DDRS Waiver Manual

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TANF recipients. Also, DFR’s Head Start program provides federal grants to local public and private nonprofit and for-profit agencies to provide comprehensive child development services to economically disadvantaged children and families, with a special focus on helping preschoolers develop the early reading and math skills they need to be successful in school. The division’s overarching focus is the support and preservation of families by emphasizing selfsufficiency and personal responsibility. Information about DFR and DFR programs is available online at http://www.in.gov/fssa/2407.htm or you may call 1-800-403-0864. Section 1.8: Waiver Service Providers Waiver Service Providers are agencies, companies, and individuals that the Division of Disability and Rehabilitative Services (DDRS) has approved and that are paid by Medicaid to provide direct services to Medicaid waiver program participants. All waiver participants must have Case Management services. Waiver participants are provided a choice from among all Case Management Companies (CMCOs) that have been approved by DDRS/BDDS. After the CMCO has been chosen, the waiver participant will then chose a permanent case manager. The waiver participant’s chosen case manager provides a list of available service providers at any time that the participant desires to select or change service providers, which includes changing providers of Case Management services upon request. See Section 1.11: Helpful Hints for Participants and Guardians on How to Select Waiver Providers. Section 1.9: Hearings and Appeals Hearings and Appeals is an administrative section within FSSA that receives and processes appeals from people receiving services within any FSSA program and many others. Administrative hearings are held throughout the State of Indiana, usually at county Division of Family Resources locations, at which time all parties have the opportunity to present their case to an Administrative Law Judge. Section 1.10: Participants and Guardians It is the policy of the DDRS’ Bureau of Developmental Disabilities (BDDS) that individuals, or their legal representative when indicated, participate actively and responsibly in the administration and management of their Medicaid waiver-funded services. BDDS supports and encourages individual choice in the selection of the participant’s Case Management service provider, in the development of an Individualized Support Plan (ISP) and in the selection of all other service providers. Successful service delivery is dependent upon the collaboration of the Individual Support Team (IST) and entities with oversight responsibilities, including the Bureau of Quality Improvement Services (BQIS). The individual receiving services is the most prominent member of the IST, making their participation and cooperation in waiver service planning and administration essential. 12
Information Sharing The Individual (or the Individual’s legal representative when indicated) must upon request from BDDS, BQIS or any Division of Disability and Rehabilitative Services (DDRS) contracted vendor, provide information for the purpose of administration and/or management of waiver services. Selecting or Changing Providers When selecting a Case Management provider, the individual/participant (or the individual’s legal representative when indicated) shall participate in: Choosing a Case Management Company (provider agency) from a pick list of approved Case Management Companies o For newly approved applicants preparing to enter into waiver services, the Case Management pick list is generated by the DDRS/BDDS o For individuals already active on the waiver, the Case Management pick list may be generated by the DDRS/BDDS or by their current provider of Case Management services Interviewing and choosing a permanent case manager Completing the service planning process The individual (or the individual’s legal representative when indicated) shall complete all actions as requested by BDDS to secure any replacement provider within: Sixty calendar days from the date the change is requested; or Sixty calendar days from when the provider gives notice of terminating services to the individual. If a new provider is not in place after 60 calendar days, the current provider shall continue to provide services to an individual. See Section 1.11 (below) for Helpful Hints for Participants and Guardians on How to Select Waiver Providers Participating in Risk Plan Development and Implementation The individual (or the individual’s legal representative when indicated) shall participate in: the development of risk plans for the individual, per current BDDS and/or BQIS procedures; and the implementation of risk plans developed for the individual, in lieu of documented risk negotiation with the individual’s Individual Support Team, and a signed risk non-agreement document. Allowing Representatives of the State into the Individual’s Home The individual (or the individual’s legal representative when indicated) shall allow representatives from BDDS, BQIS, the selected Case Management agency and/or any DDRS-contracted vendor into the individual’s home for visits scheduled at least 72 hours prior. Consequences for Non-Participation Should an individual (or their legal representative when indicated) choose not to participate actively and 13
Page 1 and 2: 2016 DDRS Waiver Manual Our Mission
Page 3 and 4: Section 1: Roles and Responsibiliti
Page 5 and 6: Section 7.5: State Authorization of
Page 7 and 8: Section 10.23: Psychological Therap
Page 9 and 10: Section 1.1: The Centers for Medica
Page 11: ules or standards that may affect t
Page 15 and 16: Here are some tips on what to discu
Page 17 and 18: 6. Does each person have his or her
Page 19 and 20: Section 3: Additional Medicaid Prog
Page 21 and 22: HCBS waiver services. HCBS waiver p
Page 23 and 24: Section 4.1: Medicaid Waiver Overvi
Page 25 and 26: Section 4.4: Coordination with Medi
Page 27 and 28: personal beliefs and customs, ensur
Page 29 and 30: Section 5.1: Request for Applicatio
Page 31 and 32: Internet access, call toll free 1-8
Page 33 and 34: understanding and use of language,
Page 35 and 36: If an individual declines the offer
Page 37 and 38: waiver slot when it appears that th
Page 39 and 40: Five calendar days to interview and
Page 41 and 42: The individual or guardian has sign
Page 43 and 44: Section 6: Objective Based Allocati
Page 45 and 46: adjustments to the allocation amoun
Page 47 and 48: BMAN Reserve $0 $0 $2,620.80 $5,241
Page 49 and 50: An individual’s behavioral condit
Page 51 and 52: An individual or the individual’s
Page 53 and 54: 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
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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
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Section 9.1: Overview The Family an
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Structural or environmental issues
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implemented in order to ensure that
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conducted by the ombudsman must als
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Section 10.24: Recreational Therapy
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Medicaid Waiver Services, Codes, an
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FSW CIH MFP- CIH INsite Code Servic
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The Case Manager should give the co
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Aversive techniques - any technique
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Services delivered to persons who d
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where services are not rendered wit
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Section 10.7: Community Based Habil
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Activities that do not foster the a
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The system to be installed must be
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The monitoring base staff must have
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Electronic Monitoring may not be us
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Adaptations to service provider-own
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independence and are consistent wit
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Group supports delivered to individ
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o Small (4:1 or smaller) o Medium (
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The data may reside in multiple loc
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Providers must be able to indicate,
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programmed, constructive interactio
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The IBI Director will provide a nar
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As applicable, monthly/quarterly re
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participate in their communities, a
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Homeschooling, special education, a
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or before the fifteenth day of the
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o Medium (5:1 to 10:1) o Larger (la
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Services must address needs identif
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The following activities are not al
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maintaining natural supports, physi
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tool for individual assessment. The
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o o o o o Individuals receiving RHS
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(C) requires minimal residential ha
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as well the development, oversight,
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Available only under the Community
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Services furnished to a minor by a
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Section 10.30: Speech/Language Ther
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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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