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Date ArticleType
4/30/2018 INCAL
FSSA Resumes Enrollment in Medicaid Waiver for Most ALs

On April 24th FSSA Secretary Jen Walthall presented information regarding the agency’s work the past 90-days during which new enrollment into Medicaid Waiver HCBS programs was paused.  The below outline highlights the presentation and meeting, as well as expected next steps.


·        Enrollment Timelines

o   New AL providers:  Enrollment of new AL providers, except those with secure memory care, will resume on May 1st

o   New AL providers with secured memory care:  An enrollment process will be developed and re-open by December 31, 2018 for AL providers with secure memory care.

·        Compliance Timelines

o   Existing AL providers: ALs that are currently waiver providers will have until 2022 to come into compliance, though providers who determine not to comply are being requested to let FSSA know by sometime in 2021 so that residents may be moved to compliant communities

o   Existing AL providers:  The Division of Aging will be sending feedback to each existing provider that submitted a remediation plan based on the site reviews already conducted.  To the extent a provider disagrees with the legal basis, or other basis, of a required remediation area the provider should communicate with the DA of the disagreement and the DA will review the provider’s position.  The DA does not want to re-conduct those initial site visits.  All site visits going forward will be conducted by DA staff and not contractors.

o   New AL providers:  Must be compliant with the Settings Rule upon certification.

o   Heightened Scrutiny Review:  FSSA/DA is awaiting CMS guidance on this topic, however statements made on conference calls suggest that communities that go through heightened scrutiny that requires remediation may be permitted a longer compliance window beyond 2022.

·        Licensed and Unlicensed AL

o   FSSA clarified the slide from the last presentation that makes clear licensed RCFs and unlicensed ALs will be permitted into the program.

o   At this point there is no specific timeline for when unlicensed communities will be permitted into the program and it appears this is not likely until summer of 2019 at the earliest.

·        Statewide Transition Plan (STP)

o   The STP, required of each state by CMS, will be revised again and the latest version will be released for comment later this summer.  Once updates are made, it will be resubmitted to CMS for final approval.

·        Key Topics (see Key Topics in the presentation)

o   Day Services – no change from last presentation.  Significant concern from day service providers about the way community integration is defined in this presentation.  Presentation was more focused on developmentally disabled populations.  Unclear as to impact on adult day services for the aged, but language is concerning about ongoing availability of this service.

o   Memory Care – no change from last presentation.  Workgroup is to be formed as soon as possible. 

o   Lease & Residency Agreements – New information.  FSSA provides a complete list of Indiana Code provisions that must be represented in a lease agreement.  FSSA will review leases or residency agreements, as they are used, for these requirements.

o   Physical Plant – New information on minimum standards, which are the same as those in Settings Rule.  Modification may be made based on person centered plan.  Three examples were given:

§  Knock & Enter – may violate privacy, depending on person centered plan

§  Egress to facility – must be permitted without the resident being required to interact with staff, 24/7

§  Visitors – No prior approval for visitors.  Only “reasonable” restrictions permitted.  This undefined and without more detail at the moment.

·        A&D Waiver

o   The renewal for the A&D waiver has been submitted and approval is expected.

o   An amendment to the waiver, previously discussed to redefined AL service definitions, allow unlicensed settings to participate, and revise rate methodology and rates has not been planned.  At best these items would occur after the 2019 legislative session (budget session).


o   A request for information is to be released shortly for providers to give feedback on how to structure rates and why increased rates are needed, as well as for vendors to respond to in order to perform work in building a new rate methodology.  Vendor selection is anticipated to be done by or before end of the year, but development of a new rate methodology is not anticipated to be done this year.

o   It is unclear at the moment whether FSSA is including in its budget request additional funds for increased rates.