Direct support professionals serving Indiana's Family Supports waiver must now be listed on the state's DSP registry, and Participant Assistance and Care services need hourly shift notes, under waiver changes effective for services on or after Jan. 1, 2026.
Indiana Health Coverage Programs announced in bulletin BT202612 on Jan. 22, 2026, that the Centers for Medicare & Medicaid Services had approved the amendment to the waiver, which serves people with intellectual and developmental disabilities. Some changes were first announced in an earlier bulletin, BT2025169.
Registry and documentation
Under a 2023 state law, House Enrolled Act 1342, direct support professionals (called home and community support professionals) serving waiver participants must be listed on the Home and Community Support Professional Training Registry. The bulletin describes competency-based training of up to 16 hours, with periodic recertification. It refers to 12 core competency areas but lists 11.
Caregivers providing Participant Assistance and Care must now document the services delivered in each hour of a shift.
Service changes
The amendment adds self-direction for Participant Assistance and Care, Respite and Workplace Assistance, and a new Benefits Counseling service. Home Modifications and Home Modification Assessments become one service. Recreational therapy and music therapy are each capped at six hours a month.
Behavioral Support Services are restructured. Consultation is limited to three hours a month and comprehensive support to 12, a functional behavioral assessment is capped at 20 hours within 60 days, and state templates are required. Clinical supervision of one hour a month is required only when restrictive interventions are used.
Facility-based prevocational services are closed to new enrollees and limited to 18 months, with one possible extension. The state's LOCSI assessment is replaced by interRAI tools for adults, children ages 4 to 17 and children up to age 3.
Paid family caregivers
A new extraordinary care allowance lets parents of minors or spouses be paid for Participant Assistance and Care, up to 40 hours a week in total, when a participant has intensive medical needs such as a ventilator, tracheostomy or IV nutrition. It is not available when services are self-directed.
Why this matters for providers and DSPs
Unregistered staff can no longer provide these services, and hourly notes add paperwork to every shift. Indiana agencies need to track registry status and build the new documentation into scheduling.