INDIANA – The Office of Medicaid Policy and Planning and the Division of Aging announces the addition of one new service to the Aged and Disabled Waiver. Caregiver Coaching and Behavioral Management are designed to help equip the participants’ lay caregivers with the skills needed to manage the individuals’ medical conditions and health needs.
Service Description
The complete service description can be found in the A&D waiver. The purpose of Caregiver Coaching and Behavior Management is to enable the stabilization and continued community tenure of a waiver participant by equipping the participant’s lay caregiver(s) with the necessary skills to manage the participant’s chronic medical conditions and associated behavioral health needs related to cognitive impairment and/or dementia. This is not a service provided directly to the waiver participant, but to their lay caregiver(s). This service allows family caregivers who are not eligible to participate in Structured Family Caregiving to access support. This service is available to any and all caregivers who are not served through Structured Family Care. Medicaid- participating Structured Family Caregiving agencies may be service providers.
The waiver participant will receive additional waiver services outside of what the informal caregiver delivers. The goal of the caregiver coach and behavior management service is to address the caregiver’s needs as far as training and education on how to best support the person.
How to Bill
Effective for claims with dates of service on or after Jan. 1, 2023, the service in Table 1 will be available for reimbursement.
This information will be reflected in the next regular update to the Professional Fee Schedule, accessible from the IHCP Fee Schedules page here.
Billing questions or concerns should be directed to the Family and Social Services Administration Indiana Health Coverage Programs reimbursement mailbox at FSSA.IHCPReimbursement@fssa.in.gov.
Table 1 – New A&D service, effective for dates of service on or after Jan. 1, 2023.
| Service Name | Procedure Code | Modifier 1 | Modifier 2 | Rate | Limit |
| Caregiver Coaching & Behavioral Management | S5140 | U7 | U4 | The initial rate is $10 per unit.One unit = 15 minutes | Max 32 quarter hours (8 hours) /month; cap $320/month per member |
FSSA anticipates providers will be delivering services throughout the month and should document all activities that would be considered billable activities, including assessments, service planning, caregiver engagement, collaboration with case managers, and reviews.
CCBM services are provided on an ongoing basis and may continue until the caregiver is no longer participating, or the consumer chooses to discontinue services.
Applying to Add this Service
Refer to the updated A&D waiver, by clicking here, to read the service definition and service standards. Be sure to read this carefully before requesting to add this service. This is not the same as the Behavior Management/ Behavior Program and Counseling service on the Traumatic Brain Injury waiver, nor is this service the same as Behavior Support Services currently offered on the Family Support Waiver and Community Integration and Habilitation Waiver and it does not have the same provider requirements as those two services.
The provider should contact daproviderapp@fssa.in.gov to add this service to their certification letter.
Requirements:
- Because CCBM is designed to support unpaid caregivers, background checks are not required for caregivers participating in CCBM, however, caregiver coaches are still subject to background check requirements stated in 455 IAC 2-15-2.
- The service description states that services may be delivered telephonically and through HIPAA secure electronic communication platforms. When applying to add this service, the provider should include a policy about how communication will be conducted.
- Provider agencies must employ caregiver coaches with the experience and qualifications appropriate to the needs of each family. Job descriptions should be included in the service application.
- The service description states that the caregiver coach will conduct a structured caregiver assessment, assess any health and safety risks, devise interventions to ensure health and safety, and develop emergency/crisis plans in collaboration with the care manager and participant. The provider should include a policy, template, or other materials to illustrate how these requirements will be carried out operationally, to be included in the provider’s operations manual.
- Providers of this service must conduct incident reporting.
Questions about this service can be sent to fssa.daresponseteam@fssa.in.gov.
Future Services
It was previously announced that an additional service would be implemented, called Goal Engagement. That service is on hold due to comments from CMS that will require FSSA to update service definitions. FSSA plans to include the concept of this program in future waiver operations.
The Division of Aging is a program of the Indiana Family & Social Services Administration. If you have questions about Aging programs and services, visit us online at www.IN.gov/fssa/aging.
