Ind. Code ch. 12-8-1.6

Ind. Code ch. 12-8-1.6
in effect

Ind. Code § 12-8-1.6-1 "Assisted living services"

Sec. 1. As used in this chapter, "assisted living services" refers to services covered under a home and community based services waiver and provided in any of the following entities: (1) A residential care facility licensed under IC 16-28. (2) Any other housing with services establishment. As added by P.L.174-2025, SEC.14.

Ind. Code § 12-8-1.6-2 "Home and community based services waiver"

Sec. 2. (a) As used in this chapter, "home and community based services waiver" refers to a federal Medicaid waiver granted to the state under 42 U.S.C. 1396n(c) to provide home and community based long term care services and supports to individuals with disabilities and the elderly. (b) The term does not include home and community services offered as part of the approved Medicaid state plan. As added by P.L.174-2025, SEC.14. Amended by P.L.160-2026, SEC.1.

Ind. Code § 12-8-1.6-3 "Level of services"

Sec. 3. As used in this chapter, "level of services" means a determination of the type of services an individual may receive under a Medicaid waiver based on the individual's impairment and dependence and the corresponding reimbursement rate for the determined level of care. As added by P.L.174-2025, SEC.14.

Ind. Code § 12-8-1.6-4 Powers and duties of the office of the secretary

Sec. 4. (a) The office of the secretary has all powers necessary and convenient to administer a home and community based services waiver. (b) The office of the secretary shall do the following: (1) Administer money appropriated or allocated to the office of the secretary by the state, including money appropriated or allocated for a home and community based services waiver. (2) Take any action necessary to implement a home and community based services waiver, including applying to the United States Department of Health and Human Services for approval to amend or renew the waiver, implement a new Medicaid waiver, or amend the Medicaid state plan. (3) Ensure that a home and community based services waiver is subject to funding available to the office of the secretary. (4) Ensure, in coordination with the budget agency, that the cost of a home and community based services waiver does not exceed the total amount of funding available by the budget agency, including state and federal funds, for the Medicaid programs established to provide services under a home and community based services waiver. (5) Establish and administer a program for a home and community based services waiver, including the assisted living waiver described in IC 12-15-1.3-26, to provide an eligible individual with care that does not cost more than services provided to a similarly situated individual residing in an institution. (6) Within the limits of available resources, provide service coordination services to individuals receiving services under a home and community based services waiver, including the development of an individual service plan that: (A) addresses an individual's needs; (B) identifies and considers family and community resources that are potentially available to meet the individual's needs; and (C) is consistent with the person centered care approach for receiving services under a waiver. (7) Monitor services provided by a provider that: (A) provides services to an individual using funds provided by the office of the secretary or under the authority of the office of the secretary; or (B) entered into one (1) or more provider agreements to provide services under a home and community based services waiver. (8) Establish and administer a confidential complaint process for: (A) an individual receiving; or (B) a provider described in subdivision (7) providing; services under a home and community based services waiver. (9) Establish a procedure for documenting compliance with subdivision (6) in the individual service plan of an individual receiving services under a home and community based services waiver, which must include provider attestation that services delivered to a recipient align with the recipient's individual service plan. (c) The office of the secretary may do the following: (1) At the office's discretion, delegate any of its authority under this chapter to any division or office within the office of the secretary. (2) Issue administrative orders under IC 4-21.5-3-6 regarding the provision of a home and community based services waiver. As added by P.L.174-2025, SEC.14. Amended by P.L.160-2026, SEC.2.

Ind. Code § 12-8-1.6-5 Eligibility and certification

Sec. 5. (a) The office of the secretary shall establish: (1) eligibility criteria for an individual to receive; and (2) certification criteria for a provider of; services under a home and community based services waiver. (b) The eligibility criteria established under subsection (a) may vary based on the targeted need of each home and community based services waiver. (c) An individual who is determined by the office of the secretary to be ineligible for services under a home and community based services waiver may appeal the determination under IC 4-21.5. As added by P.L.174-2025, SEC.14.

Ind. Code § 12-8-1.6-6 Placement authority

Sec. 6. The office of the secretary shall serve as the placement authority for individuals receiving services under a home and community based services waiver and an individual service plan. As added by P.L.174-2025, SEC.14.

Ind. Code § 12-8-1.6-7 Access to services

Sec. 7. Subject to the availability of applicable waiver slots and funding, the office of the secretary shall provide access to home and community based services that are appropriate and necessary for an individual determined to be eligible by the office of the secretary for services under a home and community based services waiver. As added by P.L.174-2025, SEC.14.

Ind. Code § 12-8-1.6-8 Provider compliance with waiver requirements

Sec. 8. A provider of services under a home and community based services waiver shall follow any waiver requirements under federal law and developed by the office of the secretary, including the planning process, service plan, and home and community based setting requirements set forth in 42 CFR 441.301. As added by P.L.174-2025, SEC.14.

Ind. Code § 12-8-1.6-9 Waiver requirements

Sec. 9. A home and community based services waiver, including the delivery and receipt of services provided under the home and community based services waiver, must meet the following requirements: (1) Be provided under public supervision. (2) Be individualized and designed to meet the needs of individuals eligible to receive services under the home and community based services waiver. (3) Meet applicable state and federal standards. (4) Be provided by qualified personnel. (5) Be provided, to the extent appropriate, with services provided under the home and community based services waiver that are provided in a home and community based setting where nonwaiver individuals receive services. (6) Be provided in accordance with an individual's: (A) service plan; and (B) choice of provider of waiver services. As added by P.L.174-2025, SEC.14. Amended by P.L.160-2026, SEC.3.

Ind. Code § 12-8-1.6-9.5 Duties of waiver recipient and case manager

Sec. 9.5. (a) An individual receiving services under a home and community based services waiver shall do the following: (1) Review any record or statement the individual receives under IC 12-15-11-11. (2) Not later than forty-five (45) days after receiving a record or statement described in subdivision (1), report to the office of the secretary, the provider, or other appropriate entity any: (A) error in the record or statement; or (B) inconsistency between the record or statement and services received. (b) Upon request, the case manager of a recipient described in subsection (a) shall do the following: (1) Assist the recipient in reviewing the recipient's record or statement described in subsection (a)(1). (2) Assist in reporting and resolving any error or inconsistency under subsection (a). As added by P.L.160-2026, SEC.4.

Ind. Code § 12-8-1.6-10 Reimbursement for certain services; home and community based services; limitations concerning assisted living services; integrated health care coordination; rules

Sec. 10. (a) This section applies to the following: (1) A home and community based services waiver that included assisted living services as an available service before July 1, 2025. (2) An assisted living waiver described in IC 12-15-1.3-26. (b) As used in this section, "office" includes the following: (1) The office of the secretary of family and social services. (2) A managed care organization that has contracted with the office of Medicaid policy and planning under IC 12-15. (3) A person that has contracted with a managed care organization described in subdivision (2). (c) Under a home and community based services waiver that provides services to an individual who is aged or disabled, the office shall reimburse for the following services provided to the individual by a provider of assisted living services, if included in the individual's home and community based services plan: (1) Assisted living services. (2) Integrated health care coordination. (3) Transportation. (d) If the office approves an increase in the level of services for a recipient of assisted living services, the office shall reimburse the provider of assisted living services for the level of services for the increase as of the date that the provider has documentation of providing the increase in the level of services. (e) The office may reimburse for any home and community based services provided to a Medicaid recipient beginning on the date of the individual's Medicaid application. (f) The office may not do any of the following concerning assisted living services provided in a home and community based services program: (1) Require the installation of a sink in the kitchenette within any living unit of an entity that participated in the Medicaid home and community based services program before July 1, 2018. (2) Require all living units within a setting that provides assisted living services to comply with physical plant requirements that are applicable to individual units occupied by a Medicaid recipient. (3) Require a provider to offer only private rooms. (4) Require a housing with services establishment provider to provide housing when: (A) the provider is unable to meet the health needs of a resident without: (i) undue financial or administrative burden; or (ii) fundamentally altering the nature of the provider's operations; and (B) the resident is unable to arrange for services to meet the resident's health needs. (5) Require a housing with services establishment provider to separate an agreement for housing from an agreement for services. (6) Prohibit a housing with services establishment provider from offering studio apartments with only a single sink in the unit. (7) Preclude the use of a shared bathroom between adjoining or shared units if the participants consent to the use of a shared bathroom. (8) Reduce the scope of services that may be provided by a provider of assisted living services under the aged and disabled Medicaid waiver in effect on July 1, 2021. (g) A Medicaid recipient who has a home and community based services plan that includes: (1) assisted living services; and (2) integrated health care coordination; shall choose whether the provider of assisted living services or the office provides the integrated health care coordination to the recipient. (h) Integrated health care coordination provided by a provider of assisted living services under this section is not duplicative of any services provided by the office. (i) The office of the secretary may adopt rules under IC 4-22-2 that establish the right, and an appeals process, for a resident to appeal a provider's determination that the provider is unable to meet the health needs of the resident as described in subsection (f)(4). The process: (1) must require an objective third party to review the provider's determination in a timely manner; and (2) may not be required if the provider is licensed by the Indiana department of health and the licensure requirements include an appellate procedure for such a determination. As added by P.L.174-2025, SEC.14. Amended by P.L.23-2026, SEC.73; P.L.160-2026, SEC.5.

Ind. Code § 12-8-1.6-11 Determination of savings; report

Sec. 11. (a) The office of the secretary shall annually determine any state savings generated by home and community based services under this chapter by reducing the use of institutional care. (b) The office of the secretary shall annually report to the governor, the budget agency, the budget committee, the interim study committee on public health, behavioral health, and human services established by IC 2-5-1.3-4, and the executive director of the legislative services agency the savings determined under subsection (a). A report under this subsection to the executive director of the legislative services agency must be in an electronic format under IC 5-14-6. (c) Savings determined under subsection (a) may be used to fund the state's share of additional home and community based Medicaid waiver slots. As added by P.L.174-2025, SEC.14.

Ind. Code § 12-8-1.6-12 Rules

Sec. 12. The office of the secretary may adopt rules under IC 4-22-2 to implement this chapter. As added by P.L.174-2025, SEC.14.
Source: Open US Law by Vaquill AI (CC BY 4.0)URL: https://iga.in.gov/laws/2026/ic/titles/12Fetched: 10/17/2026