DDRS Waiver Manual

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Qualifications of Individuals Performing Initial Evaluation: Only individuals (FSSA employees/contractors) who are Qualified Intellectual Disability Professionals (QIDP) as specified by the federal standard within 42 CFR §483.430(a), may perform initial Level of Care determinations. Level of Care Criteria: If collateral records are not available or are not a valid reflection of the individual, additional assessments may be obtained from contracted psychologists, physicians, nurses and licensed social workers. Following review of the collateral records, the LOC assessment tool is completed, applicable to individuals with intellectual disability and other related conditions, in order to ascertain if the individual meets ICF/IID LOC. The LOC assessment tool is used for: Reviewing and referencing documentation related to the intellectual/developmental disabilities of the applicant/participant as well as any psychiatric diagnosis and results of the individual’s intellectual assessment Recording age of onset Identifying areas of major life activity within which the individual may exhibit a substantial functional limitation, including the areas of mobility, understanding and use of language, selfcare, capacity for independent learning, self-direction, and, for the state definition of developmental disability found in Indiana Code [IC 12-7-2-61], economic self-sufficiency. The BDDS Service Coordinator/contractor (initial LOC) or selected provider of Case Manager (reevaluations) reviews the LOC assessment tool and collateral material, applicable to individuals with intellectual/developmental disability and other related conditions, in order to ascertain if the individual meets ICF/IID LOC. An applicant/participant must meet each of four basic conditions and three of six substantial functional limitations in order to meet LOC. The basic conditions are: intellectual disability, cerebral palsy, epilepsy, autism, or other condition (other than a sole diagnosis of mental illness) similar to intellectual disability the ID, DD or other related condition is expected to continue indefinitely, the ID, DD or other related condition had an age of onset prior to age 22, and the ID, DD or other related condition results in substantial functional limitations in at least three (3) major life activities. The substantial functional limitation categories, as defined in 42 CFR §435.1010, are: self-care, learning, self-direction, capacity for independent living, 32
understanding and use of language, and mobility. Section 5.4: Waiting List for the Family Supports Waiver It is the policy of the Bureau of Developmental Disabilities Services (BDDS) that individuals may be placed on a single statewide waiting list after applying for waiver services and meeting specified criteria. Individuals are responsible for maintaining current collateral and contact information with their local DDRS/BDDS office. For initial Placement on a single, statewide Home and Community Based Services (HCBS) Waiver Waiting List, the following requirements must be met: Individuals or their legal representative must complete an application and submit the application to their local BDDS office to apply for HCBS waiver services. The individual or their legal representative is expected to participate in the completion of the following: o Application o Collateral Information, including the following: • Level of Care (LOC) assessment tool • Supporting documents: Diagnostic Evaluation(s) Functional Evaluation(s) Psychological Report(s) Individualized Education Program from schools School records Physician’s diagnosis and remarks Existing evaluation done by Supplemental Security Income (SSI) or Vocational Rehabilitation Intelligence Quotient (IQ) testing done at any time o Medicaid application for individuals over eighteen years of age o SSI application, if applicable • Level of Care (LOC) must be assessed for all individuals An individual must meet: o the State definition of a developmental disability found in IC 12-7-2-61(a); and o Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) Level of Care (LOC) with substantial functional limitations as defined in 42 CFR §435.1010. If an individual completes the application and meets the LOC criteria listed in Section 5.3 above, they will be placed on a waiting list using the individual’s application date. 33
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 and 30: Section 5.1: Request for Applicatio
Page 31: Internet access, call toll free 1-8
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
Page 81 and 82: 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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