DDRS Waiver Manual

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Section 4.2: State Definition of Developmental Disability Individuals meeting the state criteria for an intellectual/developmental disability and meeting the criteria for an ICF/IID level of care determination are eligible to receive waiver services when approved by the state. Per Indiana Code [IC 12-7-2-61], “developmental disability" means a severe, chronic disability of an individual that meets all of the following conditions: Is attributable to: o intellectual disability, cerebral palsy, epilepsy, or autism; or o any other condition (other than a sole diagnosis of mental illness) found to be closely related to intellectual disability, because this condition results in similar impairment of general intellectual functioning or adaptive behavior or requires treatment or services similar to those required for a person with an intellectual disability. Is manifested before the individual is twenty-two (22) years of age. Is likely to continue indefinitely. Results in substantial functional limitations in at least three (3) of the following areas of major life activities: o Self-care. o Understanding and use of language. o Learning. o Mobility. o Self-direction. o Capacity for independent living. o Economic self-sufficiency. An individual with an intellectual/developmental disability must also be found to meet the federal level of care requirements for admission into an ICF/IID and be approved for entrance into the waiver program prior to receiving waiver-funded services through an Indiana Medicaid Home and Community Based Services waiver program administered by the Division of Disability and Rehabilitative Services. See Section 5.3: Initial Level of Care Evaluation for details. Section 4.3: Cost Neutrality Indiana must demonstrate that average per capita expenditure for the Family Supports Waiver and the Community Integration and Habilitation Waiver program participants are equal to or less than the average per capita expenditures of institutionalization for the same population. Indiana must demonstrate this cost neutrality for each waiver separately. 24
Section 4.4: Coordination with Medicaid State Plan Services CMS requires that a HCBS waiver member exhaust all services on the State Plan before utilizing HCBS waiver services. HCBS waiver programs are considered funding of last resort and have a closed funding stream. Please reference Section 3.3 for more specific information. Section 4.5: Family Supports Waiver (FSW) PURPOSE: The Family Supports Waiver (FSW) program provides Medicaid Home and Community-Based Services (HCBS) to participants residing in a range of community settings as an alternative to care in an intermediate care facility for individuals with intellectual disability (known as an ICF/IID) or related conditions. The FSW serves persons with an intellectual/developmental disability, intellectual disability or autism and who have substantial functional limitations, as defined in 42 CFR 435.1010. Participants may choose to live in their own home, family home, or community setting appropriate to their needs. Participants develop an Individualized Support Plan (ISP) using a person-centered planning process guided by an Individual Support Team (IST). The IST consists of the participant, the participant’s case manager and anyone else of the participant’s choosing but typically family and/or friends. The participant, with the IST, selects services, chooses service providers and develops a Plan of Care/Cost Comparison Budget (POC/CCB). The POC/CCB is subject to an annual waiver services cost cap of $16,545. GOALS and OBJECTIVES: The FSW provides access to meaningful and necessary home and community-based services and supports, seeks to implement services and supports in a manner that respects the participant’s personal beliefs and customs, ensures that services are cost-effective, facilitates the participant’s involvement in the community where he/she lives and works, facilitates the participant’s development of social relationships in his/her home and work communities, and facilitates the participant’s independent living. LIST OF SERVICES CURRENTLY AVAILABLE UNDER THE FSW: • Adult Day Services • Behavioral Support Services • Case Management • Community Based Habilitation - Group • Community Based Habilitation – Individual • Extended Services • Facility Based Habilitation - Group • Facility Based Habilitation - Individual • Facility Based Support Services 25
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 and 14: Information Sharing The Individual
Page 15 and 16: Here are some tips on what to discu
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: Section 4.1: Medicaid Waiver Overvi
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
Page 69 and 70: Objective-based allocation (OBA): T
Page 71 and 72: administrative hearing must still b
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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
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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
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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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