Section 455IAC1-5-3. Selection of local administrative units

   (a) The division shall contract with the AAAs to administer CHOICE funds. These activities include local administrative functions, including, but not limited to, the following:

(1) Budgeting.

(2) Case management.

(3) Oversight.

(4) Monitoring.

(5) Quality assurance.

(6) Submission of fiscal claims to the division.

  (b) Each AAA shall submit a plan to the division that contains the following:

(1) The referral and intake process, including a description of how the process of eligibility determination will take place.

(2) The assessment process, format, and procedures used by case managers employed by the AAA to do assessments.

(3) Procedures for an offer of an assessment to current nursing home residents who apply for CHOICE.

(4) Policies for the selection and qualifications of staff.

(5) Procedures for development of and expected timelines for care plan development, including the process for involving the client or family in the development of the care plan.

(6) All available long term support services, both public and private, within the area.

(7) Policies and procedures for the case management and service coordination system.

(8) Policies and procedures for coordinating CHOICE with the Medicaid waivers and other funding sources for in-home and community-based services.

(9) The CHOICE cost sharing plan, including cost share collection procedures.

(10) The current appeal procedures, including procedures for notifying applicants or participants of the right to an administrative hearing.

(11) Policies and procedures for waiting lists for CHOICE services.

(12) Policies and procedures for approved waivers and for requesting state approved waivers.

(13) Description of the development of the budget, as approved by the division, including the following:

(A) A breakdown of proposed spending on client services.

(B) Assessments.

(C) Care plan development.

(D) Reassessments.

(E) AAA administration.

(F) Any other appropriate costs.

(14) The estimated number of individuals who have a high functional need that warrants exceeding the established benchmark by twice the stated amount, and the methods of managing those costs.

(15) Procedures for selection of service providers.

(16) Policies and procedures for case file documentation and record keeping.

(17) Description of follow-up evaluation.

(18) The manner in which care plans and services are to be evaluated and monitored.

  (c) Each AAA shall arrange for the provision of individually needed CHOICE services through local provider agencies or individuals.

  (d) An AAA may provide community and home care services to individuals in the CHOICE program if the division determines that an appropriate alternative provider agency is not available. Before an AAA can provide community and home care services to individuals in the CHOICE program, the AAA must be granted a waiver from the division for the specific services to be delivered by the AAA.

  (e) Under subsection (d), an AAA submitting a waiver request to provide services shall include documentation of the unavailability of appropriate alternative providers, including, but not limited to, failure to obtain responses after advertising the availability of CHOICE funds and description of the efforts that it has exercised to solicit provider expansion into the given area or description of the efforts utilized to stimulate new provider growth.

  (f) The contract period for an AAA shall be two (2) years.

  (g) The AAA and all CHOICE providers shall abide by all applicable state and federal laws and regulations. (Division of Aging; 455 IAC 1-5-3; filed Dec 5, 1995, 8:30 a.m.: 19 IR 1104; readopted filed Oct 1, 2001, 3:38 p.m.: 25 IR 528; readopted filed Nov 30, 2007, 4:47 p.m.: 20071226-IR-460070733RFA; readopted filed Nov 15, 2013, 3:22 p.m.: 20131211-IR-455130453RFA) NOTE: Transferred from the Division of Disability and Rehabilitative Services (460 IAC 1-4-3) to the Division of Aging (455 IAC 1-5-3) by P.L.153-2011, SECTION 21, effective July 1, 2011.