DDRS Waiver Manual

An individual’s behavioral conditions change: i. A copy of the behavioral support plan;
ii. Monthly documentation supporting the change in condition(s); and
iii. Incident reports.
g. The IST believes the ICAP assessment has significant errors:
i. The IST’s review of the ICAP assessment with detailed notes on areas needing reviewed; and ii. The
medical and behavior documentation needed to update the addendum
h. The IST believes the ICAP addenda (behavioral and health factors) are incorrect:
i. Documentation from a medical professional outlining the change in condition or diagnosis, with an
anticipated duration of the condition, risk factors to consider and any other special considerations
ii. A copy of the behavioral support plan;
iii. Monthly documentation supporting the change in condition(s); and
iv. Incident reports.
i. The individual has a High Cost Allocation:
i. A completed high budget/needs assessment;
ii. Behavior Support Plan with data from the last 90 calendar days;
iii. Any medical documentation that supports the extraordinary health needs; and
iv. Documentation and information to substantiate that the standard OBA determination cannot
meet the individual’s health and safety needs.
When requested, the BRQ and supporting documentation and information are reviewed by the Personal Allocation
Review (PAR) unit within the DDRS. The PAR unit may request additional information from the Case Manager to
support the BRQ and may allocate funding above the OBA determination for a period of up to 90 calendar days while
waiting for the additional documentation that is needed. If, after 90 calendar days, the Case Manager fails to provide
the requested additional information for the PAR unit, the request to modify the individual’s budget may be denied.
However, when all needed supporting documentation is provided, the PAR unit determines the individual’s Algo
score based on that information. If the individual’s Algo has changed, a new Algo and corresponding budget
allocation is entered into the state’s case management system. The PAR unit will notify the waiver case manager of
any changes in the Algo or allocation. An individual who is dissatisfied with the PAR unit’s determination may appeal
the NOA within 33 calendar days of the date of the notice. During an appeal, BDDS maintains the budget from the
last agreed-upon budget allocation.
For High Cost Allocations, the PAR unit will automatically notify the waiver Case Manager of the budget allocations
of individuals who have High Cost Allocations annually.
BDDS sends the waiver Case Manager a notification to submit a High Cost BRQ and supporting documentation 90
calendar days before the start of an individual’s new budget year if the Individual Support Team (IST) determines the
individual requires a budget above the standard OBA.
If the waiver Case Manager fails to provide BDDS the High Cost BRQ and supporting documentation before the new
budget year:
The individual shall receive the budget allocation based upon the standard OBA
BDDS shall send a Notice of Action (NOA) based upon the standard OBA with appeal rights
The BMR
The Budget Modification Review (BMR) allows participants on the Community Integration and Habilitation (CIH)
Waiver to obtain additional funds for a short-term when the individual experiences an unanticipated event that
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