Communication from Division of Aging

To initially determine each site’s level of compliance with the new HCBS requirements, Indiana Division of Aging is requesting documentation and evidence related to each HCBS standard from each HCBS Assisted Living and Adult Day Services provider site. The HCBS standards and associated examples of acceptable evidence are in the table below. Providers should provide as much information and documentation as possible to demonstrate how it is addressing each HCBS standard in the table below; examples of acceptable documentation include (but are not limited to):

  • Policies/Procedures
  • Plan of Care templates (not for individuals)
  • Resident handbook
  • Lease/Residency agreements or template (for Residential settings only)
  • Staff training curriculum and materials
  • Staffing/Training schedules
  • Site/program accreditation

Providers must submit materials for each site where HCBS services are provided; submitting one set of materials for an organization with multi-sites is not acceptable. Documentation submitted to DA should not include any individual identifying information for residents or participants. All documentation and supporting evidence must be submitted to DA and PCG to INaging@pcgus.com by January 15, 2016.

Please contact INaging@pcgus.com for any questions or technical assistance on DA’s provider assessment activities.

# HCBS Standards Examples of Acceptable Evidence or Documentation
1 The setting is integrated in and supports full access to the greater community
  • Transportation and other support resources’ options, schedules, and policies
  • Policies for managing individuals’ money and possessions
  • Policies for job opportunities and supports
  • Policies for resident activities (options, schedules, etc.)
2 The setting is selected by the individual from among setting options
  • Policies that require specific information is provided to individuals on options, considerations, and alternatives
  • Policies that require a planning process for individuals selecting the setting
3 Each individual has a right to privacy, is treated with dignity and respect, and is free from coercion and restraint
  • Evidence of availability of space and time for individuals to have personal and alone time
  • Evidence of informed consent
  • Policies around physical restraint and medication distribution
4 Provides individuals independence in making life choices
  • Evidence of availability and support for individuals making their own daily decisions and life choices
  • Evidence of availability of resources to communicate beyond the site
5 The individual is given choice regarding services, supports, and who provides them
  • Evidence that support staff understand and cater towards residents’ capabilities, interests, likes, and dislikes
  • Evidence of a policy that ensures individual(s) has the needed supports to develop his/her plan that is specifically reflects their needs
6 Responsibilities and rights of tenant, legally enforceable agreement
  • Lease, memorandum of agreement or other agreed upon form of documentation between the individual and the landlord which assures the individual is protected against unlawful eviction
7 Privacy in sleeping or living unit
  • Evidence of individuals’ privacy (e.g. floor plans)
  • Evidence that privacy and comfort was given reasonable consideration in the living arrangements
8 Lockable doors, staff have keys only as needed
  • Evidence/description of key system and locking for building and living spaces (including private sleeping areas)
9 Freedom to furnish and decorate
  • Evidence of choices for items in personal living spaces, accounting for an individual’s financial resources
  • Evidence for opportunities to research other options for items in living space (e.g. shopping elsewhere, on-line shopping, etc.)
10 Choice of roommates for shared rooms and assurance of choice to not have a roommate within that setting
  • Process for determining and/or requesting roommates/housemates
  • Evidence that married couples have choice of sharing a room
  • Process for changing roommates/housemates when necessary
  • Policy assuring that individuals have the option of choosing to not have a roommate within that setting
11 Control own schedule and activities and access to food at any time
  • Evidence of differing schedules across individuals/residents
  • Evidence of availability and noted use of various activities when appropriate
  • Evidence of free/supported control of an individuals’ daily choice of preferred activities may include personal preference assessments or interest inventories to help identify what individuals like to do.
12 Able to have visitors at any time
  • Evidence of policies for visiting hours, allowable visitors, and allowable social practices/space for visitors
13 Physically accessible
  • Evidence that all parts of site are accessible for all individuals/residents
  • Evidence for how the site accommodates individuals with special needs, including any modifications to the site