us-in/regulation/iac/455

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us-in/regulation/iac/455 — Axiom

(1)(1-2)Definitions#

Authority: IC 12-9.1-2-3

Affected: IC 12-10 ; IC 12-14 ; IC 12-15-2 ; IC 16-28-2

Sec. 2. (a) The definitions in this section apply throughout this rule.

(b) "Applicant" means an individual who has directly, or through a responsible party, made application to participate in the nursing home prescreening program under IC 12-10-12 in order to determine the appropriateness of the individual's placement in a health facility.

(c) "Admission to a health facility" means as soon as an individual is physically present in a health facility unless the admittance is designee-approved. A person approved by a designee is considered admitted twenty-four (24) hours after entering the facility.

(d) "Bureau" refers to the bureau of aging and in-home services established within the division under IC 12-10-1-1 .

(e) "DDARS" or "division" refers to the Indiana division of disability, aging, and rehabilitative services.

(f) "Designee" means an individual appointed by the prescreening agency, who may authorize temporary admittance to a health facility, under IC 12-10-12-28 through IC 12-10-12-31 .

(g) "Equivalent degree" means a bachelor's degree or a master's degree, which meets the following requirements: (1) The degree is in the same field of study as those listed in section 10(c)(1) of this rule. (2) The degree requires courses comparable to the courses required for the degrees listed in section 10(c)(1) of this rule. (3) The degree has a different title than the degree listed in section 10(c)(1) of this rule.

(h) "Health facility" means a facility licensed by the department of health under IC 16-28-2 , whether Medicare or Medicaid certified or not, that: (1) provides comprehensive: (A) nursing care; (B) room; (C) food; (D) laundry; (E) administration of medications; (F) special diets; and (G) treatments; and (2) may provide rehabilitative and restorative therapies under the order of an attending physician. The term, for purposes of this rule, does not include intermediate care facilities for the mentally retarded (ICF/MR) or facilities licensed for residential care.

(i) "Level I: Identification Evaluation Screen" refers to a screening tool designed to ascertain whether an individual has or is suspected of having a condition of mental illness (MI) and/or mental retardation /developmental disability (MR/DD).

(j) "Medicaid or medical assistance" means payment for part or all of the cost of medical or remedial services furnished on behalf of eligible needy individuals as defined in IC 12-15-2 .

(k) "Medicaid waiver" refers to specific provisions concerning home and community based services as specified under 42 U.S.C. 1396n, which have been approved by the Secretary of the federal Department of Health and Human Services, for implementation in Indiana.

(l) "Office" means the office of Medicaid policy and planning established under IC 12-8-6-1 [ IC 12-8-6 expired under IC 12-8-6-10 . See IC 12-8-6.5 .] .

(m) "PAS process" means the process specified in section 4 of this rule.

(n) "PAS team" means the screening team under IC 12-10-12-14 .

(o) "Preadmission screening", "prescreening", and "screening program" mean the screening process under IC 12-10-12 .

(p) "Prescreening agency" or "PAS agency" means an area agency on aging designated by the bureau under IC 12-10-1-4 (18).

(q) "Responsible party" means an individual chosen by an applicant or, if the applicant is a minor or has been adjudicated incompetent, a parent or guardian of an applicant who assists in the process of making application for prescreening under this rule.

(1)(1-5)Application#

Authority: IC 12-9.1-2-3

Affected: IC 12-10-12-7 ; IC 12-10-12-27.1 ; IC 16-28-2

Sec. 5. (a) The individual requesting care in a health facility or the individual's responsible party shall fill out and sign an application for the prescreening program prior to admission to a health facility under IC 12-10-12-7 . The application is considered to be completed when it is filled out, signed, and given to a representative of a health facility, the designee, or a member of the prescreening team.

(b) The applicant shall, as part of the application process, state the name, address, and telephone number of the physician that he or she requests to serve on the screening team.

(c) The effective date of the application for prescreening is the date on which the prescribed form is signed by the applicant.

(d) A person in a residential living arrangement who is at risk of institutionalization or who could benefit from home-based care may make a request to the PAS agency in the county in which the applicant resides under IC 12-10-12 prior to application for admission to a health facility to determine if home-based services are available and appropriate. The application will be made to the prescreening agency serving the area in which the applicant resides.

(e) An individual who is a resident of a health facility may request to be screened, as part of a discharge planning process, to determine what services are available to help the individual live outside of the health facility. The application will be made to the prescreening agency serving the area in which the health facility is located.

(f) Requirements for a person residing in another state requesting admission to a health facility in Indiana shall be as follows: (1) The person must participate in the prescreening program under IC 12-10-12-27.1 . (2) An application for the prescreening program by a person residing in another state shall be made to the prescreening agency serving the county in which the health facility is located, and the availability of community services shall be based on services available in the area in which the health facility is located. Determination is to be rendered within ten (10) days of receipt of the required documents.

(g) The screening under IC 12-10-12 shall not be required: (1) for a person admitted to a health facility following direct discharge from another health facility licensed under IC 16-28-2 ; (2) for a person readmitted to a health facility from a hospital after discharge directly from a health facility to the hospital, if his or her placement in a health facility was found to be appropriate under IC 12-10-12 or if he or she was admitted to a health facility prior to April 30, 1983; (3) for transfer from one (1) nursing facility level of services to another nursing facility level of services in the same health facility or in another health facility; (4) for a person admitted to an intermediate care facility for the mentally retarded or a facility licensed for residential care; or (5) for an individual who transfers from a continuing care retirement community bed to the bed of a comprehensive care facility licensed under IC 16-28-2 that serves only residents of that retirement community for a recuperative stay not to exceed five (5) days, but if the individual remains longer than five (5) days, the individual must apply for screening no later than the fifth day.

(h) Authorization for admission under IC 12-10-12-31 may be granted by the designee when a medical emergency exists in that care in the health facility is required within seventy-two (72) hours of the request for admission and the attending physician certifies the need for emergency admission to the prescreening agency following the procedures established by the division. An emergency admission shall only be granted for admission from a noninstitutional living arrangement or an emergency room of an in-state hospital.

(i) For individuals who have undergone the screening process and have been determined to be ineligible for placement in a health facility, that individual shall not apply for participation in further screening for a minimum of one (1) year unless the medical condition or the support system of the individual is significantly changed to the degree that the attending physician believes a new screening process is medically necessary. The attending physician may certify the need for such additional screening to the prescreening agency. The screening team will make the final decision on the need for another screening based on the attending physician's certification. The screening shall be conducted in accordance with IC 12-10-12 . The effective date of the application for additional screening shall be the date of the screening team's final decision on the need for another screening.

(j) For persons not admitted to a health facility, the determination under IC 12-10-12-20 that placement in a health facility is appropriate shall be valid for a period not to exceed ninety (90) days from the date of issuance by the office. If the person has not been admitted to a health facility ninety (90) days after the issuance of the determination, the individual must apply for PAS screening again, and must have a physician's certification of the need for additional screening.

(k) An individual who was not notified of the requirement for prescreening and who is in a health facility may be prescreened after receiving notification of the requirement.

(1)(1-7)Prescreening agency; duties#

Authority: IC 12-9.1-2-3

Affected: IC 12-10-12 ; IC 12-13-5 ; IC 12-14

Sec. 7. The prescreening agency shall do the following: (1) Seek cooperation from other public and private agencies in the community which offer services to the disabled and elderly. (2) Provide information and education to the general public regarding availability of the screening program. (3) Accept prescreening referrals from individuals, families, human service professionals, and health facility personnel. (4) Assess health and social needs of referred individuals and identification of services needed to maintain these persons in the least restrictive environment. (5) Identify available noninstitutional services to meet the care needs of individuals referred. (6) Compute the cost effectiveness of noninstitutional versus health facility services. (7) Upon receipt of a completed application, immediately schedule the prescreening activities to be completed within the time designated at IC 12-10-12-28 through IC 12-10-12-31 or within twenty-five (25) days for persons making application under IC 12-10-12-7 . (8) Determine the composition of the PAS teams provided for under IC 12-10-12-14 . The division may require the PAS agency to seek approval of PAS team members from the division. (9) Make appointments and fill vacancies on the PAS team and appoint designees under IC 12-10-12-27 . (10) Appoint to the PAS team at the time of each prescreening, the applicant's physician as required in IC 12-1-12-14 (b) [ IC 12-1 was repealed by P.L.2-1992, SECTION 897, effective February 14, 1992.] . In the event that the applicant is unable to specify an attending physician, the prescreening agency may assist to locate a physician who shall be named as a member of the screening team with the approval of the applicant. (11) Notify each appointee of his or her selection, in writing. (12) Retain a signed copy of the prescribed notification, application form, and supporting documentation for a period of three (3) years. (13) Prepare reports as required by the division. (14) Report to the prosecuting attorney of the county in which the violation occurred the failure of the health facility to notify the individual that he or she must be prescreened prior to admission to the health facility or the failure of the health facility to deliver the signed copy of the notification to the prescreening agency serving the county in which the applicant resides.

(1)(1-8)Health facility; duties#

Authority: IC 12-9.1-2-3

Affected: IC 12-10-12 ; IC 12-13-5 ; IC 12-14

Sec. 8. (a) When an individual applies to a health facility for admission, the health facility shall notify the applicant: (1) that he or she must apply to the prescreening agency for participation in the prescreening program; (2) that the preadmission screening program consists of an assessment of the applicant's need for care in a health facility made by a team of individuals familiar with the needs of persons seeking admission; and (3) the penalty that the individual will incur under IC 12-10-12-33 and IC 12-10-12-34 if he or she does not comply with the prescreening program.

(b) The notification shall be in writing on forms prescribed by the division and shall contain the information set out in IC 12-10-12-10 (a) and IC 12-10-12-10 (b).

(c) The applicant must be given one (1) signed copy acknowledging that he or she has received the notice and the date that the notice was received. The health facility that the individual has entered shall keep one (1) signed copy on file for one (1) year from the date of signature or, if the individual is admitted to the health facility, from the date of admission, whichever is later. One (1) signed copy must be forwarded to the prescreening agency within five (5) working days from the date of signature or, if the individual is admitted to the health facility, from the date of admission, whichever is later.

(d) It is the responsibility of the health facility to provide verification that: (1) the application for prescreening was made prior to admission; (2) an individual admitted prior to the prescreening determination under IC 12-10-12-20 had designee authorization for admission required under IC 12-10-12-27 ; and (3) the copy of the application and other designated documentation were forwarded to the prescreening agency within five (5) working days from the date of designee authorization.

(e) The health facility shall promptly provide to the screening team an estimate of the cost of all services that the individual is anticipated to require in the health facility. The estimate will be at the cost charged to private payors.

(1)(1-10)PAS team; duties#

Authority: IC 12-9.1-2-3

Affected: IC 12-10-12-16 ; IC 12-10-12-18 ; IC 12-13-5 ; IC 12-14

Sec. 10. (a) The PAS team shall conduct the preadmission assessment pursuant to the policies and procedures prescribed by the division.

(b) The preadmission assessment shall be conducted by the use of the assessment forms developed or approved by the division and shall include the following elements: (1) Client demographic information. (2) Present medical condition of client. (3) Present psychosocial status of client. (4) Assessment of functional capacity of client. (5) Present formal or informal services being provided to the client. (6) Present unmet needs of client. (7) Formal and informal services that are presently available but are not being provided to the client. (8) Observations of the PAS team during the on-site visit. (9) Persons consulted during the screening process. (10) Client's preference for care. (11) A preliminary care plan.

(c) Each PAS team member, other than the physician member, shall have one (1) of the following: (1) A bachelor's degree in social work, psychology, gerontology, sociology, counseling, nursing, or an equivalent degree. (2) A license as a registered nurse or a bachelor's degree in any field and a minimum of two (2) years of direct service experience with the elderly or persons with disabilities, which includes activities such as the following: (A) Assessment. (B) Plan development. (C) Implementation. (D) Monitoring. A master's degree in a related field may substitute for the required experience.

(d) An individual who meet the educational requirement and a minimum of one (1) year of the required experience may qualify provisionally as a PAS team member. In order for any individual to qualify provisionally as a PAS team member, the PAS agency shall have in place a written plan, approved by the division, outlining the manner in which the individual shall achieve the experience needed to become a PAS team member. The written plan shall include the following: (1) A specific proposal of how the remaining amount of the deficient experience will be satisfied within a time period equal to the amount of remaining experience needed, but not to exceed twelve (12) months. (2) Arrangements for the provisional PAS team member to meet, at least biweekly, with a supervisor or an individual who meets the qualifications in section 10(c) of this rule, to discuss the provisional PAS team member's care plans. (3) A statement asserting that the provisional PAS team member's care plans will be reviewed and approved by the supervisor or an individual who meets the qualifications in section 10(c) of this rule. Provisional PAS team member certification shall be withdrawn by the division if the terms of the written plan are not met at least twelve (12) months from the date of provisional certification.

(e) Designees shall meet the criteria in subsection (c).

(f) After the assessment is completed, the PAS team shall find whether the placement of the individual in a health facility is appropriate, utilizing the guidelines set forth in section 12(c) and 12(d) of this rule.

(g) The vote of the PAS team shall be conducted at the time and place as set by the member of the screening team who represents the prescreening agency. The vote may either be made by a signature at the time of individual contact, based on a review of all necessary data, or the vote may be conducted by telephone. The vote of the physician team member will be made by completion of and signature on the prescribed form. The assessment of the appointee of the prescreening agency, together with the assessments of any other team member who desires to comment, shall be submitted to the office for the prescreening determination designated under IC 12-10-12-18 . All screening forms, narrative reports, and other pertinent applicant data shall be submitted to the office with the findings of the PAS team.

(h) If the PAS team finds that placement in a health facility should be denied, then it shall: (1) list the reason(s) for denial; (2) list the community services available to the applicant that would be more appropriate than care in a health facility; (3) detail the cost of those community services, regardless of the source of payment; (4) detail the cost of placement in a health facility (which shall include the cost of all services, including those costs in addition to per diem that the applicant will require), regardless of the source of payment; (5) discuss the alternative service plan with the applicant after completion of the assessment; (6) submit the findings in writing to the office; and (7) make appropriate referral for case management services if the services are available.

(i) The member of the PAS team who is appointed as the representative of the prescreening agency shall obtain the information for, and prepare the assessment required by IC 12-10-12-16 .

(1)(1-14)Penalties#

Authority: IC 12-9.1-2-3

Affected: IC 12-10-12 ; IC 12-13-5 ; IC 12-14

Sec. 14. (a) A person admitted to a health facility will not incur the penalties set out in IC 12-10-12-33 and IC 12-10-12-34 if authorization for admission from the prescreening agency under IC 12-10-12-28 through IC 12-10-12-31 or approval for admission under IC 12-10-12-20 has been rendered.

(b) A person admitted to a health facility on designee authorization under IC 12-10-12-28 through IC 12-10-12-31 will not incur the penalties set out in IC 12-10-12-33 and IC 12-10-12-34 if, regardless of when the determination is made: (1) placement in the health facility is determined to be appropriate under IC 12-10-12-20 ; or (2) the individual is discharged from the health facility within fourteen (14) days after receipt of the decision that placement in the health facility is determined to be inappropriate.

(c) The penalty under IC 12-10-12-34 shall continue only until the person receives a determination that placement in a health facility certified as a skilled nursing facility is appropriate, but in no case will last more than one (1) year from the date of admission. The time of the penalty will be computed to include the period authorized under IC 12-10-12-28 through IC 12-10-12-31 except that the penalty will not be imposed for the designee authorized time.

(d) A person who refuses to be screened by the PAS team shall incur the penalty set out in IC 12-10-12-33 or IC 12-10-12-34 .

(e) However, a person who was not notified of the preadmission screening requirement will incur no penalty, unless the individual refuses to be screened after notification or is found to be inappropriate for services, in which case the individual would incur the penalty beginning with the date of notification that preadmission screening is required.

(f) The penalty set out in IC 12-10-12-33 and IC 12-10-12-34 shall not be levied against an individual who: (1) is eligible for and requires home and community based services approved by the Secretary of the federal Department of Health and Human Services under 42 U.S.C. 1396n; and (2) chooses to go into a health facility.

(1)(2-2)Definitions#

Authority: IC 12-9.1-2-3

Affected: IC 12-10-3 ; IC 35-42-2-1 ; IC 35-46-1-13

Sec. 2. (a) The definitions in this section apply throughout this rule.

(b) "APS unit" is the adult protective services unit, charged with receiving and investigating reports regarding endangered adults, located throughout the state in areas designated by DDARS.

(c) "Available services" means services needed by the individual to sustain his or her life, liberty, health or property which can be obtained from a service provider serving the area in which the endangered adult is living, or which could be provided by a willing neighbor, friend, or relative.

(d) "DDARS" is the division of disability, aging, and rehabilitative services.

(e) "Emergency" refers to a situation in which the possibility of immediate physical danger to the adult exists.

(f) "Endangered adult" means an individual who is eighteen (18) years of age or older and who: (1) is incapable by reason of mental illness, mental retardation, dementia, habitual drunkenness, excessive use of drugs, or other physical or mental incapacity, of managing or directing the management of the individual's property or providing self-care; and (2) is harmed or threatened with harm as a result of: (A) neglect; (B) battery; or (C) exploitation of the individual's personal services or property. The term includes individuals who are endangered as a consequence of their own inability to care for themselves and who would receive little or no help except through the services of an external intervenor.

(g) "Exploitation of the individual's personal services or property" includes, but is not limited to sexual misuse as well as the use of the endangered adult's labor without pay or exerting unauthorized control over the finances or property of the endangered adult.

(h) "Neglect" means that the endangered adult or the person who takes care of the endangered adult is unable or fails to provide adequate food, clothing, shelter or medical care.

(i) "Substantiated" means that endangerment was established to the satisfaction of the APS unit as relates to the definition of an endangered adult.

(j) "Unsubstantiated" means that endangerment of an individual was not established to the satisfaction of the APS unit, within the meaning of IC 12-10-3 .

(1)(2-5)Adult protective services unit's duties#

Authority: IC 12-9.1-2-3

Affected: IC 12-10-3 ; IC 35-42-2-1 ; IC 35-46-1-13

Sec. 5. The APS unit shall assure that the following activities are carried out: (1) Secure and maintain a full-time equivalent qualified protective services coordinator, as defined in 455 IAC 1-2-6 [section 6 of this rule] . (2) Cooperate with DDARS to provide information and education to the general public within the designated area regarding the existence of the adult protective services law and available services. (3) Accept all reports of adult battery, neglect and exploitation from individuals, health care and human service professionals, institutions, law enforcement officials, DDARS, and other sources. (4) Document the receipt of reports on the official report form developed by DDARS, obtaining all available and pertinent information. (5) Conduct an investigation of all reports of battery, neglect, and exploitation to ascertain the condition and safety of the allegedly endangered adult: (A) immediately when the possibility of physical danger to the adult exists; or (B) as soon as possible after receipt of a report (within twenty calendar days). (6) Follow procedures for coordination with the Indiana department of health as per IC 12-10-3-17 . (7) Maintain procedures for appropriate access to and for safeguarding of the confidentiality of records. (8) Be familiar with available community resources. (9) Seek cooperation from other public and private agencies and individuals in the geographic services region which offer services as may be needed by endangered adults. (10) Cooperate with all the APS units in Indiana. (11) Participate in DDARS-sponsored in-service training. (12) After initial investigation, proper notification that the report is unsubstantiated shall be made to concerned parties, at the discretion of the APS unit. (13) Report to DDARS on forms provided by DDARS, information concerning each report of battery, neglect, or exploitation received and investigated, within time frames established by DDARS, including those reports made to the department of health. (14) Transmit to DDARS all identifying records concerning unsubstantiated reports in accordance with DDARS policy and procedures. (15) In instances of substantiated reports, obtain an assessment of the endangered adult's situation and needs, and coordinate with the appropriate social services agencies who will develop a service plan for the provision of protective services (in cooperation with the endangered adult). (16) The plan for the provision of protective services shall be given to the endangered adult in writing, and shall include: (A) a statement of the problem; (B) one (1) or more goal statements; (C) a description of the desired state of client functioning; (D) identification of the appropriate and least restrictive services; (E) the frequency and duration of anticipated service delivery; and (F) the manner in which the effectiveness of the services will be monitored and evaluated. (17) Approve said plan and assure that the available necessary protective services for the endangered adult are secured. (18) Monitor and maintain complete documentation of the implementation of the protective services plan. (19) Petition, through the prosecuting attorney's office, the court having probate jurisdiction in the county of the adult's residence, for an order to enjoin interference with the delivery of protective services arranged by the division or unit with the consent of the endangered adult, when such interference is occurring. (20) Petition the probate court having jurisdiction in the county in which the endangered adult resides, to secure a protective order requiring that the adult receive protective services, only when: (A) the individual does not consent, or withdraws consent previously given, to the receipt of the protective services; and (B) the individual is an endangered adult under IC 12-10-3-2 (a); and (C) the individual, in the opinion of the APS unit, lacks the capacity to understand the clear consequences of his or her decisions, in accordance with IC 29-1-18 . A petition for a protective order does not constitute an action for guardianship. (21) When a protective order is required, approve and submit to the court, a plan for the provision of the protective services, which includes, at the minimum, the items identified in subdivision (16) of this section. (22) Petition the court to modify or terminate a protective services order, as necessary, as per IC 12-10-3-25 . (23) Petition the court to hold a hearing on the question of continuing jurisdiction, as per IC 12-10-3-26 .

(1)(5-2)Definitions#

Authority: IC 12-9.1-2-3 ; IC 12-10-10-6

Affected: IC 12-7-2-184 ; IC 12-10

Sec. 2. As used in this rule, the following definitions apply: (1) "AAA" refers to the agency designated by the bureau in each planning and service area under IC 12-10-1-4 (18). (2) "Adult day care services" means the provision of a comprehensive structured program in a protective setting during the daytime and early evening hours. (3) "Advocate" means any legal representative or any other person whom the applicant or participant chooses to assist him or her at any stage of the appeals process. (4) "Applicant" means an individual who resides in Indiana and who has submitted an application to the area agency on aging for the CHOICE program. (5) "At risk of losing the individual's independence" means that the individual meets the criteria specified in IC 12-10-10-4 (b). (6) "Attendant care services" means assistance with nonmedical personal care services such as: (A) personal hygiene activities; (B) ambulation and transfer of the individual; (C) assisting the individual with communication; (D) disposal of bodily waste; (E) meeting the individual's nutritional needs; and (F) ensuring the individual's physical safety. (7) "Bureau" refers to the bureau of aging and in-home services established within the division under IC 12-10-1-1 . (8) "Care plan" means the plan of services developed by the AAA under IC 12-10-10-1 (2). (9) "Case management" means the administrative functions performed by the AAA under IC 12-10-10-1 . (10) "CHOICE" refers to the community and home options to institutional care for the elderly and disabled program. (11) "CHOICE guidelines and procedures manual" refers to the document published by the division to define the protocol of the CHOICE program. (12) "CHOICE representative" means a person authorized to act on behalf of an individual, as specified under section 4 of this rule, if the individual lacks the capacity to make a knowing and informed decision regarding his or her own care. (13) "Community and home care services", "in-home and community services", or "CHOICE services" means those services specified in IC 12-10-10-2 . (14) "Division" or "DDARS" refers to the division of disability, aging, and rehabilitative services. (15) "Home delivered meals" means an appropriate, nutritionally balanced meal that meets at least one-third (1/3) of the current recommended dietary allowance (RDA) delivered to the individual's home. (16) "Home health services and supplies" means services and supplies that include all health monitoring activities performed in the home, the supervision of medication, care and maintenance of any appliances or equipment necessary to maintain health, safety, and independence, and dressing changes. (17) "Homemaker services" means those household tasks that enable an individual to live in a clean, safe, and healthy home environment, including grocery shopping and meals preparation. (18) "Institutional care" means continuous, twenty-four (24) hour residential care provided by, among others, hospitals, nursing facilities, intermediate care facilities for the mentally retarded, community residential facilities for the developmentally disabled, residential facilities for the mentally ill, and state owned and operated institutions. (19) "Other services necessary to prevent institutionalization" includes, but is not limited to, the following: (A) "Minor home modifications" means selected internal and external modifications to the home environment, related specifically to the individual's functional limitations, which will assist the individual in remaining in the current living situation. (B) "Adaptive aids and devices" means controls, appliances, or supplies determined necessary to enable the individual to increase the ability to function in a home and community-based setting with independence and physical safety. (20) "Respite care services" means services provided temporarily or periodically to participants in the absence of the usual unpaid caregiver, including services provided in the home or on an overnight basis in an approved out-of-home setting such as a nursing facility. (21) "Transportation" means transporting the individual to and from medical or therapeutic activities that are directly related to maintaining the individual's independence.

(1)(5-3)Selection of local administrative units#

Authority: IC 12-9.1-2-3 ; IC 12-10-10-6

Affected: IC 12-10-10-1

Sec. 3. (a) The division shall contract with the AAAs to administer CHOICE funds. These activities include local administrative functions, including, but not limited to, the following: (1) Budgeting. (2) Case management. (3) Oversight. (4) Monitoring. (5) Quality assurance. (6) Submission of fiscal claims to the division.

(b) Each AAA shall submit a plan to the division that contains the following: (1) The referral and intake process, including a description of how the process of eligibility determination will take place. (2) The assessment process, format, and procedures used by case managers employed by the AAA to do assessments. (3) Procedures for an offer of an assessment to current nursing home residents who apply for CHOICE. (4) Policies for the selection and qualifications of staff. (5) Procedures for development of and expected timelines for care plan development, including the process for involving the client or family in the development of the care plan. (6) All available long term support services, both public and private, within the area. (7) Policies and procedures for the case management and service coordination system. (8) Policies and procedures for coordinating CHOICE with the Medicaid waivers and other funding sources for in-home and community-based services. (9) The CHOICE cost sharing plan, including cost share collection procedures. (10) The current appeal procedures, including procedures for notifying applicants or participants of the right to an administrative hearing. (11) Policies and procedures for waiting lists for CHOICE services. (12) Policies and procedures for approved waivers and for requesting state approved waivers. (13) Description of the development of the budget, as approved by the division, including the following: (A) A breakdown of proposed spending on client services. (B) Assessments. (C) Care plan development. (D) Reassessments. (E) AAA administration. (F) Any other appropriate costs. (14) The estimated number of individuals who have a high functional need that warrants exceeding the established benchmark by twice the stated amount, and the methods of managing those costs. (15) Procedures for selection of service providers. (16) Policies and procedures for case file documentation and record keeping. (17) Description of follow-up evaluation. (18) The manner in which care plans and services are to be evaluated and monitored.

(c) Each AAA shall arrange for the provision of individually needed CHOICE services through local provider agencies or individuals.

(d) An AAA may provide community and home care services to individuals in the CHOICE program if the division determines that an appropriate alternative provider agency is not available. Before an AAA can provide community and home care services to individuals in the CHOICE program, the AAA must be granted a waiver from the division for the specific services to be delivered by the AAA.

(e) Under subsection (d), an AAA submitting a waiver request to provide services shall include documentation of the unavailability of appropriate alternative providers, including, but not limited to, failure to obtain responses after advertising the availability of CHOICE funds and description of the efforts that it has exercised to solicit provider expansion into the given area or description of the efforts utilized to stimulate new provider growth.

(f) The contract period for an AAA shall be two (2) years.

(g) The AAA and all CHOICE providers shall abide by all applicable state and federal laws and regulations.

(1)(5-7)Duties of the AAA#

Authority: IC 12-9.1-2-3 ; IC 12-10-10-6

Affected: IC 12-10-3 ; IC 12-10-10

Sec. 7. (a) Each AAA shall maintain individual case records for each individual who applies for or receives services. Each individual's records shall be maintained by the AAA for a minimum of three (3) years after the individual's termination from the program or other final action.

(b) The AAA shall maintain the confidentiality of CHOICE files and records at all times. Such files and records shall not be disclosed except: (1) to the individual or his or her CHOICE representative; (2) to a person representing the individual in an appeal from a CHOICE decision; (3) to the division or other state agencies for purposes of securing in-home and community services; (4) to an adult or child protective services investigator under IC 12-10-3 and IC 31-6-11-3 [ IC 31-6 was repealed by P.L.268-1995, SECTION 17, effective July 1, 1995.] ; (5) under court order; or (6) as authorized by the individual or his or her CHOICE representative.

(c) The AAA shall use CHOICE records for purposes of the CHOICE program and for the coordination of other related services only. Any disclosure of information in an individual's CHOICE file for purposes of coordinating related services shall be limited to the information that is directly relevant to and required by the other related services.

(d) CHOICE funding shall be used after all other possible payment sources have been identified and all reasonable efforts have been employed to utilize those sources.

(e) The AAA shall reduce services that are paid by CHOICE in any of the following circumstances: (1) When the assessed level of need diminishes as established by an updated care plan. (2) When the AAA's CHOICE service funds are insufficient to meet the service commitment to current participants, all reasonable efforts have been made to secure resources to avoid service reductions, the AAA has stopped performing new assessments and care plans, and the AAA has adopted a fair and equitable policy for distributing service reductions among participants. (3) When an individual receiving services becomes eligible under a Medicaid home and community-based services waiver and begins receiving those services that are allowable through the Medicaid program. (4) When a current participant becomes eligible for in-home and community services from other sources for which he or she was not previously eligible and is receiving those services. (5) When other resources become available in the community and the individual begins receiving those services that were not available at the time of the development of the previous care plan. (6) If services needed by the applicant, as determined by the assessment, would be so costly that CHOICE payment for the needed services would cause the AAA to exceed the allowable cost per individual determined by the division.

(f) The AAA shall terminate services that are paid by CHOICE in any of the following situations: (1) When the individual's health or personal circumstances have improved so that he or she no longer needs in-home and community-based services to maintain his or her independence in a safe, noninstitutional environment. (2) When the health, welfare, or safety of the participant or of others who interact with the individual can no longer be reasonably assured. (3) When the services being provided are detrimental to the individual's health. (4) When the individual or his or her CHOICE representative has fraudulently obtained or misused CHOICE funded services. (5) Upon the death of the individual receiving services. (6) When the individual or his or her CHOICE representative refuses to comply with cost sharing under section 8 of this rule. (7) When the individual or his or her CHOICE representative voluntarily requests termination. (8) When the individual or his or her CHOICE representative refuses services necessary for his or her health and well-being.

(g) A participant who is found eligible for CHOICE services, but does not receive CHOICE services for a period of six (6) months due to institutionalization or lack of need, may be terminated from CHOICE services. Restoration of services, after this six (6) month period, shall be within the availability of funds and continued need for services.

(h) No CHOICE services funds shall be used to purchase real estate.

(i) No CHOICE services funds shall be used to provide care or services to an individual residing in an institution. However, funds may be used for assessment and care plan development for current residents in institutions who could return to their homes if determined to be eligible for the CHOICE program.

(j) Unless no CHOICE funds are available, the AAA shall offer initial assessments and, when appropriate, individual care plans to applicants, regardless of the applicant's income and assets.

(k) The division shall establish a maximum level of CHOICE fund expenditure per individual based on costs calculated by the division. This maximum expenditure is not to be applied monthly, but over a period of three (3) consecutive months. The dollar amount shall be published in the CHOICE guidelines and procedures.

(1)(5-10)Appeals#

Authority: IC 12-9.1-2-3 ; IC 12-10-10-6

Affected: IC 4-21.5-1 ; IC 4-21.5-3-27 ; IC 12-10-10

Sec. 10. (a) Except as provided in subsection (b), applicants, participants, or their CHOICE representative shall have a right to appeal decisions regarding CHOICE eligibility and services if: (1) they are found ineligible for the CHOICE program; (2) they disagree with the decision either to deny a service which they believe they should receive or to discontinue or reduce a particular service which they are currently receiving; and (3) they believe that any decision made or action taken concerning the CHOICE services they receive was not appropriate or in their best interests.

(b) The case manager is responsible for answering questions and attempting to resolve any problems or complaints before the applicant or participant resorts to the appeal process. The case manager is also responsible for documenting all complaints and actions taken in the case file in order to create a complete record for appeal.

(c) In case of applicants or participants who lack the capacity to make a knowing and informed decision regarding their own care, their CHOICE representative may appear on their behalf throughout the appeals process.

(d) Individuals or their CHOICE representative shall comply with the following appeals process: STEP ONE: Individuals or their CHOICE representative shall first discuss any questions, concerns, or problems regarding CHOICE services with the case manager and the case manager supervisor. This informal meeting may take place either at the agency or at the applicant's or participant's home. The applicant or participant may be accompanied by an advocate. Within five (5) working days of the date of the informal meeting, the case manager supervisor shall inform the applicant or participant in writing of the decision reached on the issues raised at the meeting. The case manager supervisor shall also inform the applicant or participant that he or she may request an agency review to the AAA's executive director or designee within eighteen (18) calendar days of the date of the case manager supervisor's decision. STEP TWO: Agency review as follows: (A) The executive director or his or her designee shall conduct the agency review at the applicant's or participant's home or at the AAA office, whichever is more convenient for the applicant or participant. The applicant or participant, his or her advocate (if desired), and the case manager or the case manager's supervisor shall attend the review. (B) Applicants and participants shall be given the opportunity to testify, present supporting materials, and explain why they disagree with the action or decision and what they would view as an appropriate alternative. The case manager or case manager supervisor may testify and explain the reasons for the decision or action taken. (C) Immediately following the review, the executive director or designee conducting the review shall consider the comments of the applicant or participant, his or her advocate, and the case manager or the case manager's supervisor. (D) Within five (5) working days, the executive director, or designee after consulting with the executive director, shall prepare the agency's final decision, in writing, including findings of fact and the specific reason for the decision. The applicant or participant and his or her advocate, if any, shall each be sent a copy of the decision by registered or certified mail, return receipt requested. The decision shall inform the applicant or participant of his or her right to have an administrative hearing under STEP THREE if dissatisfied with the agency's final decision. STEP THREE: Administrative hearing as follows: (A) If an applicant or participant is dissatisfied with the decision reached at the agency review, then he or she may appeal the decision by requesting an administrative hearing. The applicant, participant, or CHOICE representative shall make the request for an administrative hearing, in writing, including a statement of the issues the applicant or participant wishes reviewed. The request shall be signed and dated. The written request shall be sent to the deputy director of the division, bureau of aging and in-home services within eighteen (18) days of the date of the decision from the agency review. (B) Administrative hearings shall be conducted by administrative law judges (ALJs), or hearing officers, appointed by the DDARS director. The ALJ shall notify the applicant or participant and all involved persons of the date, time, and location of the hearing at least five (5) working days in advance. The applicant or participant shall be notified by registered or certified mail, return receipt requested. The AAA shall forward all written case documentation to the ALJ prior to the date of the hearing. The hearing shall be conducted in accordance with IC 4-21.5-1 . (C) Immediately, but no later than five (5) days following the hearing, the ALJ shall prepare the proposed decision, including a report of the findings of fact and the reasons for the decision based on those findings of fact. In accordance with IC 4-21.5-3-27 , the ALJ shall forward the proposed decision to the DDARS director. A copy of the proposed decision shall be sent to the AAA, the applicant or participant, and his or her advocate, if any, by registered or certified mail, return receipt requested. (D) The director of the division shall either affirm, modify, or dissolve the ALJ's proposed decision. The AAA, the applicant or participant, and his or her advocate shall be notified of the director's final order by registered or certified mail, return receipt requested.

(e) If a participant appeals a decision that terminates any service that is already being provided, then the service in question will usually be continued until the appeal is resolved, unless: (1) the services would be harmful to the participant; or (2) the services violate state or federal law or regulations and internal policies of the CHOICE program or the division.

(f) An applicant or participant may bring to his or her informal review, agency review, and administrative hearing any person he or she wishes to be present, including legal counsel. The division shall not pay for legal counsel for an applicant or participant during the appeal process.

(g) Interpreter services will be made available to assist the deaf or non-English speaking person upon request. Reader services will be made available to assist the blind person upon request. However, if the applicant or participant requires these services for participation in the agency review or administrative hearing, the applicant or participant, prior to the date of the review, shall discuss the arrangements with the case manager.

(h) The AAA shall have in place at all times an appeals process that complies with this section.

(1)(6-2)Definitions#

Authority: IC 12-9.1-2-3 ; IC 12-10-7-7

Affected: IC 12-9-1-1 ; IC 12-10 ; IC 16-36-1 ; IC 29-3-8 ; IC 30-5

Sec. 2. The following definitions apply throughout this rule: (1) "Adult guardianship services" includes full guardianship and least restrictive services. (2) "BAIHS" or "bureau" refers to the bureau of aging and in-home services established under IC 12-10-1-1 , which monitors and coordinates the adult guardianship services program. (3) "Division" or "DDARS" refers to the division of disability, aging, and rehabilitative services as established under IC 12-9-1-1 . (4) "Dual signature checking account" means an account that allows a recipient to write checks on his or her own but requires another person's signature before the checks are valid. (5) "Guardian" means an individual or organization named by order of a court to exercise any or all powers specified in IC 29-3-8 . (6) "Incapacitated individual" means an individual as defined in IC 12-10-7-1 . (7) "Indigent adult" means an individual as defined in IC 12-10-7-2 . (8) "Least restrictive" means a course of action that allows the individual to live, learn, and work in a setting that places as few limits on the individual's rights and personal freedoms as appropriate to meet the needs of the individual. (9) "Least restrictive services" refers to those services specified in IC 12-10-7-8 . (10) "Protected person" means an individual for whom a guardian has been appointed. (11) "Provider" means an entity designated by the division under section 3 of this rule. (12) "Recipient" means an individual receiving guardianship or least restrictive services. (13) "Region" means a population or geographic area identified in a provider's adult guardianship services plan and approved by the division. (14) "Representative" means any person who is legally authorized to make decisions on behalf of another under IC 16-36-1 , or a power of attorney under IC 30-5 . (15) "Representative payee" means an individual or organization as defined in IC 12-10-14-2 .

(1)(6-3)Selection of providers#

Authority: IC 12-9.1-2-3 ; IC 12-10-7-7

Affected: IC 12-10-7-8 ; IC 29-3

Sec. 3. (a) The division shall contract in writing with the designated adult guardianship services provider.

(b) In order to be designated as an adult guardianship services provider, an interested agency shall submit a proposal and an adult guardianship services plan to the division. The plan shall contain the following: (1) The population or geographic area to be served. (2) Qualifications and policies for the selection of employees. (3) The referral and intake process. (4) The assessment and reassessment process. (5) Functions that volunteers may perform in the program. (6) Policies and procedures for recruiting, training, and assigning volunteers. (7) Policies and procedures for case file documentation and record keeping. (8) A description of the manner in which ongoing cases will be evaluated and monitored. (9) The criteria by which program activities will be evaluated. (10) Policies and procedures for prioritization of eligible individuals on waiting lists for adult guardianship services. (11) A description of the development of the budget, including a breakdown of proposed spending on adult guardianship services, assessments, service plan development, reassessments, provider administration, and any other appropriate costs. (12) Procedures to avoid a conflict of interest for the provider in providing adult guardianship services to each recipient.

(c) The provider shall perform local administrative functions, including, but not limited to, the following: (1) Budgeting. (2) Oversight. (3) Monitoring. (4) Quality assurance. (5) Submission of fiscal claims to the division. (6) Case intake, assessment, and plan development.

(d) The provider shall have an employee devoted at least halftime to the adult guardianship services program as coordinator. The adult guardianship services coordinator shall be free from conflict of interest and shall have the following minimum qualifications: (1) A bachelor's degree from a four (4) year accredited college or university. Two (2) years of experience serving as guardian to an individual over eighteen (18) years of age under IC 29-3 may substitute for one (1) year of college or university training. (2) Two (2) years of experience in social services. (3) One (1) year of management experience.

(e) The board of directors of the provider shall recruit and appoint from the community an adult guardianship services committee of at least five (5) persons to provide advice to the employees and to the board of directors on action pertaining to adult guardianship services and program activities.

(f) The adult guardianship services committee must include, but is not limited to, at least one (1) representative from each of the following categories: (1) An attorney or financial professional knowledgeable about guardianship issues. (2) A psychiatrist, clinical psychologist, or psychiatric social worker. (3) A developmental disabilities specialist. (4) A person sixty (60) years of age or older, or a representative of older adults knowledgeable about guardianships. (5) One (1) member of the board of directors. Except for one (1) member from the board of directors, an individual appointed to the adult guardianship services committee shall not be a member of the board of directors or employee of the provider.

(1)(8-2)Definitions#

Authority: IC 12-9.1-2-3 ; IC 12-10-13-17

Affected: IC 12-9-1-1 ; IC 12-10-3 ; IC 12-10-13-3.3 ; IC 16-18-2-167

Sec. 2. (a) The definitions in this section apply throughout this rule.

(b) "Adult protective services program" means the program established under IC 12-10-3 .

(d) "Conflict of interest" means that other interests intrude upon, interfere with, threaten to negate, or give the appearance of interfering with or negating the ability of the state ombudsman, state level staff of the office, local ombudsmen, volunteers, or local ombudsman entities to advocate without compromise on behalf of residents of long term care facilities. It also means any situation that would create a reasonable appearance of a conflict of interest.

(e) "Consult" or "consultations" means to share information with and to keep apprised.

(f) "Dedesignation" means revocation of the designation of a representative of the office or a local ombudsman entity by the state ombudsman.

(g) "Division" means the division of disability, aging, and rehabilitative services established in IC 12-9-1-1 .

(h) "Financial interest" means the following: (1) Any ownership or investment interest represented by equity, debt, or other financial relationship in a long term care facility, long term care service, or home care organization; or (2) The right to receive, directly or indirectly, remuneration, in cash or in kind, under a compensation agreement with an owner or operator of a long term care facility or home care organization.

(i) "Health facility" or "nursing facility" means a facility as defined in IC 16-18-2-167 .

(j) "Identifying information" means the name, age, address, social security number, telephone number, name of facility, diagnosis, physical disability, or any other information that may be used to identify the individual or individuals to whom the complaint refers, or the individual or individuals making the complaint.

(k) "Immediate family member" means a spouse, parent, stepparent, brother, sister, stepbrother, stepsister, child, or stepchild.

(l) "Legal representative" has the meaning specified in IC 12-10-13-3.3 .

(m) "Local ombudsman" means an individual designated by the state ombudsman under section 8 of this rule.

(n) "Local ombudsman entity" means an entity designated by the state ombudsman under section 5 of this rule as the entity to house the local ombudsman.

(o) "Long term care facility" or "facility" means a health facility or an adult care home.

(p) "Office" means office of the state long term care ombudsman established under IC 12-10-13 .

(q) "Officer" means the president, vice-president, chairperson, director, executive director, or chief executive officer of an agency or entity.

(r) "Person" means an association, a corporation, a limited liability company, an individual, a governmental agency, or a partnership.

(s) "Program" means the long term care ombudsman program authorized under IC 12-10-13 and 42 U.S.C. 3058g.

(t) "Program records" means the following: (1) The medical, financial, and social records of residents or clients obtained for the purpose of identifying, investigating, or attempting to resolve a complaint or concern by or on behalf of residents or clients. (2) Records obtained which are necessary for the investigation of a complaint by or on behalf of residents or clients. (3) Administrative records, policies, and documents of long term care facilities and home care service organizations obtained during the process of investigating or attempting to resolve a complaint or concern. (4) Any data relating to complaints and conditions in long term care facilities or home care organizations. (5) Any other records compiled and maintained by representatives of the office in carrying out their duties pursuant to this rule.

(u) "Representative of the office" means the state ombudsman, other state level ombudsman staff, local ombudsmen, or volunteer ombudsmen.

(v) "Resident" means the resident of a long term care facility.

(w) "State long term care ombudsman" or "state ombudsman" means an individual appointed by the director of the division.

(1)(8-4)Duties of the state ombudsman; independence#

Authority: IC 12-9.1-2-3 ; IC 12-10-13-17

Affected: IC 12-10

Sec. 4. (a) The state ombudsman shall, in consultation with the director of the state unit on aging, direct the office of the long term care ombudsman program.

(b) The state ombudsman shall, personally or through representatives of the office, perform the following duties: (1) Identify, investigate, resolve, or attempt to resolve complaints by or on behalf of residents and clients. (2) Provide services to protect the health, safety, welfare, and rights of residents, including, but not limited to: (A) Information and referral services. (B) Education and training for residents, their family members, staff of long term care facilities, and the public. These services may be provided by dissemination of written information, presentations, workshops, individual meetings with residents or their family members, or any other appropriate means. (3) Inform residents, family members, long term care facility staff, and the public about ombudsman program services, how residents can access those services, or how services can be accessed on behalf of residents. (4) Inform residents about the means of obtaining services provided through providers of long term care services or their representatives, public agencies, and health and social service agencies. (5) Ensure that residents statewide have regular and timely access to representatives of the office through resident visits. (6) Ensure that complainants, clients, and residents receive timely responses to complaints and requests for assistance. (7) Advocate on behalf of residents in the following nonexclusive ways: (A) Identify problems affecting residents at the facility, local, state, or national levels and attempt to resolve those problems. (B) Identify problems in the long term care system and advocate for changes to that system. (C) Represent the interests of residents before governmental agencies. (D) Analyze, comment on, provide public testimony, and monitor the development and implementation of proposed or existing federal, state, and local laws, regulations, government policies, and actions that affect residents. (E) Facilitate public comment. (8) Seek administrative, legal, and other remedies to protect the health, safety, welfare, and rights of residents. (9) Designate and dedesignate local ombudsman entities and representatives of the office in accordance with this rule. (10) Consult in the development of the contract between the division and the local ombudsman entity regarding that portion of any contract related to the ombudsman program. (11) Direct the program related activities of the local ombudsmen in consultation with the local ombudsman entity. The state ombudsman shall, in consultation with the local ombudsman entity, provide oversight to the work of the local ombudsmen. (12) Provide administrative and technical assistance to representatives of the office and local ombudsman entities. (13) Monitor and evaluate the activities and performance of representatives of the office and local ombudsman entities in accordance with this rule. (14) Consult with the following agencies or programs: (A) The Indiana department of health. (B) The adult protective services program. (C) The Indiana protection and advocacy services. (D) Other state agencies and programs whose duties and services affect residents. (15) Provide technical support for the development and maintenance of resident and family councils. (16) Promote the development of citizen organizations to participate in the program. (17) Prepare an annual report in accordance with the Older Americans Act. (18) Ensure that the confidentiality of program records is maintained in accordance with this rule. (19) Identify duties to be performed by volunteer ombudsmen in consultation with the local ombudsman, local ombudsman entity, and the division. (20) Perform other duties the federal commissioner on aging determines to be appropriate.

(c) The state ombudsman shall report directly to the director of the state unit on aging. The state ombudsman shall be independent in all actions, but shall consult with the director of the state unit on aging or his or her designee to ensure identification and resolution of agency-wide issues, programmatic and fiscal integrity, and coordination of efforts.

(1)(8-8)Local ombudsman; designation; exemption; certification; dedesignation; notice#

Authority: IC 12-9.1-2-3 ; IC 12-10-13-17

Affected: IC 12-10-13-4.5 ; IC 12-10-13-13

Sec. 8. (a) The state ombudsman may designate a local ombudsman as representative of the office to carry out the duties specified in section 9 of this rule. If the local ombudsman is housed in a local ombudsman entity, the state ombudsman shall consult with the local ombudsman entity in the designation process.

(b) In order to be designated as a local ombudsman, an individual shall meet the following criteria: (1) Have a bachelor's degree in counseling, gerontology, nursing, psychology, sociology, social work, physical, occupational, or recreational therapy, special education, rehabilitation counseling, or other human services field or have at least four (4) years work experience in the field of long term care. Accredited college training in the areas listed above may substitute for the required work experience on a year-for-year basis. (2) Successfully complete the Indiana long term care ombudsman program training and certification program. (3) Be free of conflicts of interest as required by this rule.

(c) An individual serving as local ombudsman before the effective date of this rule shall be exempt from the requirements in this section except those referring to conflicts of interest.

(d) Each local ombudsmen [sic., ombudsman] designated in accordance with subsection (a) shall be certified by the state ombudsman to perform the duties in section 9 of this rule for a period not to exceed two (2) years.

(e) In order to be recertified, a local ombudsman shall: (1) satisfactorily perform the duties specified in section 9 of this rule; (2) remain free of conflicts of interest as required by this rule; and (3) satisfactorily meet any additional requirements specified by law or regulation.

(f) The state ombudsman may, at any time, dedesignate a local ombudsman for cause. If the local ombudsman is housed in a local ombudsman entity, the state ombudsman shall consult with the local ombudsman entity in the dedesignation process. Cause for dedesignation includes, but is not limited to, the following: (1) Failure of the local ombudsman to follow state and federal laws, regulations, and this rule. (2) Failure to satisfactorily perform the duties specified in section 9 of this rule. (3) Failure to follow the direction and supervision of the state ombudsman or appropriate state level office staff. (4) Taking any action which endangers the health, safety, welfare, or rights of residents or clients. (5) Failure to disclose or correct a conflict of interest.

(g) The state ombudsman shall give written notice of the dedesignation to the local ombudsman. The notice shall include: (1) reasons for the dedesignation; (2) effective date of the dedesignation; and (3) appeal rights.

(h) The state ombudsman must inform the local ombudsman entity of the decision not to recertify or to dedesignate a local ombudsman prior to issuing the written notice to the local ombudsman.

(1)(8-9)Duties of the local ombudsman#

Authority: IC 12-9.1-2-3 ; IC 12-10-13-17

Affected: IC 12-10-13

Sec. 9. The local ombudsman shall perform the following duties: (1) Identify, investigate, resolve, or attempt to resolve complaints made by or on behalf of residents that relate to actions, inactions, or decisions that may adversely affect the health, safety, welfare, or rights of residents. The local ombudsman shall inform the complainant, the resident, or their legal representatives of the findings of an investigation or the reasons why a complaint cannot be investigated. (2) Provide services to protect the health, safety, welfare, and rights of long term care facility residents, including, but is not limited to: (A) information and referral services; and (B) education and training for residents, their family members, staff of long term care facilities, and the public. (3) Provide residents regular and timely access to the program through frequent resident visits. (4) Respond to complaints and requests for assistance. (5) Support the development and maintenance of resident and family councils and assist in addressing council concerns. (6) Inform residents, their family members, citizens' organizations, the public, and long term care facility staff about the ombudsman program. (7) Advocate on behalf of residents in the following nonexclusive ways: (A) Identify problems affecting residents at the facility, local, state, or national levels and attempt to resolve those problems. (B) Identify problems in the long term care system and advocate for changes to that system. (C) Represent the interests of residents before government agencies, legislative committees, individual legislators, and other individuals, groups, or entities where issues that affect residents are addressed. (D) Communicate directly with legislators, policy makers, and the media about issues affecting residents and other consumers of long term care. (E) Analyze, comment on, provide public testimony, and monitor the development and implementation of proposed or existing federal, state, and local laws, regulations, government policies, and actions that affect residents. (F) Facilitate public comment. (G) Provide information regarding the problems and concerns of residents and recommendations for resolving those problems and concerns to: (i) public agencies; (ii) private entities; and (iii) state and federal legislators. (H) Take any other action relating to the ombudsman program determined to be appropriate by the state ombudsman. (8) Pursue administrative, legal, and other remedies on behalf of residents. (9) In accordance with federal and state laws and regulations, share information related to long term care facilities with the Indiana department of health. (10) Whenever possible, participate in surveys of long term care facilities conducted by the Indiana department of health. (11) Document and report activities as required by the office. (12) Accept the direction, instruction, guidance, and assistance of the state ombudsman, in consultation with the local ombudsman entity, in all program activities. (13) Follow federal and state laws and these rules. (14) Carry out other program-related activities that the state ombudsman determines to be appropriate.

(1)(8-12)Conflict of interest; board members, officers, and employees of local ombudsman entities#

Authority: IC 12-9.1-2-3 ; IC 12-10-13-17

Affected: IC 12-10-13

Sec. 12. (a) Board members of the local ombudsman entity who are not free from conflicts of interest shall not participate in any discussion or vote on any matters pertaining to the program, and such recusal shall be made a part of the minutes or other official record of the local entity's board of directors or other comparable governing body. Such conflicts of interest include the following: (1) Current direct involvement in the licensing or certification of a long term care facility or a provider of a long term care service. (2) Current employment in, contractual arrangement with, or participation in the management of a long term care facility. (3) A current financial interest in a long term care facility or a long term care service. (4) Current membership in a trade association of long term care facilities.

(b) In order to receive and maintain designation or to be redesignated as a local ombudsman entity, officers of those entities seeking to be designated or redesignated as local ombudsman entities shall be free from conflicts of interest, which include the following: (1) Current direct involvement in the licensing or certification of a long term care facility or a provider of a long term care service. (2) Current employment in, contractual arrangement with, or participation in the management of a long term care facility. (3) A current financial interest in a long term care facility or a long term care service. (4) Current membership in a trade association of long term care facilities.

(c) In order to receive designation, or redesignation, as a local ombudsman entity, employees of those entities who supervise a local ombudsman shall be free from conflicts of interest, which include the following: (1) Current direct involvement in the licensing or certification of a long term care facility or a provider of a long term care service. (2) Current employment in, contractual arrangement with, or participation in the management of a long term care facility. (3) A current financial interest in a long term care facility or a long term care service. (4) Current membership in a trade association of long term care facilities.

(1)(8-13)Conflict of interest; local ombudsman and volunteer ombudsman; family members#

Authority: IC 12-9.1-2-3 ; IC 12-10-13-17

Affected: IC 12-10-13

Sec. 13. (a) In order to receive designation or certification, or to avoid dedesignation, as a local ombudsman or a volunteer ombudsman, an individual shall be free from conflicts of interest, which include the following: (1) A financial interest in a long term care facility or a long term care service within three (3) years before the date of designation. (2) Acting as local ombudsman or volunteer ombudsman in a long term care facility in which the individual was employed within one (1) year before the date of designation. (3) Current direct involvement in the licensing or certification of a long term care facility or a provider of long term care service. (4) Current employment in, contractual arrangement with, or participation in the management of a long term care facility. (5) Current membership in a trade association of long term care facilities. (6) Currently serving as an officer of a local ombudsman entity. (7) Currently serving as a supervisor of other programs that may come in conflict with the duties of the ombudsman program. (8) Currently performing duties or providing services other than those required in this rule that are in conflict with, or that may create a conflict with, the duties required in this rule. (9) Currently serving as: (A) a resident's agent; (B) a resident's legal representative; (C) the sole witness for do not resuscitate orders or other medical directives; or (D) a member of a long term care facility's ethics committee which makes medical decisions for residents.

(b) A family member who serves as a resident who is their family member's agent or legal representative shall not be regarded as having a conflict of interest.

(c) In order to receive designation or certification, or to avoid dedesignation, as a local ombudsman or a volunteer ombudsman, an individual's immediate family members shall be free from conflicts of interest, which include the following: (1) Current direct involvement in the licensing or certification of a long term care facility or a provider of a long term care service. (2) Current participation through direct employment or contractual arrangement in the management of a long term care facility in the volunteer ombudsman's or local ombudsman's service area. (3) A current financial interest in a long term care facility or a long term care service. (4) Current membership in a trade association of long term care facilities.

(1)(9-1)Definitions#

Authority: IC 12-9.1-2-3 ; IC 12-10-17.1-20

Affected: IC 12-10-10 ; IC 12-10-17.1 ; IC 12-15-34-1 ; IC 16-25 ; IC 25-1-9-2 ; IC 25-1-9-3

Sec. 1. (a) The definitions in this section apply throughout this rule.

(b) "Ancillary services" means services ancillary to the basic services provided to an individual in need of self-directed in-home care who needs at least one (1) of the basic services listed in subsection (d). The term includes the following: (1) Homemaker type services, including shopping, laundry, cleaning, and seasonal chores. (2) Companion type services, including transportation, letter writing, mail reading, and escort services. (3) Assistance with cognitive tasks, including managing finances, planning activities, and making decisions.

(c) "Attendant care services" means those basic and ancillary services, which the individual chooses to direct and supervise a personal services attendant to perform, that enable an individual in need of self-directed in-home care to live in the individual's home and community rather than in an institution and to carry out functions of daily living, self-care, and mobility.

(d) "Basic services" means a function that could be performed by the individual in need of self-directed in-home care if the individual were not physically disabled. The term includes the following: (1) Assistance in getting in and out of beds, wheelchairs, and motor vehicles. (2) Assistance with routine bodily functions, including: (A) health related services as defined in subsection (f); (B) bathing and personal hygiene; (C) dressing and grooming; and (D) feeding, including preparation and cleanup.

(e) "Geographic area" means one (1) county of the state.

(f) "Health related services" means those medical activities that, in the written opinion of the attending physician submitted to the case manager of the individual in need of self-directed in-home care, could be performed by the individual if the individual were physically capable, and if the medical activities can be safely performed in the home, and either: (1) are performed by a person who has been trained or instructed on the performance of the medical activities by an individual in need of self-directed in-home care who is, in the written opinion of the attending physician submitted to the case manager of the individual in need of self-directed in-home care, capable of training or instructing the person who will perform the medical activities; or (2) are performed by a person who has received training or instruction from a licensed health professional, within the professional's scope of practice, in how to properly perform the medical activity for the individual in need of self-directed in-home care.

(g) "Individual in need of self-directed in-home care" means an individual with a disability, or person responsible for making health related decisions for the individual with a disability, who: (1) is approved to receive Medicaid waiver services under 42 U.S.C. 1396n(c), or is a participant in the community and home options to institutional care for the elderly and disabled program under IC 12-10-10 ; (2) is in need of attendant care services because of impairment; (3) requires assistance to complete functions of daily living, self-care, and mobility, including those functions included in attendant care services; (4) chooses to self-direct a paid personal services attendant to perform attendant care services; and (5) assumes the responsibility to initiate self-directed in-home care and exercise judgment regarding the manner in which those services are delivered, including the decision to employ, train, and dismiss a personal services attendant.

(h) "Licensed health professional" means the following: (1) A registered nurse. (2) A licensed practical nurse. (3) A physician with an unlimited license to practice medicine or osteopathic medicine. (4) A licensed dentist. (5) A licensed chiropractor. (6) A licensed optometrist. (7) A licensed pharmacist. (8) A licensed physical therapist. (9) A certified occupational therapist. (10) A certified psychologist. (11) A licensed podiatrist. (12) A licensed speech-language pathologist or audiologist.

(i) "Personal services attendant" means an individual who is registered to provide attendant care services under this rule and who has entered into a contract with an individual and acts under the individual's direction to provide attendant care services that could be performed by the individual if the individual were physically capable.

(j) "Self-directed in-home health care" means the process by which an individual, who is prevented by a disability from performing basic and ancillary services that the individual would perform if not disabled, chooses to direct and supervise a paid personal services attendant to perform those services in order for the individual to live in the individual's home and community rather than an institution.

(1)(9-9)Appeals and review#

Authority: IC 12-9.1-2-3 ; IC 12-10-17.1-21

Affected: IC 4-21.5-3 ; IC 4-21.5-5

Sec. 9. (a) The division, through designated representatives, shall investigate complaints by or on behalf of an individual in need of self-directed in-home care concerning the neglect, abuse, mistreatment, or misappropriation of property of an individual in need of self-directed in-home care by a personal services attendant.

(b) The division shall make a determination as to whether or not a personal services attendant neglected, abused or misappropriated the property of an individual in need of self-directed in-home care by a personal services attendant. The finding shall be entered into the personal services attendant's file with the division. The division shall give the personal services attendant notice of its determination.

(c) If the division determines that a personal services attendant neglected, abused, or misappropriated the property of an individual in need of self-directed care, the division may remove the personal services attendant from the list of registered personal services attendants and revoke or deny the certificate of registration.

(d) If the division determines that a personal services attendant neglected, abused, or misappropriated the property of an individual in need of self-directed care, the division shall give written notice to the personal services attendant of the procedures and time limit for seeking administrative review of the division's determination pursuant to this section.

(e) A personal services attendant found by representatives of the division to have committed neglect, abuse, mistreatment or misappropriation of property of an individual in need of self-directed in-home care and who disagrees with the decision may petition for administrative review of the decision. The petition must be in writing, show that the petitioner was directly affected by the decision, and contain the specific issues for review and the rationale for the petitioner's position. The petition must be filed within fifteen (15) days after the petitioner is given notice of the decision. The petition must be filed with the director of the division.

(f) Upon receiving timely notice of an appeal, the director or the director's designee shall appoint an administrative law judge to conduct the proceedings on review. The proceedings shall be conducted in accordance with IC 4-21.5-3 .

(g) Upon exhaustion of the administrative remedies in subsections (c) and (d), a personal services attendant who is dissatisfied with the outcome may file a petition for judicial review pursuant to IC 4-21.5-5 . The petition must be filed in a court of competent jurisdiction within thirty (30) days after receiving notice of the final agency decision. The petition must be served upon the director of the division, the attorney general, and any other party to the agency proceeding.

(1)(10-5)Program plans#

Authority: IC 12-9.1-2-3 ; IC 12-10.5-1-4

Affected: IC 12-10-1 ; IC 12-10.5-1

Sec. 5. Each area agency on aging shall annually submit a plan, as part of its area plan, which includes the following information: (1) A description of area agency on aging caretaker programs that include strategies for the strengthening or developing of a local network of family caretaker resources. The use of network models that may involve local voluntary groups, faith-based groups, and health care organizations active in the areas of Alzheimer's disease, support groups for family caretakers and grandparents raising grandchildren, and other similar organizations is strongly encouraged. (2) An explanation of how the area agency on aging will assure that, in providing services, priority shall be given to older individuals with greatest social and economic need, with particular attention to low-income older individuals and older individuals providing care and support to persons with mental retardation and related developmental disabilities. The provision of services may be affected as follows: (A) If state funding is used, services will be provided to individuals at least sixty-five (65) years of age who are caretakers or who are taking care of individuals with special needs at least eighteen (18) years of age and unable to perform at least three (3) activities of daily living. For respite services, this applies to individuals that are unable to perform at least two (2) activities of daily living. (B) If federal funding is used, priority will be given to persons at least eighteen (18) years of age who are caretakers of individuals at least sixty (60) years of age who are unable to perform at least two (2) activities of daily living, and older adults, grandparents, or stepgrandparents at least sixty (60) years of age who are caretakers of children eighteen (18) years of age or younger for respite and supplemental services. (3) A description of strategies for carrying out caretaker education so that different kinds of caretaker education needs are effectively met. Caretaker education shall involve to the extent possible the participation of available community resources. These efforts may include support groups if appropriate. (4) A twelve (12) month operating budget on a form provided by BAIHS.

(1)(11-3)Rights to be included in notice#

Authority: IC 12-9.1-2-3 ; IC 12-10-15-14

Affected: IC 12-10-15 ; IC 16-27-1-5 ; IC 16-28

Sec. 3. The notice required by section 2 of this rule shall advise residents of housing with services establishments of the following rights: (1) That each resident, or the resident's representative, must be given: (A) a complete copy of the contract between the establishment and the resident or the resident's representative; (B) all supporting documents and attachments; and (C) any changes whenever changes are made. (2) That the housing with services establishment contract must include the following elements in the contract or through supporting documents or attachments in clear and understandable language: (A) The name, street address, and mailing address of the establishment. (B) The name and mailing address of the owner or owners of the establishment and, if the owner or owners are not natural persons, identification of the type of business entity of the owner or owners. (C) The name and mailing address of the managing agency, through management agreement or lease arrangement, of the establishment, if different from the owner or owners. (D) A statement describing the disclosure document and licensure status, if any, of the establishment and any person providing health related services or supportive services under arrangement with the operator. (E) The term of the contract. (F) A description of the services to be provided to the resident in the base rate to be paid by the resident or on the resident's behalf. (G) A description of any additional services available for an additional fee from the establishment directly or through arrangements with the establishment. (H) The fee schedules outlining the cost of any additional services. (I) A description of the process through which the contract may be modified, amended, or terminated. (J) A description of the establishment's complaint resolution process available to the residents. (K) The resident's designated representative, if any. (L) The establishment's referral procedures if the contract is terminated. (M) The criteria used by the establishment to determine who may continue to reside in the establishment. That the criteria must address the following: (i) When a resident must be transferred because the establishment and the resident are unable to develop a means for assuring that the resident is able to respond to an emergency in a manner that is consistent with local fire and safety requirements. (ii) When the establishment is unable to assure that the resident's physical, mental, and psychosocial needs can be met. (N) A description of the process for assuring that the resident's needs are assessed on admission and periodically thereafter in conjunction with the resident and the resident's representative and for assuring that the resident's physical, mental, and psychosocial needs are met within the terms of the contract criteria for residence provided under clause (M). (O) The billing and payment procedures and requirements. (3) That an establishment's contract must state that: (A) except as stated in the contract, residency in the establishment may not be terminated due to a change in the resident's health or care needs; (B) the ability of a resident to engage in activities away from the establishment regardless of time, duration, and distance of the activities may not be restricted; (C) except to protect the rights and activities of other residents, the establishment may not restrict the ability of a resident to have visitors and to receive family members and guests; and (D) except as stated in the contract and identified in the disclosure document, the operator may not: (i) restrict the ability of a resident to use a home health agency, home health provider, hospice, home health attendant, or case management service of the resident's choice; or (ii) require a resident to use home health services as defined in IC 16-27-1-5 . (4) That except where a resident's health or safety or the health and safety of others are endangered, an operator shall provide at least thirty (30) days notice to the resident or the resident's designated representative before terminating the resident's residency.

(1)455 IAC Article 1: Aging (Indiana Administrative Code, 2026 edition)#

(1)(1-1)Purpose#

(1)455 IAC Article 1: Aging (Indiana Administrative Code, 2026 edition)#

(1)(1-1)Purpose#

(1)(1-2)Definitions#

(1)(1-3)Exemption#

(1)(1-4)PAS process#

(1)(1-5)Application#

(1)(1-6)Agency cooperation#

(1)(1-7)Prescreening agency; duties#

(1)(1-8)Health facility; duties#

(1)(1-9)Applicant's physician or physician member of PAS team; duties#

(1)(1-10)PAS team; duties#

(1)(1-11)Designee; duties#

(1)(1-12)Office of Medicaid policy and planning; duties#

(1)(1-13)Individual compliance with PAS program#

(1)(1-14)Penalties#

(1)(1-15)Waiver of sanctions#

(1)(1-16)Appeals#

(1)(2-1)Purpose#

(1)(2-2)Definitions#

(1)(2-3)Agency cooperation#

(1)(2-4)Division's duties#

(1)(2-5)Adult protective services unit's duties#

(1)(2-6)Coordinator's qualifications#

(1)(2-7)Complaints regarding residents of health facilities#

(1)(2-8)Indiana department of health; duties#

(1)(2-9)Maintenance of records#

(1)(2-10)Reporting battery, neglect, or exploitation#

(1)(2-11)Rights of the alleged endangered adult#

(1)(2-12)Appeal rights of the allegedly endangered adult#

(1)(3-1)Policy; scope#

(1)(3-2)Definitions#

(1)(3-3)Per diem reimbursement rates#

(1)(3-4)Annual review of per diem reimbursement rate#

(1)(4-1)Definitions#

(1)(4-2)Eligibility for assistance for county home residents#

(1)(4-3)Eligibility for assistance in a residential home#

(1)(4-4)Continuing financial eligibility#

(1)(4-5)Annual review#

(1)(5-1)Purpose#

(1)(5-2)Definitions#

(1)(5-3)Selection of local administrative units#

(1)(5-4)Participant involvement in decision making#

(1)(5-5)Assessment#

(1)(5-6)Care plan#

(1)(5-7)Duties of the AAA#

(1)(5-8)Cost sharing#

(1)(5-9)Conflicts of interest#

(1)(5-10)Appeals#

(1)(5-11)Guidelines and procedures#

(1)(6-1)Purpose#

(1)(6-2)Definitions#

(1)(6-3)Selection of providers#

(1)(6-4)Participant involvement in decision making#

(1)(6-5)Assessment#

(1)(6-6)Service plan#

(1)(6-7)Specific tasks of the provider#

(1)(6-8)Provider policy conformance#

(1)(6-9)Confidentiality#

(1)(6-10)Conflict of interest#

(1)(8-1)Purpose#

(1)(8-2)Definitions#

(1)(8-3)Appointment of the state long term care ombudsman; qualifications#

(1)(8-4)Duties of the state ombudsman; independence#

(1)(8-5)Local ombudsman entity; designation; term; dedesignation; notice#

(1)(8-6)Responsibilities of local ombudsman entity#

(1)(8-7)Responsibilities of state ombudsman as to local ombudsman entity#

(1)(8-8)Local ombudsman; designation; exemption; certification; dedesignation; notice#

(1)(8-9)Duties of the local ombudsman#

(1)(8-10)Volunteer ombudsman; designation; certification; dedesignation#

(1)(8-11)Conflict of interest; state ombudsman and state level office staff#

(1)(8-12)Conflict of interest; board members, officers, and employees of local ombudsman entities#

(1)(8-13)Conflict of interest; local ombudsman and volunteer ombudsman; family members#

(1)(8-14)Ombudsman program records; confidentiality; access; disclosure of identity of complainant or resident#

(1)(8-15)Access to facilities and facilities' records#

(1)(8-16)Access to agency records#

(1)(8-17)Legal counsel#

(1)(8-18)Monitoring#

(1)(8-19)Noninterference#