CHAPTER 10. COMMUNITY AND HOME OPTIONS TO INSTITUTIONAL CARE FOR THE ELDERLY AND DISABLED PROGRAM
IC 12-10-10
Chapter 10. Community and Home Options to Institutional Carefor the Elderly and Disabled Program
IC 12-10-10-1
"Case management" defined
Sec. 1. As used in this chapter, "case management" means anadministrative function conducted locally by an area agency on agingthat includes the following:
(1) Assessment of an individual to determine the individual'sfunctional impairment level and corresponding need forservices.
(2) Development of a care plan addressing an eligibleindividual's needs.
(3) Supervision of the implementation of appropriate andavailable services for an eligible individual.
(4) Advocacy on behalf of an eligible individual's interests.
(5) Monitoring the quality of community and home careservices provided to an eligible individual.
(6) Reassessment of the care plan to determine the continuingneed and effectiveness of the community and home careservices provided to an eligible individual under this chapter.
(7) Provision of information and referral services to individualsin need of community and home care services.
As added by P.L.2-1992, SEC.4. Amended by P.L.150-1995, SEC.5;P.L.154-1995, SEC.1.
IC 12-10-10-1.5
"Activities of daily living" defined
Sec. 1.5. As used in this chapter, "activities of daily living" refersto an activity described in the long term care services eligibilityscreen.
As added by P.L.150-1995, SEC.6.
IC 12-10-10-2
"Community and home care services" defined
Sec. 2. As used in this chapter, "community and home careservices" means services provided within the limits of availablefunding to an eligible individual. The term includes the following:
(1) Homemaker services and attendant care, including personalcare services.
(2) Respite care services and other support services for primaryor family caregivers.
(3) Adult day care services.
(4) Home health services and supplies.
(5) Home delivered meals.
(6) Transportation.
(7) Attendant care services provided by a registered personalservices attendant under IC 12-10-17.1 to persons described inIC 12-10-17.1-6. (8) Other services necessary to prevent institutionalization ofeligible individuals when feasible.
As added by P.L.2-1992, SEC.4. Amended by P.L.150-1995, SEC.7;P.L.154-1995, SEC.2; P.L.255-2001, SEC.10; P.L.141-2006,SEC.43.
IC 12-10-10-3
"Individual with a disability" defined
Sec. 3. As used in this chapter, "individual with a disability"refers to an individual with a severe chronic disability that isattributable to a mental or physical impairment or combination ofmental and physical impairments that is likely to continueindefinitely.
As added by P.L.2-1992, SEC.4. Amended by P.L.99-2007, SEC.63.
IC 12-10-10-4
"Eligible individual" defined
Sec. 4. (a) As used in this chapter, "eligible individual" means anindividual who:
(1) is a resident of Indiana;
(2) is:
(A) at least sixty (60) years of age; or
(B) an individual with a disability;
(3) has assets that do not exceed five hundred thousand dollars($500,000), as determined by the division; and
(4) qualifies under criteria developed by the board as having animpairment that places the individual at risk of losing theindividual's independence, as described in subsection (b).
(b) For purposes of subsection (a), an individual is at risk oflosing the individual's independence if the individual is unable toperform two (2) or more activities of daily living. The use by or onbehalf of the individual of any of the following services or devicesdoes not make the individual ineligible for services under thischapter:
(1) Skilled nursing assistance.
(2) Supervised community and home care services, includingskilled nursing supervision.
(3) Adaptive medical equipment and devices.
(4) Adaptive nonmedical equipment and devices.
As added by P.L.2-1992, SEC.4. Amended by P.L.150-1995, SEC.8;P.L.246-2005, SEC.99; P.L.99-2007, SEC.64.
IC 12-10-10-4.5
"Long term care services eligibility screen" defined
Sec. 4.5. (a) As used in this chapter, "long term care serviceseligibility screen" refers to the long term care services eligibilityscreen used by the division in making eligibility determinationsunder this chapter.
(b) The long term care services eligibility screen must conformwith the activities of daily living standard established by this chapter.As added by P.L.150-1995, SEC.9.
IC 12-10-10-5
"Program" defined
Sec. 5. As used in this chapter, "program" refers to the communityand home options to institutional care for the elderly and disabledprogram established by this chapter.
As added by P.L.2-1992, SEC.4.
IC 12-10-10-6
Establishment of program; administration; duties of division
Sec. 6. The community and home options to institutional care forthe elderly and disabled program is established. The division shalladminister the program and shall do the following:
(1) Adopt rules under IC 4-22-2 for the coordination of theprogram.
(2) Administer state and federal money for the program.
(3) Develop and implement a process for the management andoperation of the program locally through the area agencies onaging based upon criteria developed by the division.
(4) Approve the selection of community and home care servicesproviders based upon criteria developed by the division.
(5) Review and approve community and home care servicesplans developed by services providers.
(6) Provide training and technical assistance for the staffproviders.
(7) Select or contract with agencies throughout Indiana toprovide community and home care services.
(8) Assist the office in applying for Medicaid waivers from theUnited States Department of Health and Human Services tofund community and home care services needed by eligibleindividuals under this chapter.
(9) Have self-directed care options and services available for aneligible individual who chooses self-directed care services.
As added by P.L.2-1992, SEC.4. Amended by P.L.150-1995, SEC.10;P.L.154-1995, SEC.3; P.L.112-1997, SEC.2; P.L.47-2009, SEC.1.
IC 12-10-10-6.3
Long term care eligibility screen; publication; public inspection
Sec. 6.3. (a) The division shall file for publication in the IndianaRegister a copy of the long term care services eligibility screen.
(b) The division shall:
(1) keep on file in the division's office; and
(2) make available for public inspection during regular businesshours;
a copy of the long term care services eligibility screen.
(c) The division shall provide a copy of the long term careservices eligibility screen to any individual upon request.
As added by P.L.150-1995, SEC.11.
IC 12-10-10-6.5
Restrictions on adoption of rules or criteria governing eligibility
Sec. 6.5. (a) The division shall not adopt any rule governing theeligibility of an individual under this chapter that is more restrictivethan the definition of eligible individual in section 4 of this chapter.
(b) The division and the board shall not adopt an eligibilitycriterion that is more restrictive than the definition of eligibleindividual described in section 4 of this chapter.
(c) Any:
(1) eligibility rule adopted by the division; or
(2) eligibility criterion adopted by the division or the board;
must be specific to the program established under this chapter andmay not be defined by reference to a rule, guideline, or procedure foranother program or service, for a service provided under a Medicaidwaiver, or for institutional care.
As added by P.L.150-1995, SEC.12.
IC 12-10-10-7
Agency conducting case management not to provide services;exception
Sec. 7. (a) Except as provided in subsection (b), the casemanagement under this chapter of an individual leading toparticipation in the program may not be conducted by any agencythat delivers services under the program.
(b) If the division determines that there is no alternative agencycapable of delivering services to the individual, the area agency onaging that performs the assessment under the program may alsodeliver the services.
As added by P.L.2-1992, SEC.4. Amended by P.L.150-1995, SEC.13;P.L.154-1995, SEC.4.
IC 12-10-10-8
Distribution of funds for home health services
Sec. 8. Except as provided in section 9 of this chapter, statemoney for home health services under this chapter must bedistributed only to licensed health care professionals, facilities, andagencies.
As added by P.L.2-1992, SEC.4.
IC 12-10-10-9
Eligible individuals' relatives training program; reimbursementfor provision of services by relative
Sec. 9. (a) The division shall establish a program to train relativesof eligible individuals to provide homemaker and personal careservices to those eligible individuals.
(b) Relatives of eligible individuals who complete the trainingprogram established under this section are eligible for reimbursementunder this chapter or under the Medicaid program for the provisionof homemaker and personal care services to those eligibleindividuals. Reimbursement under the Medicaid program is limited
to those cases in which the provision of homemaker and personalcare services to an eligible individual by a relative results in financialhardship to the relative.
As added by P.L.2-1992, SEC.4.
IC 12-10-10-10
Services funding; source
Sec. 10. Federal social services block grant money shall be usedto fund services under this chapter that are not otherwisereimbursable under the Medicaid program.
As added by P.L.2-1992, SEC.4.
IC 12-10-10-11
Reporting requirement; contents; submission to board and generalassembly; funding
Sec. 11. (a) Before October 1 of each year, the division, inconjunction with the office of the secretary, shall prepare a report forreview by the board and the general assembly. The report mustinclude the following information regarding clients and services ofthe community and home options to institutional care for the elderlyand disabled program and other long term care home and communitybased programs:
(1) The amount and source of all local, state, and federal dollarsspent.
(2) The use of the community and home options to institutionalcare for the elderly and disabled program in supplementing thefunding of services provided to clients through other programs.
(3) The number and types of participating providers.
(4) An examination of:
(A) demographic characteristics; and
(B) impairment and medical characteristics.
(5) A comparison of costs for all publicly funded long term careprograms.
(6) Client care outcomes.
(7) A determination of the estimated number of applicants forservices from the community and home options to institutionalcare for the elderly and disabled program who have:
(A) one (1) assessed activity of daily living that cannot beperformed;
(B) two (2) assessed activities of daily living that cannot beperformed; and
(C) three (3) or more assessed activities of daily living thatcannot be performed;
and the estimated effect of the results under clauses (A), (B),and (C) on program funding, program savings, client access,client care outcomes, and comparative costs with other longterm care programs.
(b) After receiving the report described in subsection (a), theboard may do the following:
(1) Review and comment on the report. (2) Solicit public comments and testimony on the report.
(3) Incorporate its own opinions into the report.
(c) The board shall submit the report in an electronic format underIC 5-14-6 along with any additions made under subsection (b) to thegeneral assembly after November 15 and before December 31 eachyear.
(d) Funding for the report must come entirely from:
(1) funds already available for similar purposes;
(2) discretionary funds available to the division or the office ofthe secretary;
(3) reversion funds; and
(4) private funds and grants.
As added by P.L.150-1995, SEC.14. Amended by P.L.2-1996,SEC.233; P.L.28-2004, SEC.91.
IC 12-10-10-12
Negotiation of reimbursement rates
Sec. 12. (a) The office of the secretary, in consultation with thelocal area agencies on aging, shall negotiate reimbursement rates forservices provided under this chapter.
(b) Payments for services under this chapter may not be countedin a Medicaid recipient's spend down requirement in IC 12-15.
As added by P.L.246-2005, SEC.100.