CHAPTER 6. RESIDENTIAL CARE ASSISTANCE
IC 12-10-6
Chapter 6. Residential Care Assistance
IC 12-10-6-1
Eligibility of county home residents; amount; rate; personalallowance; reimbursement rules; annual rate review
Sec. 1. (a) An individual who:
(1) is at least sixty-five (65) years of age, is blind, or has adisability; and
(2) is a resident of a county home;
is eligible to receive assistance payments from the state if theindividual would be eligible for assistance under the federalSupplemental Security Income program except for the fact that theindividual is residing in a county home.
(b) The amount of nonmedical assistance to be paid on behalf ofa resident in a county home must be based on the daily rateestablished by the division. The rate for facilities under this sectionand licensed under IC 16-28 may not exceed an upper rate limitestablished by a rule adopted by the division.
(c) The rate for facilities under this section but not licensed underIC 16-28 must be the lesser of:
(1) an upper rate limit established by a rule adopted by thedivision; or
(2) a reasonable and adequate rate to meet the costs, determinedby generally accepted accounting principles, that are incurredby efficiently and economically operated facilities in order toprovide care and services in conformity with quality and safetystandards and applicable laws and rules.
(d) The recipient shall be paid or allowed to retain from therecipient's income a monthly personal allowance. The amount:
(1) is fifty-two dollars ($52);
(2) is exempt from income eligibility consideration by thedivision; and
(3) may be exclusively used by the recipient for personal needs.
(e) In addition to the amount that may be retained as a personalallowance under this section, an individual is allowed to retain anamount equal to the individual's state and local income tax liability.The amount that may be retained during a month may not exceedone-third (1/3) of the individual's state and local income tax liabilityfor the calendar quarter in which the month occurs. This amount isexempt from income eligibility consideration by the division. Theamount retained shall be used by the individual to pay state or localincome taxes owed.
(f) In addition to the amounts that may be retained undersubsections (d) and (e), an eligible individual may retain a Holocaustvictim's settlement payment. The payment is exempt from incomeeligibility consideration by the division.
(g) The personal allowance for one (1) month for an individualdescribed in subsection (a) is the amount that an individual would beentitled to retain under subsection (d) plus an amount equal to
one-half (1/2) of the remainder of:
(1) gross earned income for that month; minus
(2) the sum of:
(A) sixteen dollars ($16); plus
(B) the amount withheld from the person's paycheck for thatmonth for payment of state income tax, federal income tax,and the tax prescribed by the federal Insurance ContributionAct (26 U.S.C. 3101 et seq.); plus
(C) transportation expenses for that month; plus
(D) any mandatory expenses required by the employer as acondition of employment.
(h) The division, in cooperation with the state department ofhealth taking into account licensure requirements under IC 16-28,shall adopt rules under IC 4-22-2 governing the reimbursement tofacilities under this section. The rules must be designed to determinethe costs that must be incurred by efficiently and economicallyoperated facilities to provide room, board, laundry, and otherservices, along with minimal administrative direction to individualswho receive residential care in the facilities under this section. A ruleadopted under this subsection by:
(1) the division; or
(2) the state department of health;
must conform to the rules for residential care facilities that arelicensed under IC 16-28.
(i) A rate established under this section may be appealedaccording to the procedures under IC 4-21.5.
(j) The division shall annually review each facility's rate using thefollowing:
(1) Generally accepted accounting principles.
(2) The costs incurred by efficiently and economically operatedfacilities in order to provide care and services in conformitywith quality and safety standards and applicable laws and rules.
As added by P.L.2-1992, SEC.4. Amended by P.L.2-1993, SEC.78;P.L.4-1993, SEC.37; P.L.5-1993, SEC.50; P.L.152-1995, SEC.2;P.L.24-1997, SEC.22; P.L.128-1999, SEC.6; P.L.272-1999, SEC.30;P.L.294-2001, SEC.1; P.L.141-2006, SEC.41; P.L.99-2007, SEC.60.
IC 12-10-6-2
Repealed
(Repealed by P.L.1-2003, SEC.104.)
IC 12-10-6-2.1
Residential care assistance; eligibility; mental retardation;alternative placement; personal allowance; prospectiveprenegotiated payment rate; Christian Science facility placement
Sec. 2.1. (a) An individual who is incapable of residing in theindividual's own home may apply for residential care assistanceunder this section. The determination of eligibility for residentialcare assistance is the responsibility of the division. Except asprovided in subsections (g) and (i), an individual is eligible for
residential care assistance if the division determines that theindividual:
(1) is a recipient of Medicaid or the federal SupplementalSecurity Income program;
(2) is incapable of residing in the individual's own homebecause of dementia, mental illness, or a physical disability;
(3) requires a degree of care less than that provided by a healthcare facility licensed under IC 16-28;
(4) can be adequately cared for in a residential care setting; and
(5) has not made any asset transfer prohibited under the stateplan or in 42 U.S.C. 1396p(c) in order to be eligible forMedicaid.
(b) Individuals with mental retardation may not be admitted to ahome or facility that provides residential care under this section.
(c) A service coordinator employed by the division may:
(1) evaluate a person seeking admission to a home or facilityunder subsection (a); or
(2) evaluate a person who has been admitted to a home orfacility under subsection (a), including a review of the existingevaluations in the person's record at the home or facility.
If the service coordinator determines the person evaluated under thissubsection has mental retardation, the service coordinator mayrecommend an alternative placement for the person.
(d) Except as provided in section 5 of this chapter, residential careconsists of only room, board, and laundry, along with minimaladministrative direction. State financial assistance may be providedfor such care in a boarding or residential home of the applicant'schoosing that is licensed under IC 16-28 or a Christian Sciencefacility listed and certified by the Commission for Accreditation ofChristian Science Nursing Organizations/Facilities, Inc., that meetscertain life safety standards considered necessary by the state firemarshal. Payment for such care shall be made to the provider of thecare according to division directives and supervision. The amount ofnonmedical assistance to be paid on behalf of a recipient living in aboarding home, residential home, or Christian Science facility shallbe based on the daily rate established by the division. The rate forfacilities that are referred to in this section and licensed underIC 16-28 may not exceed an upper rate limit established by a ruleadopted by the division. The recipient may retain from the recipient'sincome a monthly personal allowance of fifty-two dollars ($52). Thisamount is exempt from income eligibility consideration by thedivision and may be exclusively used by the recipient for therecipient's personal needs. However, if the recipient's income is lessthan the amount of the personal allowance, the division shall pay tothe recipient the difference between the amount of the personalallowance and the recipient's income. A reserve or an accumulatedbalance from such a source, together with other sources, may not beallowed to exceed the state's resource allowance allowed for adultseligible for state supplemental assistance or Medicaid as establishedby the rules of the office of Medicaid policy and planning. (e) In addition to the amount that may be retained as a personalallowance under this section, an individual shall be allowed to retainan amount equal to the individual's state and local income taxliability. The amount that may be retained during a month may notexceed one-third (1/3) of the individual's state and local income taxliability for the calendar quarter in which that month occurs. Thisamount is exempt from income eligibility consideration by thedivision. The amount retained shall be used by the individual to payany state or local income taxes owed.
(f) In addition to the amounts that may be retained undersubsections (d) and (e), an eligible individual may retain a Holocaustvictim's settlement payment. The payment is exempt from incomeeligibility consideration by the division.
(g) The rate of payment to the provider shall be determined inaccordance with a prospective prenegotiated payment rate predicatedon a reasonable cost related basis, with a growth of profit factor, asdetermined in accordance with generally accepted accountingprinciples and methods, and written standards and criteria, asestablished by the division. The division shall establish anadministrative appeal procedure to be followed if rate disagreementoccurs if the provider can demonstrate to the division the necessityof costs in excess of the allowed or authorized fee for the specificboarding or residential home. The amount may not exceed themaximum established under subsection (d).
(h) The personal allowance for one (1) month for an individualdescribed in subsection (a) is the amount that an individual would beentitled to retain under subsection (d) plus an amount equal toone-half (1/2) of the remainder of:
(1) gross earned income for that month; minus
(2) the sum of:
(A) sixteen dollars ($16); plus
(B) the amount withheld from the person's paycheck for thatmonth for payment of state income tax, federal income tax,and the tax prescribed by the federal Insurance ContributionAct (26 U.S.C. 3101 et seq.); plus
(C) transportation expenses for that month; plus
(D) any mandatory expenses required by the employer as acondition of employment.
(i) An individual who, before September 1, 1983, has beenadmitted to a home or facility that provides residential care underthis section is eligible for residential care in the home or facility.
(j) The director of the division may contract with the division ofmental health and addiction or the division of disability andrehabilitative services to purchase services for individuals with amental illness or a developmental disability by providing money tosupplement the appropriation for community residential careprograms established under IC 12-22-2 or community residentialprograms established under IC 12-11-1.1-1.
(k) A person with a mental illness may not be placed in aChristian Science facility listed and certified by the Commission for
Accreditation of Christian Science Nursing Organizations/Facilities,Inc., unless the facility is licensed under IC 16-28.
As added by P.L.1-2003, SEC.52. Amended by P.L.141-2006,SEC.42; P.L.99-2007, SEC.61; P.L.121-2008, SEC.1.
IC 12-10-6-3
Reimbursement rules for facilities under IC 12-10-6-2; rate appeal;annual rate review
Sec. 3. (a) The division, in cooperation with the state departmentof health, taking into account licensure requirements under IC 16-28,shall adopt rules under IC 4-22-2 governing the reimbursement tofacilities under section 2.1 of this chapter. The rules must bedesigned to determine the costs that must be incurred by efficientlyand economically operated facilities in order to provide room, board,laundry, and other services, along with minimal administrativedirection to individuals who receive residential care in the facilitiesunder section 2.1 of this chapter.
(b) A rule adopted under subsection (a) by:
(1) the division; or
(2) the state department of health;
must conform to the rules for residential care facilities that arelicensed under IC 16-28.
(c) Any rate established under section 2.1 of this chapter may beappealed according to the procedures under IC 4-21.5.
(d) The division shall annually review each facility's rate using thefollowing:
(1) Generally accepted accounting principles.
(2) The costs incurred by efficiently and economically operatedfacilities in order to provide care and services in conformitywith quality and safety standards and applicable laws and rules.
As added by P.L.2-1992, SEC.4. Amended by P.L.2-1993, SEC.80;P.L.4-1993, SEC.38; P.L.5-1993, SEC.51; P.L.152-1995, SEC.3;P.L.24-1997, SEC.24; P.L.1-2007, SEC.117; P.L.121-2008, SEC.2.
IC 12-10-6-4
Excess income recipients; continued eligibility
Sec. 4. (a) An individual who:
(1) is receiving residential care assistance under section 1 or 2.1of this chapter; and
(2) has an increase in income that would make the individualineligible for residential care assistance;
may elect to continue to be eligible for residential care assistance bypaying the excess income to the home or facility that providesresidential care.
(b) If an individual applies the excess income toward theresidential care assistance under subsection (a), the division shallreduce the payment to the home or facility that provides residentialcare by the amount received by the home or facility.
As added by P.L.2-1992, SEC.4. Amended by P.L.27-1992, SEC.10;P.L.24-1997, SEC.25; P.L.1-2007, SEC.118.
IC 12-10-6-5
Individuals with a mental illness; comprehensive care plan; rules
Sec. 5. (a) An individual who is determined under section2.1(a)(2) of this chapter to be incapable of residing in the individual'sown home because of mental illness may be admitted to a home orfacility that provides residential care to the extent that money isavailable for the care.
(b) Within thirty (30) days after an individual with a mentalillness is placed in a home or facility that provides residential care,a comprehensive care plan must be developed for the individual.
(c) The residential care facility, in cooperation with thecommunity mental health center or an individual's managed careprovider (as defined in IC 12-7-2-127(b)) serving the area in whichthe residential care facility is located, shall develop thecomprehensive care plan for the individual. The plan must includethe following:
(1) Psychosocial rehabilitation services that are provided withinthe community.
(2) A comprehensive range of activities to meet multiple levelsof need, including the following:
(A) Recreational and socialization activities.
(B) Social skills.
(C) Educational, training, occupational, and work programs.
(D) Opportunities for progression into less restrictive andmore independent living arrangements.
(3) Appropriate alternate placement if the individual's needscannot be met by the facility.
(d) The health facilities council shall, in coordination with thedivision of mental health and addiction and the division, adopt rulesunder IC 4-22-2 to govern:
(1) residential care; and
(2) the comprehensive care plan;
provided to individuals with a mental illness who reside under thischapter in a home or facility that provides residential care.
As added by P.L.2-1992, SEC.4. Amended by P.L.40-1994, SEC.19;P.L.215-2001, SEC.37; P.L.99-2007, SEC.62.
IC 12-10-6-6
Application for assistance
Sec. 6. (a) To obtain assistance under this chapter, an individualmust apply to the local administrative unit designated by the division.The application must be:
(1) in writing or reduced to writing;
(2) made in the manner and upon the form prescribed by thedivision; and
(3) verified by the oath of the applicant.
(b) If an individual applying for assistance is mentally orphysically unable to sign an application verified by the oath of theapplicant, an application may be made by an interested individualacting in the applicant's behalf, and the application shall be verified
upon the basis of information and belief of the interested individual.
(c) Each application must contain a statement of all of thefollowing:
(1) The amount of property, both personal and real, in which theapplicant has an interest.
(2) All income that the applicant has at the time of the filing ofthe application.
(3) Any other information prescribed by the division.
As added by P.L.2-1992, SEC.4. Amended by P.L.128-1999, SEC.8.
IC 12-10-6-7
Investigation of applicant
Sec. 7. Whenever the local administrative unit designated by thedivision receives an application for assistance under this chapter, aninvestigation shall be made of the circumstances of the applicant toascertain the facts supporting the application and any otherinformation that may be required by the rules of the division.
As added by P.L.2-1992, SEC.4.
IC 12-10-6-8
Investigative report and recommendation
Sec. 8. Upon completion of the investigation, the localadministrative unit designated by the division shall make a report anda recommendation to the division relative to the eligibility of theapplicant for assistance, the amount of the assistance, and the datewhen the assistance should begin.
As added by P.L.2-1992, SEC.4.
IC 12-10-6-9
Amount of assistance; determination
Sec. 9. The division shall determine the amount of the assistanceand the date on which the assistance should begin. In determining theamount of assistance, due account shall be taken of any income orproperty of the applicant and of any support that the applicant mayreceive from other sources, including any benefit the applicant isreceiving from the Social Security Administration. The award madeby the division and a subsequent modification of the award is bindingupon the state and shall be complied with by the state until the awardor modified award is vacated.
As added by P.L.2-1992, SEC.4.
IC 12-10-6-10
Monthly payments; warrants
Sec. 10. (a) The assistance shall be paid monthly to:
(1) the recipient; or
(2) the administrator of the county home if the localadministrative unit designated by the division so designates;
upon warrant of the auditor of state from money appropriated to thedivision for that purpose.
(b) The auditor of state shall draw the warrants based upon a
verified schedule of the recipients and the amount payable to eachrecipient, prepared and verified by the director of the division inaccordance with awards made by the division.
As added by P.L.2-1992, SEC.4.
IC 12-10-6-11
Reconsideration; report of change; hearing
Sec. 11. (a) All assistance granted under this chapter shall bereconsidered as frequently as is required by the rules of the division.After further investigation that the local administrative unitdesignated by the division considers necessary or that the divisionrequires, the amount of assistance may be changed or entirelywithdrawn if the division finds that the recipient's circumstanceshave altered sufficiently to warrant that action.
(b) Whenever assistance is withdrawn, revoked, suspended, or inany way changed, the division shall immediately report the decisionto the local administrative unit designated by the division.
(c) If assistance is in any way changed, the recipient is entitled toa hearing under the rules adopted by the division.
As added by P.L.2-1992, SEC.4.
IC 12-10-6-12
New county home admittees; aid in applying for assistance
Sec. 12. When an individual is admitted to a county home, theadministrator of the home shall assist the resident in applying forassistance under this chapter.
As added by P.L.2-1992, SEC.4.
IC 12-10-6-13
Higher education award not to be considered income or resourcefor purposes of assistance eligibility
Sec. 13. If an individual receives a state or federal highereducation award that is paid directly to an approved postsecondaryeducational institution for that individual's benefit:
(1) that individual is not required to report that award as incomeor as a resource of that individual when applying for assistanceprovided under this chapter; and
(2) the award may not be considered as income or a resource ofthe individual in determining initial or continuing eligibility forassistance under this chapter.
As added by P.L.2-1992, SEC.4. Amended by P.L.2-2007, SEC.154.
IC 12-10-6-14
Operation cost reports; annual review; rate reimbursementmodification recommendations
Sec. 14. (a) Each home or facility that receives funding from thestate for residential care assistance under this chapter shall file anoperation cost report in a manner prescribed by the division.
(b) The division shall annually conduct a review of the operationcost reports for homes and facilities: (1) that provide residential care; and
(2) receive funding from the state for residential care assistanceunder this chapter;
to determine the actual cost of providing services to individuals whoreceive residential care assistance.
(c) Applying the results of the review under subsection (b), thedivision shall submit a recommended modification of ratereimbursement for residential care assistance to the budget agencybefore April 1 of each year.
As added by P.L.2-1992, SEC.4. Amended by P.L.24-1997, SEC.26.