DDRS Waiver Manual

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Vehicle Modifications (VMOD) - are administered under separate and independent waiver policy (Vehicle Modification Policy). Items – Non-Covered The following items and equipment: hospital beds, air fluidized suspension mattresses/beds; therapy mats; parallel bars; scales; activity streamers; paraffin machines or baths; therapy balls; books, games, toys; electronics – such as CD players, radios, cassette players, tape recorders, television, VCR/DVDs, cameras or film, videotapes and other similar items; computers and software; adaptive switches and buttons; exercise equipment such as treadmills or exercise bikes; furniture; appliances - such as refrigerator, stove, hot water heater; indoor and outdoor play equipment such as swing sets, swings, slides, bicycles adaptive tricycles, trampolines, play houses, merry-go-rounds; swimming pools, spas, hot tubs, portable whirlpool pumps; temperpedic mattresses, positioning devices, pillows; bathtub lifts; motorized scooters; barrier creams, lotions, personal cleaning cloths; totally enclosed cribs and barred enclosures used for restraint purposes; medication dispensers. Any equipment or items that can be authorized through Medicaid State Plan; Any equipment or items purchased or obtained by the individual, his/her family members, or other non-waiver providers. Note: In rare circumstances, a new or unanticipated item may be presented for consideration as a covered item under this service. Prior to submission of an RFA for this item, a written proposal justifying the need for this item must be sent to the OMPP for submission to the FSSA Policy Governance Board for consideration and determination of appropriateness as a Covered Item. The written proposal should be directed to: Director of Agency Coordination and Integration Office of Medicaid Policy and Planning 402 W. Washington Street, Room W382 Indianapolis, IN 46204-2739. 178
These requests should be extremely rare and should not include items on the Non-Covered list, which have been previously vetted at the State, and determined to be Non-Covered items. Decision Making Authority: Each Division, with approval from the Office of Medicaid Policy and Planning (OMPP), shall identify a designee(s) to render decisions based upon the articles within this policy. The designee(s) is responsible for preparing and presenting testimony for all Fair Hearings. The case management entity, working as an agent of the State, shall not attend Fair Hearings in opposition of the State, unless requested by the individual when there is no other advocate to represent the individual at the Hearing. If the case manager does attend the Hearing; working as an agent of the State, he/she must also uphold the established federal, state, local and FSSA standards and the Division specific guidelines and/or policies. Additionally, the case manager must submit a letter, in writing to the Administrative Law Judge at the Fair Hearing, as to what his/her role is at the hearing. Each Division shall implement a Quality Assurance Plan. In the event of inappropriate authorizations being granted, any or all of the following actions may be required: o a corrective action plan; o reimbursement to Medicaid; o loss of decision making authority. 179
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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
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Adaptations to service provider-own
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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
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
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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
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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: Items - Covered Justification and d
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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