What is ICF/IID Level of Care?

To be eligible for intellectual disability services, an individual must meet the required ICF/IID level of care. Level of care is the minimum need an individual must have to be considered eligible for HCBS waiver services. Level of care is evaluated when you apply and then at least once a year after that. For the purposes of ICF/IID level of care, a person must have a disability that:

• Results in impairment of functioning similar to that of a person who is intellectually disabled, including autism spectrum disorder, epilepsy, cerebral palsy, or a similar condition (other than mental illness)
• Originates before the person is 22 years of age
• Has continued or is expected to continue indefinitely
• Substantially limits the person's ability to function normally in society in three of the six major life areas: self-care, receptive and expressive language, learning, mobility, self-direction, and capacity for independent living
• Requires access to 24-hour assistance, as needed

Available Waiver Services

Eligible individuals may receive authorized waiver services in conjunction with Traditional Medicaid. Authorized waiver services may include:

• Adult Day Services
• Behavioral Support Services
• Case Management
• Community-Based Habilitation- Group
• Community-Based Habilitation- Individual
• Extended Services
• Facility-Based Habilitation-Group
• Facility-Based Habilitation-Individual
• Facility-Based Support Services
• Family & Caregiver Training
• Intensive Behavioral Support
• Music Therapy
• Occupational Therapy
• Participant Assistance and Care
• Personal Emergency Response System
• Physical Therapy
• Prevocational Services
• Psychological Therapy
• Recreational Therapy
• Respite
• Specialized Medical Equipment & Supplies
• Speech/ Language Therapy
• Transportation Services
• Workplace Assistance

The specific services that meet the needs of the individual member are identified by the member’s case manager. These services are submitted by the state agency for approval and are listed on the member’s Plan of Care (POC)/Notice of Action (NOA).

Member Information

• To apply, go to your local Bureau of Developmental Disabilities Services District Office. There are 8 BDDS District Offices throughout the State. It is helpful to apply as soon as you identify a need for waiver services.

• You must also apply for Medicaid. You can learn more about applying for Medicaid by going to the Apply for Coverage webpage.

Provider Information

• To become a Medicaid provider under the FSW, a provider must first be certified by the Indiana Family and Social Services Administration, Division of Disability and Rehabilitative Services (FSSA, DDRS). Waiver providers can be certified to provider multiple waiver services. To find out more about the enrollment process, visit the Bureau of Developmental Disabilities provider services webpage.

• After certification, the provider must enroll as an Indiana Health Coverage Programs provider. Visit the IHCP Become a Provider webpage for more information about that process. Note that some providers also offer nonwaiver services within the IHCP. These providers are issued two unique provider identification numbers for billing purposes - one for waiver billing and one for nonwaiver billing. Providers must submit claims using the provider ID number that corresponds to the services rendered and entered on the claim. The waiver services that can be provided to the FSW member are limited to those listed on the member’s individualized POC/NOA.

• For more information about providing FSW services see the Division of Disability and Rehabilitative Services Home and Community-Based Services Waivers provider reference module and the Home and Community-Based Services Billing Guidelines provider reference module.