DDRS Waiver Manual

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Level: 3 (Moderate) Descriptor: Algo level three: (A) requires access to full-time supervision for medical or behavioral, or both, needs; (B) twenty-four hours a day, seven days a week staff availability; (C) behavioral and medical supports are not generally intense; and (D) behavioral and medical supports can be provided in a shared staff setting. Level: 4 (High) Descriptor: Algo level four : (A) requires access to full-time supervision for medical or behavioral, or both, needs: (i) twenty-four hours a day, seven days a week frequent staff interaction; and (ii) requires line of sight support; and (B) has moderately intense needs that can generally be provided in a shared staff setting. Level: 5 (Intensive) Descriptor: Algo level five : (A) requires access to full-time supervision with twenty-four hours a day, seven days a week absolute line of sight support; (B) needs are intense; (C) needs require the full attention of a caregiver with a one-to-one staff to individual ratio; and (D) typically only needed by those with intense behavioral needs, not medical needs alone. Level: 6 (High Intensive) Descriptor: Algo level six : (A) requires access to full-time supervision: (i) twenty-four hours a day, seven days a week; and (ii) more than a one-to-one staff to individual ratio; (B) needs are exceptional; (C) needs require more than one caregiver exclusively devoted to the individual for at least part of each day; and (D) imminent risk of individual harming self or others, or both, without vigilant supervision. The nationally recognized Inventory for Client and Agency Planning, or ICAP, was selected to be the primary 140
tool for individual assessment. The ICAP assessment determines an individual’s level of functioning for broad independence and general maladaptive factors. The ICAP addendum, commonly referred to as the behavior and health factors, determines an individual’s level of functioning on behavior and health factors. These two assessments determine an individual’s overall Algo level, which can range from 0-6. Algos 0 and 6 are considered outliers representing those who are the lowest and the highest on both ends of the functioning spectrum. On review, the State may manually adjust the designation of an individual from an Algo 5 to an Algo 6. Although this individual continues receiving the Algo 5 budget, the Algo 6 designation indicates a need for additional oversight of the individual. The stakeholder group designed a grid to build the allocations. The grid was developed with the following tenets playing key roles: Focus on daytime programming Employment Community integration Housemates The OBA is then determined by combining the overall Algo (determined by the ICAP and ICAP addendum), age, employment, and living arrangement. Reimbursable Activities Reimbursable activities include the following: Assistance with acquiring, enhancing and building natural supports. For example, a measureable outcome would be increased hours of natural supports and a decrease in the number of hours needed for paid staff. Another measurable outcome would be the number of activities an individual participates in with non-paid (natural support) supports versus paid staff. Working with the participant to meet the goals they have set for themselves on their Individualized Support Plan (ISP). Training the participant to enhance their home-making skills; meal preparation; household chores; money management; shopping; communication skills; social skills and positive behavior. Provision of transportation to fully participate in social and recreational activities in the community. For example, transportation to church, the park, the library, the YMCA, classes. Provision of transportation to community employment and/or volunteer activities. Coordination and facilitation of medical and wellness services to meet the healthcare and wellness needs, including physician consults, medications, implementation of risk plans, dining plans and wellness plans. Maintenance of each participant’s health record. The individual must be present and receive RHS Daily services for at least a portion of any day the provider bills as a day of RHS Daily service. 141
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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
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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
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 and 136: Services must address needs identif
Page 137 and 138: The following activities are not al
Page 139: maintaining natural supports, physi
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
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DDRS Waiver Manual

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