DDRS Waiver Manual

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The annual limits for each level of non-medical waiver Transportation are: o $2,500 for Level 1 Transportation o $5,000 for Level 2 Transportation o $7,500 for Level 3 Transportation Activities Not Allowed Reimbursement is not available under Transportation services (as Specified in the CIH <strong>Waiver</strong>) for the following activities: May not be used to meet medical transportation needs already available under the Indiana Medicaid State Plan May not be used in conjunction with Structured Family Care services Section 10.33: Wellness Coordination (currently under CIHW only) Service Definition Wellness Coordination services means the development, maintenance, and routine monitoring of the waiver participant’s Wellness Coordination plan and the medical services required to manage his or her health care needs. Wellness Coordination services extend beyond those services provided through routine doctor/health care visits required under the Medicaid State Plan and are specifically designed for participants requiring assistance of an RN or LPN to properly coordinate their medical needs: Tier I – Health care needs require at least weekly* consultation/review with RN or LPN, including face-to-face visits once a month. Tier II – Health care needs require at least weekly consultation/review with RN or LPN, including face-to-face visits at least twice monthly. Tier III – Health care needs require at least twice weekly consultation/review with RN or LPN, including face-to-face visits once a week. *Weekly – a calendar week (Sunday through Saturday) Conditions and Requirements Necessity for Wellness Coordination services will typically be reserved for participants assessed with health scores of 5 or higher through the State’s objective based allocation process. Participants assessed with health scores of 0-4 would not require assistance of an RN or LPN to coordinate medical needs. As medical events occur and/or a participant’s medical needs change, the Individual Support Team is expected to obtain reassessment for potential revision to the health score and to ensure utilization of the appropriate tier of services. Service Standards Reimbursement is available for Wellness Coordination services only when the following circumstances are present: 160
The participant requires assistance in coordinating medical needs beyond what can be provided through routine doctor/health care visits Wellness Coordination services are specifically included in the participant’s individualized support plan The participant has a wellness coordination plan Reimbursable Activities Coordination of Wellness services by the RN or LPN provider must include, but is not limited to, the following: Completion of the (medical/health care related section’s needs and risks) State-approved risk assessment tool Development, oversight, and maintenance of a Wellness Coordination plan Development, oversight, and maintenance of the (medical/health care) Risk Plan, which includes Training of Direct Support Professionals to ensure implementation of (medical/health care) Risk Plans Consultation with the individual’s health care providers Face-to-face consultations with the individual as described in the support plan Consultation with the individual’s support team Active involvement at all team meetings, reporting on the Wellness Coordination plan as it relates to the individual’s full array of services as listed in the ISP. Limitations The following limitations apply to Wellness Coordination services: Participants assessed with health scores of 0-4 would not require assistance of an RN or LPN to coordinate medical needs. Activities Not Allowed Reimbursement for Wellness Coordination services is not available under the following circumstances: The individual does not require Wellness Coordination services. Wellness Coordination services are not specified in the Individualized Support Plan. Wellness Coordination services may not be provided by a provider of waiver-funded Case Management services. Residential, vocational, and/or educational services otherwise provided under other Supported Living Services cannot be billed as Wellness Coordination services. Services furnished to a minor by a parent(s), stepparent(s), or legal guardian. Services furnished to a participant by the participant’s spouse. Nurses rendering waiver-funded services must obtain/maintain Indiana licensure. 161
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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
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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
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 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: Bus passes or alternate methods of
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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