DDRS Waiver Manual

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Each time an emergency response is generated, an incident report must be submitted to the State per the DDRS/BDDS and DDRS/BQIS procedures. At least every 90 calendar days, the appropriateness of continued use of the monitoring system must be reviewed by the IST; the results of these reviews must be documented in the DDRS Case Management system and/or the ISP. Areas to be reviewed include but are not limited to the number and nature of responses to the home as well as damage to the equipment. As applicable, monthly/quarterly reports must be uploaded to Advocare by the chosen service provider on or before the fifteenth day of the following month Limitations and Reimbursement Parameters The following limitations apply to Electronic Monitoring services: The budget will be completed for each participant based upon the total number of participants residing within the residence. However, lower Tiers may also appear on the service plans to reflect reimbursement rates for situations where one or more participant is away from the home during service utilization. Reimbursement will then be the hourly rate of $13.62 divided by and among the number of participants who are at home during the hours of utilization. If only one participant from a fourparticipant setting is at home during service utilization, the solitary participant pays the full hourly rate of $13.62. If only two of the four participants are home, each pays $6.81 per hour of utilization, and if three of the four are home, each pays $4.54 per hour of utilization. Table 4 – Reimbursement Rates by Tier Tier Number of Participants Reimbursement Tier 1 One participant in a home $13.62 Tier 2 Two participants in a $6.81 home Tier 3 Three participants in a $4.54 home Tier 4 Four participants in a home $3.41 Billing clarification: When all service standards are met, the service provider shall be reimbursed at the full unit rate for each hour that the Electronic Monitoring service is rendered. The unit rate for each hour of Electronic Monitoring service utilization shall be divided by and among the number of waiver participants present in the home during any portion of the hour for which reimbursement is requested. All participants present must be CIHW participants who have chosen to utilize this service. Activities Not Allowed The following activities are not allowed under Electronic Monitoring: Electronic monitoring and surveillance systems that have not received specific approval by the DDRS. 106
Electronic Monitoring may not be used concurrently with Structured Family Caregiving (SFC) Services in the SFC home Electronic Monitoring systems intended to monitor direct care staff Electronic Monitoring serves as a replacement for Residential Habilitation and Support (RHS) services Level 1 and Level 2, therefore, Electronic Monitoring and RHS services are not billable during the same time period. o However, effective July 1, 2015, when all other requirements of Electronic Monitoring are followed, Electronic Monitoring becomes an allowable component of the RHS Daily service, but may not be billed in addition to the daily rate of the RHS Daily service. Electronic Monitoring systems in ICF/IID facilities licensed under IC 16-28 and 410 IAC 16.2 Electronic Monitoring systems used in place of in-home staff to monitor minors, that is, participants under the age of 18 Installation costs related to video and/or audio equipment Services furnished to a minor by parent(s), stepparent(s), or legal guardian Services furnished to a participant by the participant’s spouse Section 10.10: Environmental Modifications (currently under CIHW only) Service Definition Those physical adaptations to the home, required by the individual’s plan of care (POC), that are necessary to ensure the health, welfare, and safety of the individual, or that enable the individual to function with greater independence in the home, and without which the individual would require institutionalization. The FSSA/DDRS waiver specialist must approve all environmental modifications prior to service being rendered. Reimbursable Activities Reimbursable activities include the following: Installation of ramps and grab bars Widening doorways Modifying existing bathroom facilities Installation of specialized electric and plumbing systems necessary to accommodate the medical equipment and supplies that are necessary for the welfare of the individual, including anti-scald devices Maintenance and repair of the items and modifications installed during the initial request Assessment and inspection Service Standards 107
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2016 DDRS Waiver Manual Our Mission
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Section 1: Roles and Responsibiliti
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Section 7.5: State Authorization of
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Section 10.23: Psychological Therap
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Section 1.1: The Centers for Medica
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ules or standards that may affect t
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Information Sharing The Individual
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Here are some tips on what to discu
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6. Does each person have his or her
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Section 3: Additional Medicaid Prog
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HCBS waiver services. HCBS waiver p
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Section 4.1: Medicaid Waiver Overvi
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Section 4.4: Coordination with Medi
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personal beliefs and customs, ensur
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Section 5.1: Request for Applicatio
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Internet access, call toll free 1-8
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understanding and use of language,
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If an individual declines the offer
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waiver slot when it appears that th
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Five calendar days to interview and
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The individual or guardian has sign
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Section 6: Objective Based Allocati
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adjustments to the allocation amoun
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BMAN Reserve $0 $0 $2,620.80 $5,241
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An individual’s behavioral condit
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An individual or the individual’s
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Your Appeal Right as an Applicant f
Page 55 and 56: Section 7.1: Level of Care Re-Evalu
Page 57 and 58: RN/LPN, who must be actively involv
Page 59 and 60: o Children receiving adoption assis
Page 61 and 62: including the DDRS Case Management
Page 63 and 64: When the individual “Re-Enters”
Page 65 and 66: (RHS) under the Community Integrati
Page 67 and 68: Section 8.1: Appeal Request The fol
Page 69 and 70: Objective-based allocation (OBA): T
Page 71 and 72: administrative hearing must still b
Page 73 and 74: The person testifying should be the
Page 75 and 76: In all cases, the decision of the A
Page 77 and 78: Section 9.1: Overview The Family an
Page 79 and 80: Structural or environmental issues
Page 81 and 82: implemented in order to ensure that
Page 83 and 84: conducted by the ombudsman must als
Page 85 and 86: Section 10.24: Recreational Therapy
Page 87 and 88: Medicaid Waiver Services, Codes, an
Page 89 and 90: FSW CIH MFP- CIH INsite Code Servic
Page 91 and 92: The Case Manager should give the co
Page 93 and 94: Aversive techniques - any technique
Page 95 and 96: Services delivered to persons who d
Page 97 and 98: where services are not rendered wit
Page 99 and 100: Section 10.7: Community Based Habil
Page 101 and 102: Activities that do not foster the a
Page 103 and 104: The system to be installed must be
Page 105: The monitoring base staff must have
Page 109 and 110: Adaptations to service provider-own
Page 111 and 112: independence and are consistent wit
Page 113 and 114: Group supports delivered to individ
Page 115 and 116: o Small (4:1 or smaller) o Medium (
Page 117 and 118: The data may reside in multiple loc
Page 119 and 120: Providers must be able to indicate,
Page 121 and 122: programmed, constructive interactio
Page 123 and 124: The IBI Director will provide a nar
Page 125 and 126: As applicable, monthly/quarterly re
Page 127 and 128: participate in their communities, a
Page 129 and 130: Homeschooling, special education, a
Page 131 and 132: or before the fifteenth day of the
Page 133 and 134: o Medium (5:1 to 10:1) o Larger (la
Page 135 and 136: Services must address needs identif
Page 137 and 138: The following activities are not al
Page 139 and 140: maintaining natural supports, physi
Page 141 and 142: tool for individual assessment. The
Page 143 and 144: o o o o o Individuals receiving RHS
Page 145 and 146: (C) requires minimal residential ha
Page 147 and 148: as well the development, oversight,
Page 149 and 150: Available only under the Community
Page 151 and 152: Services furnished to a minor by a
Page 153 and 154: Section 10.30: Speech/Language Ther
Page 155 and 156: to be utilized in service plan deve
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Transportation services through the
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Bus passes or alternate methods of
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The participant requires assistance
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Service Standards The following ser
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Section 11: Request for Approval (R
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Choice of Provider The individual c
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Reimbursement Reimbursement is avai
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Modifications/Items - Non-Covered E
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Authority: 42 CFR §441.302 Section
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Total Cost $$$$$ 175
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Items - Covered Justification and d
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These requests should be extremely
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Choice of Provider The individual c
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Completed by an approved Medicaid W
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The case management entity, working
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DDRS Waiver Manual

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