FSSA Requests Input on Extraordinary Care Definition

In order for personal care services to be an allowable option in Medicaid Waiver services, the state must define what types of supports are considered beyond what a parent or spouse would be ordinarily obligated to provide. FSSA is offering an opportunity for feedback on extraordinary care provided by a spouse or parent of a minor child, known as a Legally Responsible Individual (LRI), as defined in the provision of Attendant Care for individuals on the Health & Wellness, Traumatic Brain Injury, and Pathways for Aging waivers as well as for individuals utilizing Participant Assistance and Care on the Family Supports waiver. 

Feedback should be sent to BDS.Help@fssa.in.gov or Medicaid@fssa.IN.gov by June 15, 2025, to be considered for inclusion in upcoming waiver amendments.

Proposed Definition

“Extraordinary care” means care provided by the parent of a minor child or a spouse (LRI) that the individual is unable to perform independently to meet his or her intensive nursing care needs under the supervision of an interdisciplinary team. The care must exceed the range of activities that an LRI would ordinarily perform in the household on behalf of a person of the same age without a disability or chronic illness. Intensive nursing care needs includes: Continuous ventilator care, Ttracheostomy care, and Total Parenteral Nutrition (TPN), or other comparable nursing services approved by FSSA.

Please note that the current definition of extraordinary care in the provision of Structured Family Caregiving on Health & Wellness, Traumatic Brain Injury, and Pathways for Aging waivers will remain unchanged and will not be impacted by the proposed definition.

As a reminder, when a state provides an LRI payment for extraordinary care, the service must meet all the waiver criteria required when delivered by a customary provider. Additionally, a state must satisfy some additional policies and oversight activities which include ensuring that the provision of service by the LRI is in the best interest of the waiver participant and may include safeguards such as limiting the amount of services that an LRI may provide.

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