FSSA recently announced in Bulletin BT 2023141 that the Centers for Medicare & Medicaid Services (CMS) approved the AL waiver rate increase retroactive to July 1, 2023 dates of service. You can click here to view the rate table.
In addition, FSSA recently announced the AL waiver CY2024 Allowable Room and Board Rates. CY2024 Allowable Room and Board Rates. Available below is Division of Aging Update:
“Under 455 IAC 3-1-12, participants living in assisted living facilities are entitled to retain at least their personal needs allowance as established by the state of Indiana, found here.
A provider, after assuring that the participants retain their PNA, may bill participants up to the current maximum Federal Supplemental Security Income. The monthly maximum Federal SSI amount for 2024 is $943 per month for an eligible individual based on an 3.2% cost of living increase. Providers may not charge Medicaid eligible individuals a room and board rate for a studio apartment that exceeds the maximum SSI amount for 2024. A participant who wishes to select a larger room may pay extra for any unit exceeding the size of a studio based on the monthly amount determined by the facility.
Please see the three illustrations below for further clarification. The amounts included in the examples below are for illustrative purposes only. Providers are responsible for determining the current maximum SSI and the State PNA when calculating room and board rates. The current SSI may be found here. Per Ind. Code §12-15-7-2, the State PNA is $52.
Example 1: Medicaid Waiver Participant Receiving only SSI Income
Medicaid Waiver Participant Monthly Income $943.00
SSI for an Eligible Individual $943.00
PNA $52.00
Allowable Room and Board Rate $891.00
Example 2: Medicaid Waiver Participant with Income in Excess of the SSI Rate
Medicaid Waiver Participant Monthly Income $954.00
SSI for Eligible Individual $943.00
PNA $52.00
Allowable Room and Board Rate $902.00
Example3: Medicaid Waiver Participant with Income in Excess of the SSI Rate
Medicaid Waiver Participant Monthly Income $1,229.00
SSI for Eligible Individual $943.00
PNA $52.00
Allowable Room and Board Rate $943.00
In all these examples, the participant retains their PNA and the room and board rate is no greater than the maximum SSI.
For questions, please contact Lauren Perry at (317) 232-7132 or via email at lauren.perry@fssa.in.gov.