OASIS Guide

The following guide provides information on OASIS. Because the implementation of OASIS has been suspended, this information may change. Please check back often for updates on OASIS.

What Is OASIS?
OASIS, Objective Assessment System for Individual Supports, is a new system to determine resources available to waiver recipients and reimbursement rates for services providers.

Under OASIS, a formula that includes several factors will determine a specific resource allocation that is available to Medicaid waiver recipients to be used for services and supports from Medicaid waiver providers.

How Is The Resource Allocation Under OASIS Determined?
The resource allocation, which represents a dollar amount that is available for an individual's Medicaid waiver service, is based on a formula. This formula includes:

  • ICAP score - Several months ago, FSSA hired Arbitre Consulting to conduct an assessment of people receiving Medicaid waiver services. The assessment is called ICAP, Inventory for Clients and Agency Planning. It is also known as the Objective Assessment (OS). ICAP is an assessment of a person's skills. The assessment produces a service score, which helps determine how much care a person needs.
  • Age of Medicaid waiver recipient
  • Residence of recipient - living at home or in residential placement
  • If living in a residential placement - housemate arrangement
  • Need for specialized medical or behavior supports

These factors are run through a formula and based on the end result, a resource allocation amount is determined. For example, an older person might receive more funding than a younger person. A person living with family might receive more funding than a person living in a residential placement.

It is important to note that recipients of the Support Services Medicaid Waiver will not go through the resource allocation formula process. They are eligible to receive up to $13,500 for programs and services.

What Happens After You Receive Your Resource Allocation?
Your IPMG case manager will inform you what your resource allocation is. You will have an opportunity to use a computer based program, known as a budget allocation tool, that helps you develop a preliminary budget for the services you want to utilize with that allocation.

You will meet with a team – which can include your case manager, providers, advocates, etc. – to discuss and determine a plan of care (POC) based on the new resource allocation. Based on the new plan of care, your case manager will develop and submit a Cost Comparison Budget (CCB) to FSSA for approval. If approved, your new plan of care will be implemented. If not approved, your team will need to meet again, make changes, and resubmit the budget.

For Those New To Medicaid Waivers
If you have not received a Medicaid waiver in the past, following is what must happen before you can receive services under a Medicaid waiver:

  • You will be notified by the Bureau of Developmental Disabilities (BDDS) that you have been targeted to receive a Medicaid waiver.
  • A BDDS Service Coordinator will schedule a time to meet with you to determine if you are in fact eligible to receive services from the Medicaid waiver.
  • Once it is determined that you are eligible for the Medicaid waiver:

A case manager from IPMG will contact you to schedule a time to meet to complete a Person Centered Plan (PCP) and Individual Support Plan (ISP). The IPMG case manager will also assist you with applying for Medicaid, if you do not already have Medicaid.

The Inventory for Clients and Agency Planning (ICAP) will be conducted by an independent company called Arbitre Consulting.
The assessment will produce the service score that will be used in the formula to determine your resource allocation.

You will be able to use a computer based program called an "interactive budget tool" to determine how you want to use your resource allocation for services. The Person Centered Plan and Individual Support Plan can be used as a guide for how to use your resource allocation.

You will meet with your case manager to develop a plan of care, based on the resources available to you, and ideas generated from the interactive budget tool. Your case manager will submit a Cost Comparison Budget to FSSA. Your case manager will help you select providers to deliver the services. Once your cost Comparison Budget is approved and providers have agreed to deliver services, you will begin receiving services.

Appeals Process
The ICAP score cannot be appealed; however, the state administrative appeals process can be used to appeal services that will be provided under the plan of care. The state is refining a new policy on how it will address people who have a significant change in the services they will receive.

To Appeal
You may request an appeal within 30 days of the date you receive notice. The time limit is extended 3 days if the notice is received by mail. To file an appeal, sign, date, and return the Hearings and Appeals copy of the form that you should receive with a notice to:

MS 04, Hearings and Appeals
Indiana Family and Social Services Administration
402 W. Washington St.
Room E034
Indianapolis, IN 46204

You will be notified in writing by FSSA of the date, time, and location of the hearing. Prior to the hearing, you have the right to examine the entire contents of your case record maintained by your Case Manager. Ask for a copy of all assessments, completed forms and questionnaires that were utilized in determining your plan of care.

You may represent yourself at the hearing, or you may authorize a person to represent you.