DDRS Waiver Manual

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Participant is not expected to be able to join the general workforce or participate in sheltered employment within one year (excluding Supported Employment). Documentation Standards Prevocational Services documentation must include: Services outlined in the ISP In addition to compliance with documentation requirements outlined in 460 IAC 6, the following data elements are required for each service rendered: Name of participant served RID of the participant Name of provider Service rendered Time frame of service (include a.m. or p.m.) Date of service including the year Notation of the primary location of service delivery A brief activity summary of service rendered In addition to the brief activity summary of service rendered, provide a description* by direct care staff of any issue or circumstance concerning the participant including, but not limited to, significant medical or behavioral incidents or any other situation that may be uncommon for the participant Signature that includes at least the last name and first initial of the direct care staff person making the entry. Electronic signatures are permissible when in compliance with the Uniform Electronic Transactions Act (IC 26-2-8) Upon request, all data elements must be made available to auditors, quality monitors, Case Managers, and any other government entity. * The data may reside in multiple locations, but must be clearly and easily linked to the participant or the standard will not be met. 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 For Group Services Upon request, the provider must be able to verify in a concise format that the ratio for each claimed time frame of service did not exceed the maximum allowable ratio, whether or not all group participants utilize a waiver funding stream. Limitations The following limitations apply to Prevocational Services: The following are limitations on group sizes: o Small (4:1 or smaller) 132
o Medium (5:1 to 10:1) o Larger (larger than 10:1 but no larger than 16:1) Monitoring of prevocational services occurs on a quarterly basis. The objectives of monitoring include assessment of the participant’s progress toward achieving the outcomes identified on the participant’s ISP related to employment and to verify the continued need for prevocational services. The appropriateness of Prevocational services is determined by dividing the previous quarter’s gross earnings by the hours of attendance. If the hourly wage falls below 50% of the Federal minimum wage, Prevocational services may be continued. If the average wage exceeds 50% of the Federal minimum wage, Prevocational services should be discontinued for the next quarter. Note: Beginning July 1, 2015, outside of the following noted exception, Prevocational services may not be utilized by an individual who is receiving Extended Services. (Individuals in competitive community employment are no longer eligible for Prevocational services.) Prevocational services and Extended Services are mutually exclusive and shall not overlap. Exception: Only those waiver participants 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. Activities Not Allowed The following activities are not allowed under Prevocational Services: Services that are available under the Rehabilitation Act of 1973 or section 602(16) & (17) of the Individuals with Disabilities Education Act Activities that do not foster the acquisition and retention of skills Services in which compensation is greater than 50% of the federal minimum wage Activities directed at teaching specific job skills Sheltered employment, facility- based Services furnished to a minor by parent(s), stepparent(s), or legal guardian Note: Effective July 1, 2015, Prevocational services may not be utilized by an individual who is receiving Extended Services unless that individual waiver participant was 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). 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. 133
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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
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Section 9.1: Overview The Family an
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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 and 128: participate in their communities, a
Page 129 and 130: Homeschooling, special education, a
Page 131: or before the fifteenth day of the
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
Page 179 and 180: These requests should be extremely
Page 181 and 182: 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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