Section 455IAC1-5-7. Duties of the AAA

   (a) Each AAA shall maintain individual case records for each individual who applies for or receives services. Each individual's records shall be maintained by the AAA for a minimum of three (3) years after the individual's termination from the program or other final action.

  (b) The AAA shall maintain the confidentiality of CHOICE files and records at all times. Such files and records shall not be disclosed except:

(1) to the individual or his or her CHOICE representative;

(2) to a person representing the individual in an appeal from a CHOICE decision;

(3) to the division or other state agencies for purposes of securing in-home and community services;

(4) to an adult or child protective services investigator under IC 12-10-3 and IC 31-6-11-3 [IC 31-6 was repealed by P.L.268-1995, SECTION 17, effective July 1, 1995.];

(5) under court order; or

(6) as authorized by the individual or his or her CHOICE representative.

  (c) The AAA shall use CHOICE records for purposes of the CHOICE program and for the coordination of other related services only. Any disclosure of information in an individual's CHOICE file for purposes of coordinating related services shall be limited to the information that is directly relevant to and required by the other related services.

  (d) CHOICE funding shall be used after all other possible payment sources have been identified and all reasonable efforts have been employed to utilize those sources.

  (e) The AAA shall reduce services that are paid by CHOICE in any of the following circumstances:

(1) When the assessed level of need diminishes as established by an updated care plan.

(2) When the AAA's CHOICE service funds are insufficient to meet the service commitment to current participants, all reasonable efforts have been made to secure resources to avoid service reductions, the AAA has stopped performing new assessments and care plans, and the AAA has adopted a fair and equitable policy for distributing service reductions among participants.

(3) When an individual receiving services becomes eligible under a Medicaid home and community-based services waiver and begins receiving those services that are allowable through the Medicaid program.

(4) When a current participant becomes eligible for in-home and community services from other sources for which he or she was not previously eligible and is receiving those services.

(5) When other resources become available in the community and the individual begins receiving those services that were not available at the time of the development of the previous care plan.

(6) If services needed by the applicant, as determined by the assessment, would be so costly that CHOICE payment for the needed services would cause the AAA to exceed the allowable cost per individual determined by the division.

  (f) The AAA shall terminate services that are paid by CHOICE in any of the following situations:

(1) When the individual's health or personal circumstances have improved so that he or she no longer needs in-home and community-based services to maintain his or her independence in a safe, noninstitutional environment.

(2) When the health, welfare, or safety of the participant or of others who interact with the individual can no longer be reasonably assured.

(3) When the services being provided are detrimental to the individual's health.

(4) When the individual or his or her CHOICE representative has fraudulently obtained or misused CHOICE funded services.

(5) Upon the death of the individual receiving services.

(6) When the individual or his or her CHOICE representative refuses to comply with cost sharing under section 8 of this rule.

(7) When the individual or his or her CHOICE representative voluntarily requests termination.

(8) When the individual or his or her CHOICE representative refuses services necessary for his or her health and well-being.

  (g) A participant who is found eligible for CHOICE services, but does not receive CHOICE services for a period of six (6) months due to institutionalization or lack of need, may be terminated from CHOICE services. Restoration of services, after this six (6) month period, shall be within the availability of funds and continued need for services.

  (h) No CHOICE services funds shall be used to purchase real estate.

  (i) No CHOICE services funds shall be used to provide care or services to an individual residing in an institution. However, funds may be used for assessment and care plan development for current residents in institutions who could return to their homes if determined to be eligible for the CHOICE program.

  (j) Unless no CHOICE funds are available, the AAA shall offer initial assessments and, when appropriate, individual care plans to applicants, regardless of the applicant's income and assets.

  (k) The division shall establish a maximum level of CHOICE fund expenditure per individual based on costs calculated by the division. This maximum expenditure is not to be applied monthly, but over a period of three (3) consecutive months. The dollar amount shall be published in the CHOICE guidelines and procedures. (Division of Aging; 455 IAC 1-5-7; filed Dec 5, 1995, 8:30 a.m.: 19 IR 1106; 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 1-4-7) to the Division of Aging (455 IAC 1-5-7) by P.L.153-2011, SECTION 21, effective July 1, 2011.