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Date ArticleType
11/1/2015 Regulatory
Assisted Living Workgroup Update

The Assisted Living Workgroup, a part of the 5-8 Year Long Term Care planning effort, met in late October for the first time in a couple of months.  The agenda for the meeting can be accessed here.  The workgroup’s focus will begin to change over the next couple of months as Indiana Medicaid looks to issue a new white paper concerning rebalancing Long Term Services and Supports spending between Home and Community Based Services (HCBS) and institutional care.  Assisted Living services are part of the HCBS spectrum and will play a key role in that rebalancing effort.

The future of the AL Workgroup will be to assist the state and providers with transitioning the current Medicaid Waiver program to reach compliance with CMS’s new rule on HCBS waivers.  The state just received the first round of feedback from CMS on the state’s transition plan, submitted last December, and that feedback indicates that the Division of Aging needs to work on several areas of the transition plan to reach compliance.  Two of the most important areas of work will be detailing the Heightened Scrutiny process, under which non-compliant settings can reach compliance, and how beneficiaries will be transitioned out of non-compliance settings once full compliance is required in March of 2019.  To read CMS’s letter to Indiana Medicaid, click here, and to access Indiana’s website concerning the transition plan for the CMS HCBS Rule click here.  As the work of this group re-focuses on this transition planning, IHCA/INCAL will rely on the input of members and involve the newly formed INCAL Advisory Council.

Discussions concerning broader reform the current Medicaid Aged & Disabled Waiver, of which AL services are a part and which is necessary in order to efficiently rebalance LTSS spending, will take place in a new group that is being formed in the coming month.  The IHCA/INCAL and those that participate in the AL Workgroup will be part of this new “waiver re-design” group, as will additional stakeholders such as Indiana’s Area Agencies on Aging, the Alzheimer’s Association, AARP, and representatives from home health and adult day service providers.  Once this group is assembled, IHCA/INCAL will certainly keep membership up to date on the work of the group.

The meeting concluded by discussing whether requiring Residential Care licensure is necessary for purposes of a provider to participate in the Medicaid Waiver program.  This discussion overlaps both the AL Workgroup and what will be discussed in a waiver re-design group.  Key items in this discussion, licensure or not, include oversight of care that is provided and arranged, barriers to provider entry into the waiver program, and whether or not the current Residential Licensure rules are conducive to or can be amended to comply with the CMS HCBS rule.

There is much change that will come in how Assisted Living plays a role in the LTSS rebalancing discussion and exactly what providers need to do in order to participate in Medicaid waiver programs should they choose to do so.  IHCA/INCAL will be very active in these discussions with an on behalf of its members.  For more information or questions, please contact Zach Cattell at zcattell@ihca.org or Katie Niehoff at kniehoff@ihca.org.