordination provided by a Registered Nurse to manage the health care of the individual including physician consults, medication ordering, and development and nursing oversight of a healthcare support plan. Skilled nursing services are provided within the scope of the Indiana State Nurse Practice Act. The purpose of Health Care Coordination is stabilization; prevention of deteriorating health; management of chronic conditions; and/or improved health status.
Homemaker - Homemaker services offer direct and practical assistance consisting of household tasks and related activities. These services assists the individual to remain in a clean, safe, healthy home environment and are provided when the individual is unable to meet these needs or when an informal caregiver is unable to meet these needs for the individual.
Occupational Therapy - Occupational Therapy services are services provided by a licensed occupational therapist. These can include evaluation and training services in the areas of gross and fine motor function, self-care and sensory and perceptual motor function. Therapies provided through the TBI Waiver service will not duplicate therapies provided under any other service. Activities that are available through the Medicaid State Plan are not available through the Medicaid waiver.
Personal Emergency Response Systems (PERS) - Personal Emergency Response Systems (PERS) are electronic devices which enable certain individuals at high risk of institutionalization to secure help in an emergency. The individual may also wear a portable help button to allow for mobility. The system is connected to the person's phone and programmed to signal a response center once a "help" button is activated. The response center is staffed 24 hours daily/ 7 days per week by trained professionals.
Physical Therapy - Physical Therapy services are services provided by a licensed physical therapist. These can include treatment and training programs designed to preserve and improve abilities for independent functioning, such as gross and fine motor skills, range of motion, strength, muscle tone, activities of daily living. Therapies provided through the TBI Waiver service will not duplicate therapies provided under any other service. Activities that are available through the Medicaid State Plan are not available through the Medicaid waiver.
Residential Based Habilitation - Residential Based Habilitation service provides assistance with the acquisition, retention or improvement in skills related to activities of daily living and the social and adaptive skills necessary to enable the individual to live in a non-institutional setting.
Respite Care - Respite Care services are those services that are provided temporarily or periodically in the absence of the usual caregiver. Service may be provided in an individual’s home, in the private home of the caregiver, or in a Medicaid certified nursing facility. The level of professional care provided under respite services depends on the needs of the individual. An individual requiring assistance with bathing, meal preparation and planning, specialized feeding, such as an individual who has difficulty swallowing, refuses to eat, or does not eat enough; dressing or undressing; hair and oral care; and weight bearing transfer assistance should be considered for respite home health aide under the supervision of a registered nurse. An individual requiring infusion therapy; venipuncture; injection; oral medication; Hoyer lift; wound care for surgical, decubitus, incision, and so forth; ostomy care; and tube feedings should be considered for respite nursing services.
Specialized Medical Equipment & Supplies - Specialized Medical Equipment and Supplies include devices, controls, or appliances, specified in the plan of care, which enable individuals to increase their abilities to perform activities of daily living, or to perceive, control, or communicate with the environment in which they live and without which the individual would require institutionalization. Individuals requesting authorization for this service through the waiver must first exhaust eligibility of the equipment or supplies through the Indiana Medicaid State Plan. There should be no duplication of services. Maintenance is limited to $500 annually for the repair and service of items that have been provided though the waiver.
Speech/Language Therapy - Speech/Language Therapy are services provided by a licensed speech pathologist. These can include direct therapeutic intervention and treatment for speech and hearing disabilities such as delayed speech, stuttering, spastic speech, aphasic disorders, injuries, lip reading or signing, or the use of hearing aids. Therapies provided through the TBI Waiver service will not duplicate therapies provided under any other service. Activities that are available through the Medicaid State Plan are not available through the Medicaid waiver.
Structured Day Program - Structured Day Program is assistance with acquisition, retention, or improvement in self-help, socialization and adaptive skills, which takes place in a non-residential setting, separate from the home in which the individual resides. The program focuses on enabling the individual to attain or maintain his or her functional level and is coordinated with any physical, occupational, of speech therapies listed in the plan of care. Structured Day Program services serve to reinforce skills or lessons taught in school, therapy, or other settings. The services are normally furnished four (4) or more hours per day on a regularly scheduled basis, for one (1) or more days per week unless provided as an adjunct to other day activities included in an individual's plan of care.
Supported Employment - Supported Employment services consist of paid employment for persons for whom competitive employment at or above the minimum wage is unlikely, and who, because of their disabilities, need intensive ongoing support to perform in a work setting. Supported Employment is conducted in a variety of settings, particularly work sites where persons without disabilities are employed. The service includes activities needed to sustain paid work by individuals receiving waiver services, including supervision and training.
Transportation - Transportation services enable individuals served under the waiver to gain access to waiver and other community services, activities and resources, specified by the plan of care. Transportation services under the waiver shall be offered in accordance with an individual's plan of care and whenever possible, family, neighbors, friends, or community agencies which can provide this service without charge will be utilized. This service is offered in addition to medical transportation required under 42 CFR 431.53 and transportation services under the State plan, if applicable and shall not replace them.
Vehicle Modifications - Vehicle Modifications are the addition of adaptive equipment or structural changes to a motor vehicle that permit an individual with a disability to be safely transported in a motor vehicle. Vehicle modifications, as specified in the Plan of Care/Cost Comparison Budget, may be authorized when necessary to increase an individual’s ability to function in a home and community based setting to ensure accessibility of the individual with mobility impairments. These services must be necessary to prevent or delay institutionalization. The necessity of such items must be documented in the plan of care by a physician’s order. Vehicles necessary for an individual to attend post secondary education or job related services should be referred to Vocational Rehabilitation Services. Maintenance is limited to $500 annually for repair and services of items that have been funded though the waiver and there is a $15,000 lifetime cap.
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