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IHCP and DDARS Announce Changes to Waiver Services, Effective Jan. 1, 2026 (BT2025169)

Indianasub_regulatoryIndiana Health Coverage Programs (IHCP) / OMPP / DDARS· effective 2025-12-31

What this rule requires your agency to do

  • 1Self-directed service options are authorized annually (life of plan) based on a self-directed budget calculation reflecting the member's assessed needs and limitations.(IHCP and DDARS Announce Changes to Waiver Services, Effective Jan. 1, 2026 (BT2025169))
  • 2Behavior Management, Consultation is limited to 3 hours per month; Comprehensive is limited to 12 hours per month or 144 hours per year; FBA is limited to 20 hours total within 60 days.(IHCP and DDARS Announce Changes to Waiver Services, Effective Jan. 1, 2026 (BT2025169))
  • 3Beginning Jan. 1, 2026, new self-directed Attendant Care (S5125 U7 U1 UB) and Self-Directed Home and Community Assistance (S5130 U7 U9) must be billed as budgeted per-hour services.(IHCP and DDARS Announce Changes to Waiver Services, Effective Jan. 1, 2026 (BT2025169))
  • 4Effective Dec. 31, 2025, the listed consumer-directed Attendant Care and Participant-Directed Home Care codes (e.g., S5125 U7 U1, S5125 U7 U1 TU, S5125 U7 U2 UA, S5125 U7 U2 U9) are sunsetted and may no longer be billed.(IHCP and DDARS Announce Changes to Waiver Services, Effective Jan. 1, 2026 (BT2025169))

Applies to: personal care

Announces the sunset of certain consumer-directed and behavior-management services on Dec. 31, 2025 and addition of new self-directed and behavioral support services Jan. 1, 2026, with new procedure codes, rates, and quarterly authorization limits.

Regulatory information, not legal advice — always confirm against the cited official source. Verification reduces error; it does not certify compliance.