The Indiana Family and Social Services Administration quietly paused determinations for disability Medicaid waivers in August to review how case managers were implementing the agency’s new interRAI assessment system, as advocates raised alarm about the tool’s accuracy.

But after a break, the system is already back in place.

Case managers started using the interRAI algorithm in January to determine who is eligible for Medicaid waivers for intermediate care, a process known as level-of-care assessments.

The waivers allow disabled Hoosiers to stay in their homes, rather than an institutional setting.

FSSA used to approve nearly all disability waivers. But officials questioned the accuracy of those assessments after internal estimates suggested the approval rate should be closer to 90%, so the agency adopted interRAI.

Denials quickly surged, prompting alarm from Democratic lawmakers and advocates who worried the denials were in error.

FSSA paused level-of-care determinations Aug. 31 for assessments awaiting review by the Indiana Bureau of Disabilities Services, a spokesperson confirmed to the Indiana Capital Chronicle.

The agency undertook the review to “ensure case managers were conducting the assessment process consistently and in line with state standards,” the spokesperson said.

The Arc of Indiana, which advocates for disability rights, learned of the pause when it filed a public records request on Sept. 30 seeking clarity for how determinations were made.

Arc executives also found out FSSA had ordered new assessments for Hoosiers with pending level-of-care denials based on interRAI assessments, and that the agency had started rescinding denials currently in appeals and others who raised concerns to allow for reassessments of those cases.

“In practical terms, this process is essentially a fresh start,” said Karly Sciortino-Poulter, director of The Arc of Indiana Advocacy Network. “The new assessment replaces the previous assessment in its determination. If an individual is found eligible based on the new assessment, they will retain their waiver eligibility.”

She continued, “If they are found ineligible, they have the right to appeal the decision. Individuals should pay close attention to the new assessment and any notices they receive, particularly deadlines to appeal and steps to making the appeal.”

Determinations resumed Monday.

Indiana ‘fully confident’ in interRAI

An FSSA spokesperson said the pause on determinations was due to variability in how case managers were administering assessments, rather than an issue with interRAI itself.

InterRAI, also known as the international residential assessment instrument, started as an assessment tool for nursing homes.

“We remain fully confident in the interRAI tool and its effectiveness in evaluating individual needs,” the spokesperson said in an unsigned email statement.

Arc officials say FSSA informed them that new assessments will be conducted by mentors and specially trained assessors, alongside a persons’s assigned case manager — a decision praised by Arc CEO Kim Dodson.

Still, advocates from the Arc continue to raise questions about how assessment information is used to determine eligibility for waivers.

The group is seeking information about how FSSA maps interRAI assessment data onto Indiana’s level-of-care criteria, and how the agency uses that methodology to make eligibility determinations.

It’s also seeking records related to assessment training, quality assurance, implementation and outcomes.

“This is a sophisticated assessment that can have enormous consequences for an individual,” Dodson said.

While Dodson said the tool itself is not the fundamental problem, she remains concerned about how its implementation apparently differs from the “comprehensive, person-centered assessment” it was designed to be.

She added, “People with intellectual and developmental disabilities have a broad range of abilities and support needs. We need to understand what assessment information matters, how it is weighted, what criteria or thresholds are used, and how the methodology was developed and tested. We must have confidence that the process accurately identifies everyone who meets Indiana’s level-of-care requirements, not only people with the most significant or readily apparent disabilities.”

Indiana Capital Chronicle is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Indiana Capital Chronicle maintains editorial independence. Contact Editor Niki Kelly for questions: info@indianacapitalchronicle.com.