CHAPTER 6. RESIDENTIAL CARE ASSISTANCE
IC 12-10-6
Chapter 6. Residential Care Assistance
IC 12-10-6-1
Eligibility of county home residents; amount; rate; personal
allowance; reimbursement rules; annual rate review
Sec. 1. (a) An individual who:
(1) is at least sixty-five (65) years of age, is blind, or has a
disability; and
(2) is a resident of a county home;
is eligible to receive assistance payments from the state if the
individual would be eligible for assistance under the federal
Supplemental Security Income program except for the fact that the
individual is residing in a county home.
(b) The amount of nonmedical assistance to be paid on behalf of
a resident in a county home must be based on the daily rate
established by the division. The rate for facilities under this section
and licensed under IC 16-28 may not exceed an upper rate limit
established by a rule adopted by the division.
(c) The rate for facilities under this section but not licensed under
IC 16-28 must be the lesser of:
(1) an upper rate limit established by a rule adopted by the
division; or
(2) a reasonable and adequate rate to meet the costs, determined
by generally accepted accounting principles, that are incurred
by efficiently and economically operated facilities in order to
provide care and services in conformity with quality and safety
standards and applicable laws and rules.
(d) The recipient shall be paid or allowed to retain from the
recipient's income a monthly personal allowance. The amount:
(1) is fifty-two dollars ($52);
(2) is exempt from income eligibility consideration by the
division; and
(3) may be exclusively used by the recipient for personal needs.
(e) In addition to the amount that may be retained as a personal
allowance under this section, an individual is allowed to retain an
amount equal to the individual's state and local income tax liability.
The amount that may be retained during a month may not exceed
one-third (1/3) of the individual's state and local income tax liability
for the calendar quarter in which the month occurs. This amount is
exempt from income eligibility consideration by the division. The
amount retained shall be used by the individual to pay state or local
income taxes owed.
(f) In addition to the amounts that may be retained under
subsections (d) and (e), an eligible individual may retain a Holocaust
victim's settlement payment. The payment is exempt from income
eligibility consideration by the division.
(g) The personal allowance for one (1) month for an individual
described in subsection (a) is the amount that an individual would be
entitled to retain under subsection (d) plus an amount equal to
one-half (1/2) of the remainder of:
(1) gross earned income for that month; minus
(2) the sum of:
(A) sixteen dollars ($16); plus
(B) the amount withheld from the person's paycheck for that
month for payment of state income tax, federal income tax,
and the tax prescribed by the federal Insurance Contribution
Act (26 U.S.C. 3101 et seq.); plus
(C) transportation expenses for that month; plus
(D) any mandatory expenses required by the employer as a
condition of employment.
(h) The division, in cooperation with the state department of
health taking into account licensure requirements under IC 16-28,
shall adopt rules under IC 4-22-2 governing the reimbursement to
facilities under this section. The rules must be designed to determine
the costs that must be incurred by efficiently and economically
operated facilities to provide room, board, laundry, and other
services, along with minimal administrative direction to individuals
who receive residential care in the facilities under this section. A rule
adopted under this subsection by:
(1) the division; or
(2) the state department of health;
must conform to the rules for residential care facilities that are
licensed under IC 16-28.
(i) A rate established under this section may be appealed
according to the procedures under IC 4-21.5.
(j) The division shall annually review each facility's rate using the
following:
(1) Generally accepted accounting principles.
(2) The costs incurred by efficiently and economically operated
facilities in order to provide care and services in conformity
with quality and safety standards and applicable laws and rules.
As added by P.L.2-1992, SEC.4. Amended by P.L.2-1993, SEC.78;
P.L.4-1993, SEC.37; P.L.5-1993, SEC.50; P.L.152-1995, SEC.2;
P.L.24-1997, SEC.22; P.L.128-1999, SEC.6; P.L.272-1999, SEC.30;
P.L.294-2001, SEC.1; P.L.141-2006, SEC.41; P.L.99-2007, SEC.60.
IC 12-10-6-2
Repealed
(Repealed by P.L.1-2003, SEC.104.)
IC 12-10-6-2.1
Residential care assistance; eligibility; mental retardation;
alternative placement; personal allowance; prospective
prenegotiated payment rate; Christian Science facility placement
Sec. 2.1. (a) An individual who is incapable of residing in the
individual's own home may apply for residential care assistance
under this section. The determination of eligibility for residential
care assistance is the responsibility of the division. Except as
provided in subsections (g) and (i), an individual is eligible for
residential care assistance if the division determines that the
individual:
(1) is a recipient of Medicaid or the federal Supplemental
Security Income program;
(2) is incapable of residing in the individual's own home
because of dementia, mental illness, or a physical disability;
(3) requires a degree of care less than that provided by a health
care facility licensed under IC 16-28;
(4) can be adequately cared for in a residential care setting; and
(5) has not made any asset transfer prohibited under the state
plan or in 42 U.S.C. 1396p(c) in order to be eligible for
Medicaid.
(b) Individuals with mental retardation may not be admitted to a
home or facility that provides residential care under this section.
(c) A service coordinator employed by the division may:
(1) evaluate a person seeking admission to a home or facility
under subsection (a); or
(2) evaluate a person who has been admitted to a home or
facility under subsection (a), including a review of the existing
evaluations in the person's record at the home or facility.
If the service coordinator determines the person evaluated under this
subsection has mental retardation, the service coordinator may
recommend an alternative placement for the person.
(d) Except as provided in section 5 of this chapter, residential care
consists of only room, board, and laundry, along with minimal
administrative direction. State financial assistance may be provided
for such care in a boarding or residential home of the applicant's
choosing that is licensed under IC 16-28 or a Christian Science
facility listed and certified by the Commission for Accreditation of
Christian Science Nursing Organizations/Facilities, Inc., that meets
certain life safety standards considered necessary by the state fire
marshal. Payment for such care shall be made to the provider of the
care according to division directives and supervision. The amount of
nonmedical assistance to be paid on behalf of a recipient living in a
boarding home, residential home, or Christian Science facility shall
be based on the daily rate established by the division. The rate for
facilities that are referred to in this section and licensed under
IC 16-28 may not exceed an upper rate limit established by a rule
adopted by the division. The recipient may retain from the recipient's
income a monthly personal allowance of fifty-two dollars ($52). This
amount is exempt from income eligibility consideration by the
division and may be exclusively used by the recipient for the
recipient's personal needs. However, if the recipient's income is less
than the amount of the personal allowance, the division shall pay to
the recipient the difference between the amount of the personal
allowance and the recipient's income. A reserve or an accumulated
balance from such a source, together with other sources, may not be
allowed to exceed the state's resource allowance allowed for adults
eligible for state supplemental assistance or Medicaid as established
by the rules of the office of Medicaid policy and planning.
(e) In addition to the amount that may be retained as a personal
allowance under this section, an individual shall be allowed to retain
an amount equal to the individual's state and local income tax
liability. The amount that may be retained during a month may not
exceed one-third (1/3) of the individual's state and local income tax
liability for the calendar quarter in which that month occurs. This
amount is exempt from income eligibility consideration by the
division. The amount retained shall be used by the individual to pay
any state or local income taxes owed.
(f) In addition to the amounts that may be retained under
subsections (d) and (e), an eligible individual may retain a Holocaust
victim's settlement payment. The payment is exempt from income
eligibility consideration by the division.
(g) The rate of payment to the provider shall be determined in
accordance with a prospective prenegotiated payment rate predicated
on a reasonable cost related basis, with a growth of profit factor, as
determined in accordance with generally accepted accounting
principles and methods, and written standards and criteria, as
established by the division. The division shall establish an
administrative appeal procedure to be followed if rate disagreement
occurs if the provider can demonstrate to the division the necessity
of costs in excess of the allowed or authorized fee for the specific
boarding or residential home. The amount may not exceed the
maximum established under subsection (d).
(h) The personal allowance for one (1) month for an individual
described in subsection (a) is the amount that an individual would be
entitled to retain under subsection (d) plus an amount equal to
one-half (1/2) of the remainder of:
(1) gross earned income for that month; minus
(2) the sum of:
(A) sixteen dollars ($16); plus
(B) the amount withheld from the person's paycheck for that
month for payment of state income tax, federal income tax,
and the tax prescribed by the federal Insurance Contribution
Act (26 U.S.C. 3101 et seq.); plus
(C) transportation expenses for that month; plus
(D) any mandatory expenses required by the employer as a
condition of employment.
(i) An individual who, before September 1, 1983, has been
admitted to a home or facility that provides residential care under
this section is eligible for residential care in the home or facility.
(j) The director of the division may contract with the division of
mental health and addiction or the division of disability and
rehabilitative services to purchase services for individuals with a
mental illness or a developmental disability by providing money to
supplement the appropriation for community residential care
programs established under IC 12-22-2 or community residential
programs established under IC 12-11-1.1-1.
(k) A person with a mental illness may not be placed in a
Christian Science facility listed and certified by the Commission for
Accreditation of Christian Science Nursing Organizations/Facilities,
Inc., unless the facility is licensed under IC 16-28.
As added by P.L.1-2003, SEC.52. Amended by P.L.141-2006,
SEC.42; P.L.99-2007, SEC.61; P.L.121-2008, SEC.1.
IC 12-10-6-3
Reimbursement rules for facilities under IC 12-10-6-2; rate appeal;
annual rate review
Sec. 3. (a) The division, in cooperation with the state department
of health, taking into account licensure requirements under IC 16-28,
shall adopt rules under IC 4-22-2 governing the reimbursement to
facilities under section 2.1 of this chapter. The rules must be
designed to determine the costs that must be incurred by efficiently
and economically operated facilities in order to provide room, board,
laundry, and other services, along with minimal administrative
direction to individuals who receive residential care in the facilities
under section 2.1 of this chapter.
(b) A rule adopted under subsection (a) by:
(1) the division; or
(2) the state department of health;
must conform to the rules for residential care facilities that are
licensed under IC 16-28.
(c) Any rate established under section 2.1 of this chapter may be
appealed according to the procedures under IC 4-21.5.
(d) The division shall annually review each facility's rate using the
following:
(1) Generally accepted accounting principles.
(2) The costs incurred by efficiently and economically operated
facilities in order to provide care and services in conformity
with quality and safety standards and applicable laws and rules.
As added by P.L.2-1992, SEC.4. Amended by P.L.2-1993, SEC.80;
P.L.4-1993, SEC.38; P.L.5-1993, SEC.51; P.L.152-1995, SEC.3;
P.L.24-1997, SEC.24; P.L.1-2007, SEC.117; P.L.121-2008, SEC.2.
IC 12-10-6-4
Excess income recipients; continued eligibility
Sec. 4. (a) An individual who:
(1) is receiving residential care assistance under section 1 or 2.1
of this chapter; and
(2) has an increase in income that would make the individual
ineligible for residential care assistance;
may elect to continue to be eligible for residential care assistance by
paying the excess income to the home or facility that provides
residential care.
(b) If an individual applies the excess income toward the
residential care assistance under subsection (a), the division shall
reduce the payment to the home or facility that provides residential
care by the amount received by the home or facility.
As added by P.L.2-1992, SEC.4. Amended by P.L.27-1992, SEC.10;
P.L.24-1997, SEC.25; P.L.1-2007, SEC.118.
IC 12-10-6-5
Individuals with a mental illness; comprehensive care plan; rules
Sec. 5. (a) An individual who is determined under section
2.1(a)(2) of this chapter to be incapable of residing in the individual's
own home because of mental illness may be admitted to a home or
facility that provides residential care to the extent that money is
available for the care.
(b) Within thirty (30) days after an individual with a mental
illness is placed in a home or facility that provides residential care,
a comprehensive care plan must be developed for the individual.
(c) The residential care facility, in cooperation with the
community mental health center or an individual's managed care
provider (as defined in IC 12-7-2-127(b)) serving the area in which
the residential care facility is located, shall develop the
comprehensive care plan for the individual. The plan must include
the following:
(1) Psychosocial rehabilitation services that are provided within
the community.
(2) A comprehensive range of activities to meet multiple levels
of need, including the following:
(A) Recreational and socialization activities.
(B) Social skills.
(C) Educational, training, occupational, and work programs.
(D) Opportunities for progression into less restrictive and
more independent living arrangements.
(3) Appropriate alternate placement if the individual's needs
cannot be met by the facility.
(d) The health facilities council shall, in coordination with the
division of mental health and addiction and the division, adopt rules
under IC 4-22-2 to govern:
(1) residential care; and
(2) the comprehensive care plan;
provided to individuals with a mental illness who reside under this
chapter in a home or facility that provides residential care.
As added by P.L.2-1992, SEC.4. Amended by P.L.40-1994, SEC.19;
P.L.215-2001, SEC.37; P.L.99-2007, SEC.62.
IC 12-10-6-6
Application for assistance
Sec. 6. (a) To obtain assistance under this chapter, an individual
must apply to the local administrative unit designated by the division.
The application must be:
(1) in writing or reduced to writing;
(2) made in the manner and upon the form prescribed by the
division; and
(3) verified by the oath of the applicant.
(b) If an individual applying for assistance is mentally or
physically unable to sign an application verified by the oath of the
applicant, an application may be made by an interested individual
acting in the applicant's behalf, and the application shall be verified
upon the basis of information and belief of the interested individual.
(c) Each application must contain a statement of all of the
following:
(1) The amount of property, both personal and real, in which the
applicant has an interest.
(2) All income that the applicant has at the time of the filing of
the application.
(3) Any other information prescribed by the division.
As added by P.L.2-1992, SEC.4. Amended by P.L.128-1999, SEC.8.
IC 12-10-6-7
Investigation of applicant
Sec. 7. Whenever the local administrative unit designated by the
division receives an application for assistance under this chapter, an
investigation shall be made of the circumstances of the applicant to
ascertain the facts supporting the application and any other
information that may be required by the rules of the division.
As added by P.L.2-1992, SEC.4.
IC 12-10-6-8
Investigative report and recommendation
Sec. 8. Upon completion of the investigation, the local
administrative unit designated by the division shall make a report and
a recommendation to the division relative to the eligibility of the
applicant for assistance, the amount of the assistance, and the date
when the assistance should begin.
As added by P.L.2-1992, SEC.4.
IC 12-10-6-9
Amount of assistance; determination
Sec. 9. The division shall determine the amount of the assistance
and the date on which the assistance should begin. In determining the
amount of assistance, due account shall be taken of any income or
property of the applicant and of any support that the applicant may
receive from other sources, including any benefit the applicant is
receiving from the Social Security Administration. The award made
by the division and a subsequent modification of the award is binding
upon the state and shall be complied with by the state until the award
or modified award is vacated.
As added by P.L.2-1992, SEC.4.
IC 12-10-6-10
Monthly payments; warrants
Sec. 10. (a) The assistance shall be paid monthly to:
(1) the recipient; or
(2) the administrator of the county home if the local
administrative unit designated by the division so designates;
upon warrant of the auditor of state from money appropriated to the
division for that purpose.
(b) The auditor of state shall draw the warrants based upon a
verified schedule of the recipients and the amount payable to each
recipient, prepared and verified by the director of the division in
accordance with awards made by the division.
As added by P.L.2-1992, SEC.4.
IC 12-10-6-11
Reconsideration; report of change; hearing
Sec. 11. (a) All assistance granted under this chapter shall be
reconsidered as frequently as is required by the rules of the division.
After further investigation that the local administrative unit
designated by the division considers necessary or that the division
requires, the amount of assistance may be changed or entirely
withdrawn if the division finds that the recipient's circumstances
have altered sufficiently to warrant that action.
(b) Whenever assistance is withdrawn, revoked, suspended, or in
any way changed, the division shall immediately report the decision
to the local administrative unit designated by the division.
(c) If assistance is in any way changed, the recipient is entitled to
a hearing under the rules adopted by the division.
As added by P.L.2-1992, SEC.4.
IC 12-10-6-12
New county home admittees; aid in applying for assistance
Sec. 12. When an individual is admitted to a county home, the
administrator of the home shall assist the resident in applying for
assistance under this chapter.
As added by P.L.2-1992, SEC.4.
IC 12-10-6-13
Higher education award not to be considered income or resource
for purposes of assistance eligibility
Sec. 13. If an individual receives a state or federal higher
education award that is paid directly to an approved postsecondary
educational institution for that individual's benefit:
(1) that individual is not required to report that award as income
or as a resource of that individual when applying for assistance
provided under this chapter; and
(2) the award may not be considered as income or a resource of
the individual in determining initial or continuing eligibility for
assistance under this chapter.
As added by P.L.2-1992, SEC.4. Amended by P.L.2-2007, SEC.154.
IC 12-10-6-14
Operation cost reports; annual review; rate reimbursement
modification recommendations
Sec. 14. (a) Each home or facility that receives funding from the
state for residential care assistance under this chapter shall file an
operation cost report in a manner prescribed by the division.
(b) The division shall annually conduct a review of the operation
cost reports for homes and facilities:
(1) that provide residential care; and
(2) receive funding from the state for residential care assistance
under this chapter;
to determine the actual cost of providing services to individuals who
receive residential care assistance.
(c) Applying the results of the review under subsection (b), the
division shall submit a recommended modification of rate
reimbursement for residential care assistance to the budget agency
before April 1 of each year.
As added by P.L.2-1992, SEC.4. Amended by P.L.24-1997, SEC.26.