Contact by phone: 833.597.2777
Contact by email: INLCAR@maximus.com
Additional resources: https://www.inlcar.com
Help Desk hours: Help Desk staff are available for phone inquiries from 8 am to 6 pm EST Monday-Friday.
Level of Care assessments and determinations for children
A nursing facility level of care (NF LOC) determination is required to qualify for Medicaid coverage of nursing facility services. It is also required for certain Home- and Community-Based (HCBS) waivers. Indiana offers the following HCBS waivers for children with an NF LOC:
- Health and Wellness (H&W) Waiver.
- Traumatic Brain Injury (TBI) Waiver for children that have a TBI diagnosis.
Note: The TBI Waiver, as well as two other waiver programs, are also available to individuals who have been determined to meet LOC criteria for an intermediate care facility for individuals with intellectual disabilities [ICF/IID]. If an individual does not meet NF LOC for the TBI Waiver. LCAR will inform the TBI Waiver Case Manager as a referral to BDS to complete the ICF/IID LOC to ensure eligibility for TBI Waiver is determined. Inquiries about this process may be emailed to LCAR at INLCAR@maximus.com or BDS.Help@fssa.in.gov.
The assessments used for these determinations in Indiana for children are:
- The interRAI Pediatric Home Care (PEDS-HC) for children ages 4-17.
- The interRAI Early Years (EY) for children ages 0-3.
LCAR Services complete level of care assessments and determinations for people referred for a nursing facility level of care assessment. We also complete determinations on level of care assessments already completed by other providers when appropriate. Other providers may complete the assessment when:
- The individual is seeking nursing facility admission from a hospital, or
- When the individual is connected to their local Area Agency on Aging (AAA) to coordinate their assessment needs.
Frequently asked questions
LCAR stands for Level of Care Assessment Representative. The Indiana Family and Social Services Administration (FSSA), in partnership with various entities, conducts federally required Level of Care (LOC) assessment and determination services and intake counseling for PathWays individuals in need of a Nursing Facility Level of Care (NFLOC) for nursing facility (NF) admission or Home- and Community-Based
Services (HCBS) waiver programs.
On July 1, 2024, the LCAR began Preadmission Screening and Resident Review (PASRR) and level of care determinations for individuals entering or residing in a skilled nursing facility.
Beginning July 1, 2025, the LCAR will provide:
- PASRR
- Level of Care (LOC) assessments, and renewals
- LOC determination (outcome) recommendations and re-determinations
- Intake counseling for the PathWays 60+ population
- Medicaid application assistance
These services apply to the PathWays for Aging, Health & Wellness, and Traumatic Brain Injury Waivers.
This is consistent with the FSSA FAQ document currently under review with leadership.
A NF LOC is a measure of care needs that must be met for Medicaid recipients to access Medicaid funded nursing homes and certain HCBS Waivers. Medicaid will not pay for these services unless it is decided that a person meets that state’s NF LOC criteria. To decide if NF LOC criteria is met, an assessment must identify the person’s needs. This includes assessing their ability to complete day-to-day activities, medical conditions, medical treatments needed, cognitive abilities, and behavioral needs.
Indiana’s Home- and Community-Based Services (HCBS) Waiver services available for children that require meeting NF LOC to quality include:
- Health and Wellness Waiver
- Traumatic Brain Injury (TBI) Waiver for children that have a TBI diagnosis.
Indiana has other HCBS Waiver programs available for children that do not require meeting NF LOC to qualify.
The assessments used for NF LOC in Indiana for children are the *interRAI Early Years (EY) (ages 0-3) and the interRAI Pediatric Home Care (ages 4-17) (PEDS HC).
*InterRAI – International Resident Assessment Instrument
You can contact Maximus at 833.597.2777. A Maximus team member will gather some information about your child so they can get their nursing facility Level of Care (NF LOC) assessment scheduled.
Once you have contacted Maximus, they will have seven calendar days to gather the information for your child’s assessment, and four additional calendar days for an outcome to be given, for a total of up to eleven calendar days to get the outcome.
Your child’s nursing facility Level of Care (NF LOC) assessor will speak with you, your child, and others you would like to be included in the assessment and gather information about things like the type of help your child needs with daily activities, any medical care or treatments they need, and any conditions or diagnoses they may have.
An individual qualifies for nursing facility Level of Care (NF LOC) in IN if they have certain medical needs that must be performed by a nurse, or if they need help with completing at least three daily care tasks as a result of a medical condition. For children, developmental stage is taken into consideration when making these decisions.
The Indiana Level of Care Assessment Representative (LCAR), Operated by Maximus
Contact us: 1-833-597-2777 | INLCAR@maximus.com
