Ind. IHCP Hospice Services Provider Reference Module, Section 3, Members Receiving Home- and Community-Based Services

Home- and Community-Based Services (HCBS) programs include the following:

• 1915(c) HCBS waiver programs

➢ Under the Division of Disability and Rehabilitative Services (DDRS):

o Community Integration and Habilitation (CIH) Waiver

o Family Supports Waiver (FSW)

o Health and Wellness (H&W) Waiver

o Traumatic Brain Injury (TBI) Waiver

➢ Under the Office of Medicaid Policy and Planning (OMPP):

o Indiana PathWays for Aging (PathWays) Waiver

Note: The IHCP EVS currently identifies H&W Waiver coverage as: “Aged and Disabled

HCBS Waiver,” and PathWays Waiver coverage as: “Aged and Disabled HCBS

Pathways.”

• 1915(i) State Plan HCBS programs

➢ Under the Division of Mental Health and Addiction (DMHA)

o Adult Mental Health Habilitation (AMHH)

o Behavioral and Primary Healthcare Coordination (BPHC)

o Child Mental Health Wraparound (CMHW)

• The DDRS Bureau of Developmental Disabilities Services (BDDS) State Line Services

• The Community and Home Option to Institutional Care for the Elderly and Disabled (CHOICE)

program

HCBS programs are always the funding of last resort. This section clarifies when home health, hospice

and HCBS can be used in the delivery of services to mutual clients.

Note: The terms “client,” “participant,” “member,” “individual” and “consumer” are

used interchangeably within the Family and Social Services Administration (FSSA)

and the divisions. Each term refers to the person actually receiving hospice, Medicaid

State Plan, CHOICE, state-funded or waiver services.

IHCP members who receive home- and community-based services through one of the HCBS programs and

who meet the hospice criteria are eligible for IHCP hospice services. HCBS program participants who choose

the hospice benefit do not have to disenroll from the HCBS program and may continu e to receive HCBS

program services that are not related to the terminal condition and are not duplicative of hospice services.

Similarly, individuals who have elected the hospice benefit can also apply for and possibly receive HCBS

program services that supplement the hospice services as long as those HCBS program services are not related

to the terminal condition, do not duplicate hospice services, and are available through the applic able source.

The IHCP hospice provider must provide all required services to meet the needs of the member in relation to

the terminal diagnosis. The number of hours related to the member’s nonterminal condition is determined

on a case-specific basis. The member should not be provided with additional services other than those the

IHCP program would have provided if the member had not elected hospice care.

The IHCP expects the hospice provider to coordinate with other, nonhospice providers to ensure that the

member’s overall care is met and that nonhospice providers do not compromise the hospice plan of care.

The hospice provider and the waiver case manager must collaborate and communicate regularly to ensure

that the best possible care is provided.

It is appropriate for transition-related HCBS waiver services to be provided on the same day as long-term

care client discharges. Provision of certain HCBS waiver services to clients with hospice LOC may also be

appropriate. Payment for services provided under either of these circumstances will be systematically denied

unless specially handled. Providers submitting claims for HCBS waiver services on the client’s date of

discharge from the long-term care facility or during a period of hospice LOC should contact their Provider

Relations field consultant for special claim handling. Providers that have had claims previously denied for

these reasons should also contact their field consultant for special handling.

A member who is currently receiving hospice benefits may elect to discontinue those hospice benefits at

any time and seek alternate means of meeting the member’s healthcare needs.

It is very important that each member’s medical condition is thoroughly reviewed and all viable options are

discussed with the member so that an informed choice can be made.

For questions concerning the PathWays Waiver, contact the OMPP at INMedicaidGA@fssa.in.gov. For

questions related to the CIH, FSW, H&W or TBI Waiver, contact the DDRS Bureau of Developmental

Disabilities Services (BDDS) at BDDSprovider@fssa.in.gov. For questions related to HCBS services

offered by the DMHA, call 800-901-1133.