Section 410 IAC 16.2-3.1-16 - Admissions policyAuthority: IC 16-28-1-7
Affected: IC 16-28-5-1
Sec. 16.
(a) The facility must not: (1) require residents or potential residents to waive their rights to Medicare or Medicaid; or(2) require oral or written assurance that residents or potential residents are not eligible for, or will not apply for, Medicare or Medicaid benefits.(b) The facility must not require a third party guarantee of payment to the facility as a condition of admission or expedited admission, or continued stay in the facility. However, the facility may require an individual who has legal access to a resident's income or resources available to pay for facility care to sign a contract, without incurring personal financial liability, to provide facility payment from the resident's income or resources.(c) In the case of a person eligible for Medicaid, a nursing facility must not charge, solicit, accept, or receive, in addition to any amount otherwise required to be paid under the state plan, any gift, money, or donation, or other consideration as a precondition of admission, expedited admission, or continued stay in the facility. However, a nursing facility may: (1) charge a resident who is eligible for Medicaid for items and services the resident has requested and received and that are not specified in the state plan as included in the term "nursing facility services" so long as the facility gives proper notice of the availability and cost of these services to residents and does not condition the resident's admission or continued stay on the request for and receipt of such additional services; or(2) solicit, accept, or receive a charitable, religious, or philanthropic contribution from an organization or from a person unrelated to a Medicaid-eligible resident, or potential resident, but only to the extent that the contribution is not a condition of admission, expedited admission, or continued stay in the facility for a Medicaid-eligible resident.(d) A facility must not admit, on or after January 1, 1989, any new residents with: (1) mental illness unless the state mental health authority or its designee has determined, based upon an independent physical and mental evaluation performed by a person or entity other than the state mental health authority or its designee, prior to admission that: (A) because of the physical and mental condition of the individual, the individual requires the level of services provided by the facility; and(B) if the individual requires such level of services, whether the individual requires specialized services for mental illnesses or services of a lesser intensity; or(2) intellectual disability unless the state intellectual disability authority or its designee has determined prior to admission that: (A) because of the physical and mental condition of the individual, the individual requires the level of services provided by the facility; and(B) the individual requires such level of services, whether the individual requires specialized services or services of a lesser intensity for intellectual disability.(e) For purposes of IC 16-28-5-1, a breach of:(1) subsection (d) is a deficiency; and(2) subsection (a), (b), or (c) is a noncompliance.Indiana State Department of Health; 410 IAC 16.2-3.1-16; filed Jan 10, 1997, 4:00 p.m.: 20 IR 1540, eff Apr 1, 1997; readopted filed Jul 11, 2001, 2:23 p.m.: 24 IR 4234; readopted filed May 22, 2007, 1:44 p.m.: 20070613-IR-410070141RFA; readopted filed Sep 11, 2013, 3:19 p.m.: 20131009-IR-410130346RFAFiled 8/30/2016, 12:50 p.m.: 20160928-IR-410150385FRAReadopted filed 11/13/2019, 3:14 p.m.: 20191211-IR-410190391RFA