DDRS Waiver Manual

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Parent(s), stepparent(s) and legal guardians may not be paid to provide care to minor children while other relatives* or groups of relatives may provide a combined total of up to 40 hours per week in PAC services to a minor child. Spouses may not provide paid services at all, while reimbursable waiver-funded PAC services furnished to an adult waiver participant by any combination of relatives* and/or legal guardians may not exceed a combined total of 40 hours per week. Related/relative implies any of the following natural, adoptive and/or step relationships, whether by blood or by marriage, inclusive of half and/or in-law status: Aunt (natural, step, adopted) Brother (natural, step, half, adopted, in-law) Child (natural, step, adopted) First cousin (natural, step, adopted) Grandchild (natural, step, adopted) Grandparent (natural, step, adopted) Nephew (natural, step, adopted) Niece (natural, step, adopted) Parent (natural, step, adopted, in-law) Sister (natural, step, half, adopted, in-law) Spouse (husband or wife) Uncle (natural, step, adopted) Available individually or as a shared service: • Shared/group services in group sizes no greater than four participants to one paid staff member of the PAC provider (unit rate divided by number of PAC participants sharing service) Activities Not Allowed PAC services will not be provided to household members other than to the waiver participants. Reimbursement is not available through PAC in the following circumstances: When services are furnished to a minor by the parents, stepparents, or legal guardians When services are furnished to a participant by the participant’s spouse When services furnished to a minor by relatives* other than parents, stepparents, or legal guardians exceed a combined total of 40 hours per week When services furnished to an adult by any combination of relatives* exceed a combined total of 40 hours per week When Indiana Medicaid State Plan services are available for the same tasks When services provided are available under the Rehabilitation Act of 1973 or section 602(16) & (17) of the Individuals with Disabilities Education Act 128
Homeschooling, special education, and related activities When the participant is admitted to an institutional facility (for example, Acute Hospital, Nursing Facility, ICF/IID) For homemaker or maid service As a substitute for care provided by a registered nurse, licensed practical nurse, licensed physician, behaviorist, licensed therapist, or other health professional. Transportation costs are not included Section 10.20: Personal Emergency Response System (PERS) Service Definition Personal Emergency Response System (PERS) is an electronic device that enables certain individuals at high risk of institutionalization to secure help in the event of an emergency. The individual may also wear a portable help button to allow for mobility. The system is connected to the person’s phone and programmed to signal a response center after a “help” button is activated. The response center is staffed by trained professionals. Reimbursable Activities Reimbursable activities include the following: Device installation service Ongoing monthly maintenance of the device Service Standards Service standards require that Personal Emergency Response System must be included in the ISP. Documentation Standards Documentation standards for a Personal Emergency Response System include the following: An identified need in the ISP Documentation of expense for installation Documentation of monthly rental fee Limitations The following limitations apply to Personal Emergency Response System services: PERS is limited to those individuals who live alone, or who are alone for significant parts of the day, and have no regular caregiver for extended periods of time, and who would otherwise require extensive supervision. Activities Not Allowed Reimbursement is not available for PERS supports when the individual requires constant supervision to maintain health and safety. 129
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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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Objective-based allocation (OBA): T
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administrative hearing must still b
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The person testifying should be the
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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 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: participate in their communities, 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
Page 171 and 172: Modifications/Items - Non-Covered E
Page 173 and 174: Authority: 42 CFR §441.302 Section
Page 175 and 176: Total Cost $$$$$ 175
Page 177 and 178: 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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