in-20261118-IR-460260251FRA: ASSISTED LIVING MEDICAID WAIVER SERVICES

TITLE 460 DIVISION OF DISABILITY, AGING, AND REHABILITATIVE SERVICES Final Rule LSA Document #251 DIGEST ASSISTED LIVING MEDICAID WAIVER SERVICES Amends and readopts rules at 460 IAC 19 concerning assisted living Medicaid waiver services. Effective January 1, 2027. HISTORY Notice of First Public Comment Period: 20260722-IR-460260251FNA Regulatory Analysis submitted with Notice of First Public Comment Period: 20260722-IR-460260251RAA Date of Public Hearing August 24, 2026 CITATIONS AFFECTED: 460 IAC 19 SUMMARY/RESPONSE TO COMMENTS The Division of Disability, Aging, and Rehabilitative Services (DDARS) requested public comment from July 22, 2026, through August 24, 2026, and during the public hearing on August 24, 2026. DDARS received no comments in response to the Notice of First Public Comment Period. This adopted version of the rule is the same as or does not substantially differ from the last published version of the proposed rule. FINAL RULE Sec. 2. The following definitions apply throughout this rule: Sec. 5. (a) Each facility at which assisted living Medicaid waiver services are provided shall meet the following requirements: (b) If a facility was in operation prior to July 1, 2001, and was in compliance with the requirements of IC 12-10-15-7 on June 30, 2001, individual living units provided to recipients shall must have a minimum of one hundred sixty (160) square feet of livable floor space, including closets and counters, but excluding space occupied by the bathroom. (c) If a facility was in operation prior to the original effective date of this rule and was licensed under 410 IAC 16.2-5, individual living units provided to recipients shall must contain the following: (d) All other facilities shall provide recipients with individual living units meeting the following additional requirements: (e) Residential units provided to recipients must be single units, unless the recipient chooses to live in a dual-occupied unit and the recipient and the other occupant consent to the arrangement. (f) Residential units provided to recipients shall must be able to be locked at the discretion of the recipient, unless a physician or a mental health professional certifies in writing that the recipient is cognitively impaired so as to be a danger to self or others if given the opportunity to lock the door. Appropriate staff may hold keys for emergency access. This subsection does not apply if this requirement conflicts with applicable fire codes. Sec. 7. (a) Assisted living Medicaid waiver services will be provided and paid according to three (3) levels of service, with level one (1) being the least impaired and level three (3) the most impaired/dependent. No assisted living Medicaid waiver services may be provided that meet the skilled level of care as defined in 405 IAC 1-3-1. (b) The impairment level assessment tool for assisted living Medicaid waiver services will be based on the point system definitions designated on the level of service assessment form and will be documented on forms prescribed by the division. Sec. 9. (a) If deemed appropriate and determined to be necessary by a recipient's interdisciplinary team, the provider shall establish a negotiated risk plan with a recipient. (b) The negotiated risk plan shall must address unusual situations in which a recipient's assertion of a right, preference, or behavior exposes the recipient or someone else to a real and substantial risk of injury. (c) The negotiated risk plan shall must identify and accommodate a recipient's need in a way that is acceptable to both the provider and the recipient. (d) A negotiated risk plan shall must include: (e) The provider shall involve the recipient and the recipient's interdisciplinary team in developing, implementing, and reviewing a negotiated risk plan. (f) The provider shall review a negotiated risk plan with a recipient and a recipient's team at least quarterly. Sec. 10. (a) An individual recipient record shall must be developed and kept current and available on the premises for each recipient receiving assisted living Medicaid waiver services. In addition to the requirements of 410 IAC 16.2-5-8.1, a recipient's record shall must include the following: (b) Recipient records shall must be readily available to all of the following: (c) Records shall must be kept for the time period required by 410 IAC 16.2-5-8.1 or a minimum of three (3) years, whichever is longer. (d) If a recipient is transferred, discharged, or the provider otherwise ceases to provide services, the recipient's records shall must be transferred with the recipient pursuant to 410 IAC 16.2-5-8.1. Sec. 11. The provider shall do the following: Sec. 12. Each recipient is responsible for payment of for the room and board services. The provider shall charge recipients room and board rates that are no higher than the SSI rate current at the time room and board services are provided, less the amount of the personal needs allowance for room and board for Medicaid eligible individuals. LSA Document #26-251 Notice of First Public Comment Period: July 22, 2026 Last Hearing Held: August 24, 2026 Approved by Attorney General: October 8, 2026 Approved by Governor: October 19, 2026 Filed with Publisher: October 23, 2026, 9:41 a.m. Documents Incorporated by Reference: None Received by Publisher