DDRS Waiver Manual

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esponsibly in the administration and management of their Medicaid waiver-funded services, BDDS may terminate the individual’s waiver services. If BDDS decides to terminate the individual’s waiver services pursuant to this policy, BDDS must provide the individual (or the individual’s legal representative when indicated) with written notice of intent to terminate the individual’s waiver services. Should a termination occur, the individual (or their legal representative when indicated) has a right to appeal the State’s decision. See Section 8: Appeal Process for further information regarding appeals. Additional information regarding DDRS’ policy on this issue can be found here: http://www.in.gov/fssa/files/Individual_and_Guardian_Responsibilities.pdf Section 1.11: Helpful Hints for Participants and Guardians on How to Select Waiver Providers Here are some tips on selecting a provider: 1. Selecting good providers is critical. It is helpful to think about the issues that are important to you and your family member before you begin the process. A list of certified waiver providers for each county is available through your Case Manager. If you are new to waiver services, or your current agency has terminated your service, you need to prioritize the providers and try to schedule interviews and visits within a short time frame, so the process does not become extended. Individuals who are new to the waiver program are asked to select a provider within 14 calendar days of receiving the pick list. Individuals who have been terminated by the current provider must select and transition to a new provider within 60 calendar days of termination. 2. You will be able to make an informed choice by reading information, such as the DDRS Waiver Manual, or by discussing alternatives with the Case Manager or an advocate. You may want to visit an individual who is currently receiving waiver services or meet with various service providers. Case Managers can assist in setting up visits or meeting with service providers. 3. Sometimes a provider can arrange for you to visit people who are receiving services from the provider. Remember, when you visit a house or apartment where waiver services are being provided, you are visiting someone’s home. 4. When meeting with providers or Case Managers, it is important to take notes because it is easy to forget details later. Ask for copies of any written materials, write down names, titles, telephone numbers, email addresses, and so on, and the date of the meeting. It’s important to maintain accurate information. On the following pages are some questions to consider when selecting waiver providers. The questions you ask depend on what kind of service it is, and whether you will be served in your family home, or in your own home or apartment, with or without housemates. Many of the questions are applicable to any setting, and others can be skipped or modified as needed. General Topics to Discuss with Service Providers 14
Here are some tips on what to discuss with a service provider: 1. Discuss all areas of service that are absolute requirements for you and your family member, such as medications being administered on time, direct supervision, sign-language training, and so on. 2. What makes you and your family member happy? What causes pain? How will the provider maximize opportunities for happiness, and minimize or eliminate the things that cause pain? 3. What do you/your family member want to happen? To find a job? To attend or become a member of a church or local group? To live within a half-hour drive of family? How many housemates would you/ your family member like? Anything else? Are these wishes or requirements? 4. What are the risks for you/your family member? Examples might include daily seizures, a lack of street-safety skills, the inability to talk or use sign language, forgetfulness, a tendency to hit others when angry, and so on. How will the provider deal with those risks? Questions to Ask Prospective Service Providers The following are good questions to ask a prospective service provider: 1. What is the provider’s mission? (Does it match the intent you are seeking?) 2. Is the provider certified, accredited, or licensed? What are the standards of service? 3. What kind of safety measures does the provider have in place to protect and assure treatment? 4. How does the provider assure compliance with the person’s rights? Did you (and family members and advocates) receive copies of your rights as a consumer of services, as well as have these rights explained? 5. What is the provider’s experience working with children and adults with disabilities, or adults who are elderly? 6. How would the provider ensure the implementation of the person-centered plan? 7. What connections has the provider established in the community? How would the provider assist in building a support system in the community? 8. Is the provider interested in what you/your family member want or dream about? 9. Is the provider connected to other programs that you may need, such as day support, local school and education services, or work programs? How is the provider connected? Ask for specific contacts. 10. If you are to live in a home shared with other people, can families drop in whenever they wish? 11. How are birthdays, vacations, and special events handled? 12. How would family money issues be handled? What is the policy on personal finances of the waiver participant? 13. How would minor illnesses and injuries be handled? What about major illnesses and injuries? 14. What information is routinely reported to families? 15. Can you get a copy of the provider’s complaint policies and procedures? Is there someone else whom family members can talk to if there is a disagreement? 15
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: Information Sharing The Individual
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
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Objective-based allocation (OBA): T
Page 71 and 72:
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
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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
Page 91 and 92:
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
Page 109 and 110:
Adaptations to service provider-own
Page 111 and 112:
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
Page 161 and 162:
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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