DDRS Waiver Manual

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Annual maintenance service is available and is limited to $500 per year. If the need for maintenance exceeds $500, the Case Manager will work with other available funding streams and community agencies to fulfill the need. Documentation Standards Specialized Medical Equipment and Supplies services documentation must include: Identified need in ISP and the POC/CCB. Identified direct medical benefit for the individual. Documentation of the request for IHCP prior approval (denied PA). Documentation of the reason of denial of IHCP prior authorization. Receipts for purchases. Signed and approved Request for Approval to Authorize Services (State Form 45750) Limitations The following limitations apply to Specialized Medical Equipment and Supplies services: Service and repair up to $500 per year is permitted for maintenance and repair of previously obtained specialized medical equipment that was funded by a waiver service. If the need for maintenance exceeds $500, the Case Manager will work with other available funding streams and community agencies to fulfill the need. A lifetime cap of $15,000 is available for vehicle modifications. In addition to the $15,000 lifetime cap, $500 will be allowable annually for repair, replacement, or an adjustment to an existing modification that has been provided through the HCBS waiver. If the lifetime cap is fully utilized, and a need is identified, the Case Manager will work with other available funding streams and community agencies to fulfill the need. Vehicle Modifications have a cap of $7,500 under the Family Supports <strong>Waiver</strong>, but a cumulative lifetime cap of $15,000 across all HCBS waiver programs administered by the State. Activities Not Allowed The following activities are not allowed under Specialized Medical Equipment and Supplies services: Equipment and services that are available under the Medicaid State Plan Equipment and services that are not of direct medical or remedial benefit to the individual Equipment and services that are not included in the comprehensive POC Equipment and services that have not been approved on a Request for Approval to Authorize services (RFA) Equipment and services that are not reflected in the ISP Equipment and services that do not address needs identified in the person-centered planning process 152
Section 10.30: Speech/Language Therapy Service Definition Speech/Language Therapy services are services provided by a licensed speech pathologist under 460 IAC 6 Supported Living Services and Supports requirements. These services cannot be provided as a substitute for services offered under the Medicaid State Plan. Reimbursable Activities Reimbursable activities under Speech/Language Therapy services include the following: Screening Assessment Direct therapeutic intervention and treatment for speech and hearing disabilities such as delayed speech, stuttering, spastic speech, aphasic disorders, injuries, lip reading or signing, or the use of hearing aids Evaluation and training services to improve the ability to use verbal or non-verbal communication Language stimulation and correction of defects in voice, articulation, rate, and rhythm Design, fabrication, training, and assistance with adaptive aids and devices Consultation demonstration of techniques with other service providers and family members Planning, reporting, and write-up when in association with the actual one-on-one direct care/therapy service delivery with the waiver participant Service Standards The following service standards apply to Speech/Language Therapy services: Individual Speech-Language Therapy services must be reflected in the ISP regardless of the funding source. To be eligible for this service, the individual must have been examined by a certified audiologist and/or a certified speech therapist who has recommended a formal speech and audio logical program. The need for such services must be documented by an appropriate assessment and authorized in the individual’s ISP. Documentation Standards Speech/Language Therapy Services documentation must include: Documentation of an appropriate assessment Services provided both under the Medicaid State Plan and the waiver must be outlined in the ISP <strong>DDRS</strong>/BDDS-approved provider 153
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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
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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
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 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: Services furnished to a minor by a
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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