FSSA implements extraordinary care allowance for Attendant Care and Participant Assistance and Care

From FSSA, original announcement can be found here: https://www.in.gov/medicaid/providers/files/bulletins/BT202603.pdf

"The Indiana Family and Social Services Administration (FSSA) is implementing the “extraordinary care” allowance for individuals receiving the following services through one of the indicated Home- and Community-Based Services (HCBS) Medicaid waivers: 

• Attendant Care – Health and Wellness (H&W) Waiver; Indiana PathWays for Aging (PathWays) Waiver
• Participant Assistance and Care (PAC) – Family Support Waiver (FSW) 

This allowance is outlined in the approved HCBS Medicaid waiver, effective Dec. 31, 2025. 

Extraordinary care means care provided by the parent of a minor child or by a spouse (also known as a legally responsible individual [LRI]), that the individual receiving the care is unable to perform independently to meet his or her intensive nursing care needs under the supervision of an interdisciplinary team. The care must be provided under the supervision of an interdisciplinary team and must exceed the range of activities that an LRI would ordinarily perform in the household on behalf of a person of the same age without a disability or chronic illness.  

Extraordinary care refers to the characteristics of the individual in waiver services, not the care that will be provided through Attendant Care or PAC. All paid staff must adhere to the service definition and allowable activities when providing that service.  

To qualify for the extraordinary care allowance, the care must: 

• Meet the definition of extraordinary care
• Be documented in the Person-Centered Plan
• Be approved by the Individualized Support Team (IST) and FSSA 

Extraordinary care is defined as those individuals who have the following needs:

• Tracheostomy care; or
• Continuous Ventilator management; or
• Total Parenteral Nutrition (TPN); or 
• Other comparable nursing services which include a combination of at least two of the below:
• Seizures that are: frequent, severe, or medically complex and require monitoring of the individual following seizures, monitoring for needed post-seizure assistance
• IV medication administration that requires close monitoring and observation
• Complex wound care that is ongoing in nature and requires regular positioning, monitoring for signs of infection, protection of wound sites during activities of daily living (ADL) care, etc.
• Noncontinuous ventilator management which may require close monitoring for signs of distress, breathing difficulty, etc. 

Requests for state review of extraordinary care must be submitted to the FSSA by the waiver case manager or managed care service coordinator. Documentation from a physician involved in the individual’s care confirming skilled needs as outlined above must accompany the request using State Form 450b."