Ind. Admin. Code tit. 455, r. 1-1-12 – Office of Medicaid policy and planning; duties

Affected: IC 12-10-12-20; IC 12-13-5; IC 12-14

Sec. 12. (a) The final preadmission screening determination under IC 12-10-12-20(b) shall be rendered by the office within three (3) working days of receipt of the prescreening documentation and recommendation.

(b) The office shall notify:

(1) the applicant;
(2) the prescreening agency; and
(3) the health facility;

in writing of the prescreening determination, including data on alternative community services as identified in the recommendation of the prescreening team.

(c) A final determination that the person is appropriate for nursing facility care shall be rendered when the person's condition meets the nursing facility level of services as set forth in 405 IAC 1-3-1 through 405 IAC 1-3-3 and:

(1) alternative community services are not sufficient to meet the needs of the person;
(2) appropriate and beneficial alternative community services that have been identified are not immediately accessible by the person due to the lack of services in the county or a waiting list for needed services in the county; or
(3) appropriate and beneficial alternative community services that have been identified are immediately accessible, regardless of whether the cost of such services is greater than the cost of nursing home care.

(d) When the criteria in subsection (c) are not met, a final determination that the person is inappropriate for nursing facility care shall be rendered.

(e) The office shall retain a record of each determination that is a disapproval of admission or a waiver of a requirement in this rule for at least three (3) years.

(Division of Aging; 455 IAC 1-1-12; filed Jul 25, 1985, 3:39 p.m.: 8 IR 1989; filed Aug 7, 1995, 10:00 a.m.: 18 IR 3392; readopted filed Nov 14, 2001, 4:45 p.m.: 25 IR 1276; readopted filed Nov 30, 2007, 4:47 p.m.: 20071226-IR-460070733RFA; readopted filed Nov 15, 2013, 3:22 p.m.: 20131211-IR-455130453RFA; readopted filed Nov 13, 2019, 11:55 a.m.: 20191211-IR-455190488RFA; readopted filed Oct 8, 2025, 3:16 p.m.: 20251105-IR-455240503RFA) NOTE: Transferred from the Department on Aging and Community Services (450 IAC 1-1-12) to the Division of Aging and Rehabilitative Services (460 IAC 1-1-12) by P.L.41-1987, SECTION 23, effective July 1, 1987. NOTE: Transferred from the Division of Disability and Rehabilitative Services (460 IAC 1-1-12) to the Division of Aging (455 IAC 1-1-12) by P.L.153-2011, SECTION 21, effective July 1, 2011.