We greatly appreciate that the Indiana Family and Social Services Administration (FSSA) is proposing Medicaid Waiver amendments that will allow Legally Responsible Individuals (LRIs) – parents of minor children and spouses – to provide attendant care and personal assistant care to individuals who require extraordinary care. This is something The Arc of Indiana has fought for since the 2024 legislative session, when LRIs were no longer allowed to be reimbursed for providing attendant care.
FSSA is seeking feedback on the proposed definition of extraordinary care that would allow LRIs to provide attendant care (ATTC) to individuals on the Health & Wellness, Traumatic Brain Injury, and Pathways for Aging waivers, as well as individuals utilizing Participant Assistance and Care (PAC) on the Family Supports waiver.
If this is an issue important to you, we encourage you to provide feedback to BDS.Help@fssa.in.gov or Medicaid@fssa.IN.gov by June 15, 2025, to be considered for inclusion in the upcoming waiver amendment.
Proposed definition: “Extraordinary care” means care provided by the parent of a minor child
or a spouse that the individual is unable to perform independently to meet his or her intensive nursing care needs under the supervision of an interdisciplinary team. Intensive nursing care needs includes continuous ventilator care, tracheostomy care, Total Parenteral Nutrition (TPN),
or other comparable nursing services approved by FSSA. The care must exceed the range of activities that a legally responsible individual would ordinarily perform in the household on
behalf of a person of the same age without a disability or chronic illness.
The Arc of Indiana supports this long-awaited and much-needed revision to allow LRIs to provide attendant care to those who meet the extraordinary care definition. We support the inclusion of safeguards to ensure that attendant care services provided by LRIs are in the best interest of the individual. We also support guardrails to ensure the fiscal integrity of payment for services. We strongly recommend that FSSA develop clear guidelines for those approving this service, so all families and recipients of attendant care are treated equally. This includes clarifying how an individual needing “other comparable nursing services” qualifies for attendant care.
It is critical that FSSA put forth an assessment tool to ensure that assessments to determine if someone meets the extraordinary care definition are consistent. We will be recommending this in our comments. In addition, we want to make sure that the definition appropriately recognizes the complexity of care for some people and allows them access to the care they need. The ambiguity around “other comparable nursing services” is concerning, and we hope to get more clarification as this issue progresses.
Please note that the current definition of extraordinary care in the provision of Structured Family Caregiving on H&W, TBI, and PathWays for Aging waivers will remain unchanged and will not be impacted by the above proposed definition.