DDRS Waiver Manual

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Caring for medically fragile individuals Service Standards The following service standards apply to Family and Caregiver Training services: Family and Caregiver Training services must be included in the ISP. The ISP shall be based on the person-centered planning process for that individual. Documentation Standards Documentation standards for Family and Caregiver Training services include the following: Services outlined in the ISP Receipt of payment for activity Proof of participation in activity if payment is made directly to individual/family Documentation in compliance with 460 IAC 6 Supported Living Services and Supports requirements 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 The following limitations apply to Family and Caregiver Training services: Reimbursement for this service is limited to $2,000 per year. Activities Not Allowed The following activities are not allowed under Family and Caregiver Training services: Training/instruction not pertinent to the caregiver’s ability to give care to the individual Training provided to caregivers who receive training reimbursement within their Medicaid or State line item reimbursement rates Meals, accommodations, and so on, while attending the training Section 10.16: Intensive Behavioral Intervention Service Definition Intensive Behavioral Intervention (IBI) is a highly specialized, individualized program of instruction and behavioral intervention. IBI is based upon a functional, behavioral and/or skills assessment of an individual’s treatment needs. The primary goal of IBI is to reduce behavioral excesses, such as tantrums and acting-out behaviors, and to increase or teach replacement behaviors that have social value for the individual and increase access to their community. Program goals are accomplished by the application of research-based interventions. Generally, IBI addresses manifestations that are amenable to change in response to specific, carefully 120
programmed, constructive interactions with the environment. IBI must include: A detailed functional/behavioral assessment Reinforcement Specific and ongoing objective measurement of progress Family training and involvement so that skills can be generalized and communication promoted Emphasis on the acquisition, generalization, and maintenance of new behaviors across other environments and with other people Training of caregivers, IBI direct care staff, and providers of other waiver services Breaking down targeted skills into small, manageable, and attainable steps for behavior change Utilizing systematic instruction, comprehensible structure, and high consistency in all areas of programming Provision for one-on-one structured therapy Treatment approach tailored to address the specific needs of the individual Skills training under IBI must include Measurable goals and objectives (specific targets may include appropriate social interaction, negative or problem behavior, communication skills, and language skills) Heavy emphasis on skills that are prerequisites to language (attention, cooperation, imitation) Reimbursable Activities Reimbursable activities include the following: Preparation of an IBI support plan in accordance with the <strong>DDRS</strong>’ Behavioral Support Plan Policy Application of a combination of the following empirically-based, multi-modal, and multidisciplinary comprehensive treatment approaches: Intensive Teaching Trials (ITT), also called Discrete Trial Training, is a highly specific and structured teaching approach that uses empirically validated behavior change procedures. This type of learning is instructor-driven and may use error-correction procedures or reinforcement to maintain motivation and attention to task. ITT consists of the following: o Antecedent: A directive or request for the individual to perform an action o Behavior: A response from the individual, including anything from successful performance, non-compliance, or no response o Consequence: A reaction from the therapist, including a range of responses from strong positive reinforcement, faint praise, or a negative (not aversive) reaction o A pause to separate trials from each other (inter-trial interval) Natural Environment Training (NET) is learner-directed training in which the learner engages in activities that are naturally motivating and reinforcing to him or her, rather than the more contrived reinforcement employed in ITT. 121
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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
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including the DDRS Case Management
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When the individual “Re-Enters”
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(RHS) under the Community Integrati
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Section 8.1: Appeal Request The fol
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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 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: Providers must be able to indicate,
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
Page 163 and 164: Service Standards The following ser
Page 165 and 166: Section 11: Request for Approval (R
Page 167 and 168: Choice of Provider The individual c
Page 169 and 170: 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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