DDRS Waiver Manual

Recommendations

Info

ecreational program to restore, remediate, or rehabilitate an individual in order to Improve the individual’s functioning and independence Reduce or eliminate the effects of an individual’s disability Reimbursable Activities Reimbursable activities under Recreational Therapy services include the following: Organizing and directing adapted sports, dramatics, arts and crafts, social activities, and other recreation services designed to restore, remediate, or rehabilitate Planning, reporting, and write-up when in association with the actual one-on-one direct care/therapy service delivery with the waiver participant Individual services Group services in group sizes no greater than four participants to one Recreational Therapist (Unit rate divided by number of participants served) Service Standards The following service standards apply to Recreational Therapy services: Recreational Therapy services should be reflected in the ISP regardless of the funding source. Services must address needs identified in the person-centered planning process and be outlined in the ISP Services must complement other services the individual receives and enhance increasing independence for the individual Documentation Standards Recreational Therapy services documentation must include Documentation by appropriate assessment Services provided under both the Medicaid State Plan and the waiver must be outlined in ISP Appropriate credentials for service provider Attendance record, therapist logs, and/or charts detailing services provided, dates, and times Documentation in compliance with 460 IAC 6 Supported Living Services and Supports requirements Documentation of this service being requested on Medicaid State Plan shall be included in the ISP 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 Recreational Therapy services: One hour of billed therapy service must include a minimum of 45 minutes of direct patient care with the balance of the hour spent in related patient services. Activities Not Allowed 136
The following activities are not allowed as part of Recreational Therapy services: Payment for the cost of the recreational activities, registrations, memberships, or admission fees associated with the activities being planned, organized, or directed Any services that are reimbursable through the Medicaid State Plan Therapy services furnished to the participant within the educational/school setting or as a component of the participant’s school day. Group sizes greater than four participants to one Recreational Therapist or group sizes exceeding the maximum allowable group size determined by the IST for each group participant Group services when group settings were not determined to be appropriate by the IST for each group participant Section 10.25: Rent and Food for Unrelated Live-in Caregiver (currently under CIHW only) Service Definition Rent and Food for Unrelated Live-in Caregiver means the additional cost that a participant incurs for the room and board of an unrelated live-in caregiver (who has no legal responsibility to support the participant) as provided for in the participant’s Residential Budget. Reimbursable Activities Reimbursable activities under Rent and Food for Unrelated Live-in Caregiver Services include the following: The individual participant receiving these services lives in his or her own home. For payment to not be considered income for the participant receiving services, payment for the portion of the costs of rent and food attributable to an unrelated live-in caregiver (who has no legal responsibility to support the participant) must be made directly to the live-in caregiver. Room and board for the unrelated live-in caregiver (who is not receiving any other financial reimbursement for the provision of this service) Room: Shelter-type expenses including all property-related costs such as rental or purchase of real estate and furnishings, maintenance, utilities, and related administrative services Board: Three meals a day or other full nutritional regimen Caregiver is unrelated: Unrelated by blood or marriage to any degree Caregiver: An individual providing a covered service as defined by <strong>DDRS</strong>/BDDS service definitions or in a Medicaid HCBS waiver, to meet the physical, social, or emotional needs of the participant receiving services Service Standards The following service standards apply to Rent and Food for Unrelated Live-in Caregiver Services: 137
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 and 12:
ules or standards that may affect t
Page 13 and 14:
Information Sharing The Individual
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
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 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 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: Services must address needs identif
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
Page 183 and 184: Completed by an approved Medicaid W
Page 185 and 186: The case management entity, working
show all

DDRS Waiver Manual

Create successful ePaper yourself

Delete template?

Save as template?