IHCP Updates the Billing Policy for HCBS Assisted Living Providers (BT2025173)

What this rule requires your agency to do

• 1No separate payment is allowed for services integral to Assisted Living (Adult Day Services, Attendant Care, Home and Community Assistance, Home-Delivered Meals, PERS, Respite, Structured Family Caregiving, Transportation, etc.); room and board is not covered.(IHCP Updates the Billing Policy for HCBS Assisted Living Providers (BT2025173))
• 2Assisted living providers may only submit claims after the HCBS waiver services are rendered; claims for future (unrendered) dates of service will be denied.(IHCP Updates the Billing Policy for HCBS Assisted Living Providers (BT2025173))
• 3Assisted living providers must document, for each day the member is present in the facility, the participant's status and services rendered per the person-centered service plan (including medication management records where applicable and quarterly updated service plans).(IHCP Updates the Billing Policy for HCBS Assisted Living Providers (BT2025173))
• 4Providers must notify the participant's care manager/service coordinator within 48 hours of any changes in the participant's care plan.(IHCP Updates the Billing Policy for HCBS Assisted Living Providers (BT2025173))
• 5Providers must maintain the participant's personal records (SSN, medical insurance number, birth date, emergency contacts, current medications, hospital preference, primary care physician, mortuary if known).(IHCP Updates the Billing Policy for HCBS Assisted Living Providers (BT2025173))
• 6Providers must maintain copies (if available) of advance directive, living will, power of attorney, health care representative, DNR order, letters of guardianship, and the fully executed lease agreement.(IHCP Updates the Billing Policy for HCBS Assisted Living Providers (BT2025173))
• 7Attendant care within assisted living must be delivered by aides trained on the individual's specific needs (CNAs or individuals who complete all attendant care training requirements).(IHCP Updates the Billing Policy for HCBS Assisted Living Providers (BT2025173))