DDRS Waiver Manual

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Fourteen calendar days to complete the service planning process enabling the POC/CCB to be created. Three calendar days to review and sign all service planning documents after the POC/CCB is completed If the individual is unable to start waiver services within the given time frames, the individual may be removed from the targeting process. Note: Entrance into services under the Community Integration and Habilitation Waiver program now occurs only by meeting and being approved for certain priority criteria known as reserved waiver capacity. Section 5.6: Entrance into the Community Integration & Habilitation Waiver Program Effective September 1, 2012, entering the Home and Community Based Services (HCBS) waiver program known as the Community Integration and Habilitation (CIH) Waiver requires the individual to meet and be approved for certain federally approved priority criteria technically known as reserved waiver capacity categories within the CIH Waiver. To move onto the needs-based CIH Waiver, an individual must meet and be approved for the specific priority criteria of at least one of the following categories: o Eligible individuals transitioning to the community from NF, ESN and SOF o Eligible individuals determined to no longer need/receive active treatment in Supervised Group Living (SGL) o Eligible individuals transitioning from 100% state-funded services o Eligible individuals aging out of Department of Education (DOE), Department of Child Services (DCS), or SGL o Eligible individuals requesting to leave a Large Private ICF/IID o Eligible individuals meeting the following emergency placement criteria: • Death of a Primary Caregiver where there is no other caregiver available, or • Caregiver over 80 years of age where there is no other caregiver available, or • Evidence of abuse or neglect in the current institutional or SGL placement, or • Extraordinary health and safety risk as reviewed and approved by the division director Individuals, their legal representative or other persons acting on their behalf must request a priority 36
waiver slot when it appears that the individual meets the specific criteria of one or more reserved waiver capacity categories It is necessary to complete an application and submit the application to their local DDRS/BDDS office to apply for HCBS waiver services. The Individual and/or any legal guardian are expected to participate in the completion of the following: o Application o Collateral Information, including the following: • Level of Care assessment tool • Supporting documents: Diagnostic Evaluation(s) Functional Evaluation(s) Psychological Report(s) Individualized Education Program from schools School records Physician diagnosis and remarks Existing evaluation done by Supplemental Security Income or Vocational Rehabilitation IQ testing done at any time o Medicaid application for individuals over eighteen (18) years of age o Supplemental Security Income 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. Additionally, if an individual meets the LOC criteria listed in Section 5.3 above, and a funded priority slot is available in the reserved waiver capacity category met by the individual, the DDRS/BDDS Office will first determine whether or not other potential placement options have been exhausted before offering the slot to the individual Individuals are responsible for maintaining current collateral and contact information with their local BDDS office. Application for a CIH Waiver Priority Slot When application for a CIH Waiver priority slot is made, priority access by reserved waiver capacity category is made available only as long as available capacity exists for the current waiver year. Responsibilities of Individuals Applying for a CIH Waiver Priority Slot The responsibilities of individuals applying for a CIH Waiver priority slot are as follows: 37
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 and 32: Internet access, call toll free 1-8
Page 33 and 34: understanding and use of language,
Page 35: If an individual declines the offer
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
Page 83 and 84: conducted by the ombudsman must als
Page 85 and 86: Section 10.24: Recreational Therapy
Page 87 and 88:
Medicaid Waiver Services, Codes, an
Page 89 and 90:
FSW CIH MFP- CIH INsite Code Servic
Page 91 and 92:
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
Page 103 and 104:
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
Page 153 and 154:
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
Page 159 and 160:
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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