DDRS Waiver Manual

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Otherwise, the Family and Social Services Administration (FSSA) Division of Family Resources (DFR) is responsible for processing applications and establishing eligibility for state benefits including: • Medicaid / Indiana health coverage plans • Supplemental Nutrition Assistance Program (SNAP) / food assistance • Temporary Assistance for Needy Families (TANF) / cash assistance • IMPACT (Job Training) • Early Learning/Child Care • How do I know if I qualify? • A assessment tool that will help you see if you qualify for Medicaid and other benefits is available online at https://www.ifcem.com/CitizenPortal/application.do# . NOTE: Individuals may also apply for Medicaid based on disability. Applications to the Social Security Administration for Supplemental Security Income are treated as applications for Medicaid under 1634 status. See http://www.in.gov/fssa/ddrs/4861.htm#Post for more information. Where do I apply? To apply for Medicaid and other DFR benefits, you will need to fill out and submit an application. You may apply online at or in person at a local office, or call 1-800-403-0864 to request an application be mailed to you. • To apply online, go to the Division of Family Resources Benefits Portal at https://www.ifcem.com/CitizenPortal/application to apply for benefits and complete your application. The online application is available 24 hours a day, 7 days a week. • To apply in person, go to your local DFR office, Monday through Friday, 8:00 a.m. to 4:30 p.m. A DFR office is located in every county in Indiana; with multiple offices located in Marion, Lake and St. Joseph counties. • To apply by mail, call toll free 1-800-403-0864 Monday through Friday between 8:00 a.m. and 4:30 p.m. to request an application be mailed to you. Complete the application and return it in the mail, FAX it toll free to 1-800-403-0864, or bring it into the DFR office in the county where you reside. DFR office locations To find a DFR office near you, go online to http://www.DFRBenefits.IN.gov. Enter your ZIP code in the search box provided, or click on the name of the county where you live in the table shown. This will take you to a page listing the address and other information about your local office. If you do not have 30
Internet access, call toll free 1-800-403-0864 and an operator will provide you with this information. Information required to complete a Medicaid application Go to the http://www.DFRBenefits.IN.gov web site to learn what information is required to complete a Medicaid application. To get started, the following information for all of your household members may help you complete the application o Names, date of birth and social security numbers o Employer and income information o Tax filing status and tax dependent information o Current health insurance information including policy numbers DFR may contact you by phone or by mail if additional information or documentation is required to complete your application. Applicants under the age of 18 should submit the Plan of Care/Cost Comparison Budget (POC/CCB) approval letter (described under Section 5.8) to the Division of Family Resources (DFR) when submitting an application for Medicaid benefits or when requesting for a change of Medicaid Aid Category in order to qualify for waiver eligibility. NOTE: Medicaid eligibility is required prior to the start of waiver services. Section 5.3: Initial Level of Care Evaluation An individual targeted for the Family Supports Waiver (FSW) or meeting reserved waiver capacity (priority) criteria and approved for entrance to the FSW or Community Integration and Habilitation (CIH) Waiver must meet the level of care required for placement in an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID). Initial Level of Care determinations are made by a Family and Social Services Administration (FSSA)/Division of Disability and Rehabilitative Services (DDRS)/Bureau of Developmental Disabilities Services (BDDS) Service Coordinator Reevaluations are performed by the selected provider of Case Management services. For those applicants whose initial Level of Care (LOC) evaluation was unfavorable, an independent third party contractor conducts a subsequent LOC evaluation and makes a recommendation to the State Medicaid Agency, the Family and Social Services Administration (FSSA), and FSSA makes the final determination of eligibility. 31
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 and 24: Section 4.1: Medicaid Waiver Overvi
Page 25 and 26: Section 4.4: Coordination with Medi
Page 27 and 28: personal beliefs and customs, ensur
Page 29: Section 5.1: Request for Applicatio
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
Page 73 and 74: The person testifying should be the
Page 75 and 76: In all cases, the decision of the A
Page 77 and 78: Section 9.1: Overview The Family an
Page 79 and 80: 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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