DDRS Waiver Manual

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Group services may only be rendered at the discretion of the IST and in group sizes no greater than four individuals to one staff. In addition, the provider must be able to provide appropriate documentation, as outlined in the Indiana Health Coverage Programs’ Provider Reference Module titled Division of Disability and Rehabilitative Services Home and Community-Based Services Waivers, demonstrating that the ratio for each claimed time frame of services did not exceed the maximum allowable ratio determined by the IST for each group participant, and provide documentation identifying other group participants, by using the individuals’ HIPAA naming convention. Activities Not Allowed Reimbursement is not available under Extended Services for the following activities: Any non-community based setting where the majority (51% or more) of the individuals have an Intellectual or Developmental Disability. Sheltered work observation or participation. Volunteer endeavors. Any service that is otherwise available under the Rehabilitation Act of 1973 or Public Law 94-142. Public relations. Incentive payments made to an employer to subsidize the employer’s participation in Extended Services. Payment for vocational training that is not directly related to the individual’s Extended Service needs outlined in the ISP. Extended Services do not include payment for supervisory activities rendered as a normal part of the business setting. Extended Services provided to a minor by a parent(s), step-parent(s), or legal guardian, or spouse. Waiver funding is not available for the provision of vocational services delivered in facility based or sheltered work settings, where individuals are supervised for the primary purpose of producing goods or performing services. The provision of transportation is not a reimbursable activity within Extended Services. Only those waiver participants who were engaged in competitive community employment and actively utilizing a combination of Supported Employment Follow-Along (SEFA) and Prevocational services as of June 30, 2015 (as reflected in their ISP, approved POC/CCB and NOA) may utilize the combination of Extended Services and Prevocational services on or after July 1, 2015. Effective July 1, 2015, for all other waiver participants, there is no longer an option to utilize this service combination as Prevocational services and Extended Services are considered to be mutually exclusive and shall not overlap. The latter group of waiver participants includes all new enrollees to the waiver as well as other active participants not utilizing a combination of Extended Services and Prevocational services as of June 30, 2015, whether or not they are/were engaged in competitive community employment. Going forward, individuals from the latter group of waiver participants who engage competitive community employment are no longer eligible for Prevocational services. 112
Group supports delivered to individuals who are utilizing different support options. For example, one individual in the group is using Extended Services and another individual in the same group setting is using Facility-Based Habilitation. This type of activity would not be allowed. Note: Supported Employment services continue to be available under the Rehabilitation Act of 1973 through the Vocational Rehabilitation Services (VRS) program within FSSA/DDRS’s Bureau of Rehabilitation Services (BRS). Section 10.12: Facility Based Habilitation – Group Service Definition Facility-Based Habilitation Services are services provided outside of the participant’s home and within the facility of a DDRS-approved provider. These services support learning and assistance in the areas of self-care, sensory/motor development, socialization, daily living skills, communication, community living, and social skills. Facility settings are defined as non-residential, non-integrated settings that take place within the same buildings for the duration of the service rather than being out in the community. Reimbursable Activities Reimbursable activities include the following: Monitoring, training, education, demonstration, or support to assist with the acquisition and retention of skills in the following areas: Leisure activities (for example, segregated camp settings) Educational activities Hobbies Unpaid work experiences (that is, volunteer opportunities) Maintaining contact with family and friends Training and education in self-direction designed to help participants achieve one or more of the following outcomes: Develop self-advocacy skills Exercise civil rights Acquire skills that enable self-control and responsibility for services and supports received or needed Acquire skills that enable the participant to become more independent, integrated, or productive in the community Service Standards The following service standards apply to Facility-Based Habilitation – Group Services: 113
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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
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RN/LPN, who must be actively involv
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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 and 108: Electronic Monitoring may not be us
Page 109 and 110: Adaptations to service provider-own
Page 111: independence and are consistent wit
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
Page 159 and 160: Bus passes or alternate methods of
Page 161 and 162: 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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