DDRS Waiver Manual

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The following service standards apply to Environmental Modifications: Equipment and supplies must be for the direct medical or remedial benefit of the individual. All items shall meet applicable standards of manufacture, design, and installation. To ensure that environmental modifications meet the needs of the individual and abide by established, federal, state, local, and FSSA standards, as well as Americans with Disabilities Act (ADA) requirements, approved environmental modifications will reimburse for necessary Assessment of the individual’s specific needs, conducted by an approved, qualified individual who is independent of the entity providing the environmental modifications. Independent inspections during the modification process and at completion of the modifications, prior to authorization for reimbursement, based on the complexities of the requested modifications. Equipment and supplies shall be reflected in the ISP. Equipment and supplies must address needs identified in the person-centered planning process. Documentation Standards Documentation standards for Environmental Modifications include the following: Documentation of the identified direct medical benefit for the individual Documented prior authorization denial from Medicaid, if applicable Receipts for purchases Identified need in ISP Documentation in compliance with 460 IAC 6, Supported Living Services and Supports requirements Limitations The following limitations apply to Environmental Modifications: Reimbursement for Environmental Modification services has a lifetime cap of $15,000. Service and repair up to $500 per year, outside this cap, is permitted for maintenance and repair of prior modifications that were funded by a waiver service. If the lifetime cap is fully utilized, and a need is identified, the Case Manager will work with other available funding streams and community agencies to fulfill the need. Activities Not Allowed The following activities are not allowed under Environmental Modifications services: Adaptations to the home that are of general utility Adaptations that are not of direct medical or remedial benefit to the individual (such as carpeting, roof repair, or central air conditioning) Adaptations that add to the total square footage of the home Adaptations that are not included in the comprehensive plan of care (POC) Adaptations that have not been approved on a Request for Approval to Authorize Services form 108
Adaptations to service provider-owned and -leased housing. Home accessibility modifications as a service under the waiver may not be furnished to individuals who receive residential habilitation and support services, except when such services are furnished in the participant’s own home. Compensation for the costs of life safety code modifications and other accessibility modifications made with participant waiver funds to provider-owned housing. Section 10.11: Extended Services Service Definition Extended Services are ongoing employment support services which enable an individual to maintain integrated competitive employment in a community setting. Individuals must be employed in a communitybased, competitive job that pays at or above minimum wage in order to access this service. The initial job placement, training, stabilization may be provided through Indiana Vocational Rehabilitation Services. Extended Services provide the additional work related supports needed by the individual to continue to be as independent as possible in community employment. If an employed individual has obtained community based competitive employment and stabilization without Vocational Rehabilitation’s services, the participant is still eligible to receive Extended Services, as long as the participant meets the qualifications below. Ongoing employment support services are identified in the participants’ Individualized Support Plan and must be related to the participants’ limitations in functional areas (for example, self-care, understanding and use of language, learning, mobility, self-direction, capacity for independent living, economic self-sufficiency), as necessary to maintain employment. Reimbursable Activities Reimbursable activities include the following: Ensuring that natural supports at the work site are secured through interaction with supervisors and staff. A tangible outcome of this activity would be a decrease in the number of hours of Extended Services an individual accessed over time. Training for the participant, and/or the participant’s employer, supervisor or coworkers, to increase the participant’s inclusion at the worksite. Regular observation or supervision of the participant to reinforce and stabilize the job placement. Job-specific or job-related safety training. Job-specific or job-related self-advocacy skills training. Reinforcement of work-related personal care and social skills. 109
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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
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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 and 106: The monitoring base staff must have
Page 107: Electronic Monitoring may not be us
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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
Page 157 and 158: 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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