DDRS Waiver Manual

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Appropriate credentials for service provider Attendance record, therapist logs, and/or chart 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 Speech-Language Therapy services: One hour of billed therapy service must include a minimum of 45 minutes of direct patient care/therapy, with the balance of the hour spent in related patient services. Activities Not Allowed The following activities are not allowed under Speech/Language Therapy services: Services available through the Medicaid State Plan (a Medicaid State Plan prior authorization denial is required before reimbursement is available through the Medicaid waiver for this service). Therapy services furnished to the participant within the educational/school setting or as a component of the participant’s school day Activities delivered in a nursing facility Section 10.31: Structured Family Caregiving (currently under CIHW only and ends 9/30/2016 if CIHW 2 nd Amendment is approved) Service Definition Structured Family Caregiving (SFC) is a living arrangement in which a participant lives in the private home of a principal caregiver who may be a non-family member (foster care) or a family member who is not the participant’s spouse, the parent of the participant who is a minor, or the legal guardian of the minor participant. Necessary support services are provided by the principal caregiver (family caregiver) as part of SFC. Only agencies may be SFC providers, with the SFC settings being approved, supervised, trained, and paid by the approved agency provider. The provider agency must conduct two visits per month to the home – one by a Registered Nurse and one by a SFC Home Manager. The provider agency must keep daily notes that can be accessed by the State. Service Levels and Rates There are three service levels of SFC, each with a unique rate. Beginning January 1, 2013, the Algo level assigned to the participant will drive and determine the appropriate level of SFC service and reimbursement 154
to be utilized in service plan development at the participant’s next annual anniversary date. With the phasein of this methodology, all participants will be served at or above their pre-existing level of SFC service. Level 1 – Appropriate for participants choosing SFC and having an Algo level of 0 or 1 Level 2 – Appropriate for participants choosing SFC and having an Algo level of 2 Level 3 – Appropriate for participants choosing SFC and having an Algo level of 3, 4, 5, or 6 Reimbursable Activities Reimbursable activities under SFC services include the following: Personal care and services. Homemaker or chore services. Attendant care and companion care services. Medication oversight. Respite for the family caregiver (funding for this respite is included in the per diem paid to the service provider; the actual service of Respite care may not be billed in addition to the per diem). Other appropriate supports as described in the ISP. Service Standards The following service standards apply to SFC services: SFC services must be reflected in the ISP. Services must address the needs (for example, intellectual/developmental needs, vocational needs, and so forth) identified in the person-centered planning process and must be outlined in the ISP. Ten percent of the total per diem amount is intended for use by the provider for respite care as needed. It is the provider’s responsibility to approve any providers of respite chosen by the family or the participant. The provider determines the total amount per month paid to the family caregiver. The agency’s administrative/supervision fee comes from the remaining total amount and includes the following duties: Publish written policies and procedures regarding Structured Family Caregiver support services. Maintain financial and service records to document services provided to the individual. Establish a criteria for the acceptance of the family caregiver or foster parent, screen potential family caregivers/foster parents for qualities of stability, maturity, and experiences so as to ensure the safety and well-being of the individual, and obtain a criminal background and reference check. Coordinate/provide adequate initial training and ongoing training, consultation and supervision to the family caregiver/foster parent. Provide for the safety and well-being of the participant by inspection of environment for compliance with the <strong>DDRS</strong> policies and procedures, including, but not limited to, the provider and Case Management standards found in 460 IAC 6 Supported Living Services and Supports requirements. Reimburse family caregiver/foster parent. 155
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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
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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 and 152: Services furnished to a minor by a
Page 153: Section 10.30: Speech/Language Ther
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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