in-20260722-IR-460260251FNA: ASSISTED LIVING MEDICAID WAIVER SERVICES

TITLE 460 DIVISION OF DISABILITY, AGING, AND REHABILITATIVE SERVICES Notice of First Public Comment Period LSA Document #26-251 ASSISTED LIVING MEDICAID WAIVER SERVICES PURPOSE OF NOTICE The Family and Social Services Administration's Division of Disability, Aging, and Rehabilitative Services (DDARS) is soliciting public comment on amending and readopting rules at 460 IAC 19 concerning assisted living Medicaid waiver services. ADDITIONAL DOCUMENTS Regulatory Analysis: 20260722-IR-460260251RAA Notice of Public Hearing: 20260722-IR-460260251PHA CITATIONS AFFECTED: 460 IAC 19 AUTHORITY: IC 12-8-1.6-12 OVERVIEW Basic Purpose and Background This proposed rule amends and readopts rules at 460 IAC 19 prior to their expiration on January 1, 2027. The implementation costs of the proposed rule are not expected to exceed the threshold set in IC 4-22-2-22.7(c)(6). For purposes of IC 4-22-2-28.1, small businesses affected by this rulemaking may contact the Small Business Regulatory Coordinator: For purposes of IC 4-22-2-28.1, the Small Business Ombudsman designated by IC 5-28-17-6 is: Resources available to regulated entities through the small business ombudsman include the ombudsman's duties stated in IC 5-28-17-6, specifically IC 5-28-17-6(9), investigating and attempting to resolve any matter regarding compliance by a small business with a law, rule, or policy administered by a state agency, either as a party to a proceeding or as a mediator. REQUEST FOR PUBLIC COMMENT DDARS is soliciting public comment on the proposed rule. Comments may be submitted in one of the following ways: COMMENT PERIOD DEADLINE All comments must be postmarked or time-stamped not later than August 24, 2026. The rule, Regulatory Analysis, appendices referenced in the Regulatory Analysis, and materials incorporated by reference (if applicable) are on file at the Family and Social Services Administration, 402 West Washington Street, Room W451, Indianapolis, Indiana and are available for public inspection. Copies of the rule, Regulatory Analysis, and appendices referenced in the Regulatory Analysis are available at the Family and Social Services Administration office. If DDARS does not receive substantive comments during the public comment period or public hearing, the rule may be adopted with text that is the same as or does not substantially differ from the text of the proposed rule published in this notice. PROPOSED RULE 460 IAC 19-1-2 Definitions Sec. 2. The following definitions apply throughout this rule: 460 IAC 19-1-5 Facility requirements 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. 460 IAC 19-1-7 Levels of service; level of service assessment/evaluation tool; provider enrollment 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. 460 IAC 19-1-9 Negotiated risk plan appropriate to level of service 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. 460 IAC 19-1-10 Recipient records 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. 460 IAC 19-1-11 Administration Sec. 11. The provider shall do the following: 460 IAC 19-1-12 Payment for room and board 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 Documents Incorporated by Reference: None Received by Publisher Small Business Regulatory Coordinator: Jessica-Harlan York, Chief Operating Officer, Division of Disability, Aging, and Rehabilitative Services, Indiana Government Center South, 402 West Washington Street, Room W453, Indianapolis, IN 46204, (317) 234-1147, Jessica.harlan-york@fssa.in.gov