DDRS Waiver Manual

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Section 7: Monitoring and Continuation of Waiver Services Section 7.1: Level of Care Re-Evaluation Sections 7.1 – 7.9 Section 7.2: Medicaid Eligibility Re-Determination Section 7.3: Annual Plan of Care/Cost Comparison Budget (POC/CCB) Development Section 7.4: Plan of Care/Cost Comparison Budget (POC/CCB) Updates and Revisions Section 7.5: State Authorization of the Annual/Update Cost Comparison Budget Section 7.6: Service Plan implementation and Monitoring Section 7.7: Interruption/Termination of Waiver Services Section 7.8: Waiver Slot Retention after Termination and Re-Entry Section 7.9: Parents, Guardians & Relatives Providing Waiver Services Return to Table of Contents 54
Section 7.1: Level of Care Re-Evaluation The process for re-evaluation of level of care is the same as the initial evaluation process, except that a new confirmation of diagnosis form is no longer required for each re-evaluation. The re-evaluation is typically performed by the waiver Case Management agency as opposed to being performed by the Division of Disability and Rehabilitative Services (DDRS)/Bureau of Developmental Disabilities Services (BDDS) staff. However, under specific circumstances, such as with potential denials of level of care, reevaluations may be completed either by DDRS/BDDS Staff or by the DDRS Central Office. Re-evaluation is required at least annually, or as needed. Per federal guidelines, Family Supports Waiver (FSW) and Community Integration and Habilitation (CIH) Waiver program participants must be re-evaluated each year to meet intermediate care facility for individuals with intellectual disabilities (ICF/IID) level of care. Only individuals 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 (LOC) determinations. The local DDRS/BDDS office completes the initial level of care evaluation for these waivers. Annual level of care re-evaluations are completed by the Case Manager, who must be a QIDP. Section 7.2: Medicaid Eligibility Re-Determination The Family and Social Services Administration’s (FSSA) Division of Family Resources (DFR) is the group that determines eligibility for all Indiana social services programs. The FSSA/DFR will assist you in determining which programs are right for you and your family. You can learn more about the application process by going to Apply for Medicaid at http://member.indianamedicaid.com/applyfor-medicaid.aspx . Each year, the local FSSA/DFR determines the individual’s continuing eligibility to receive Medicaid. Section 7.3: Annual Plan of Care/Cost Comparison Budget (POC/CCB) Development All individuals/participants (also known as consumers, or members for Medicaid purposes) receiving waiver services must have a new Plan of Care/Cost Comparison Budget (POC/CCB) approved at least annually. The Person-Centered Plan (PCP) must also be updated at least annually. The Annual POC/CCB represents the service plan identified for the individual during the required review/update of the Individualized Support Plan (ISP). Annual POC/CCBs are to start the date following the expiration of the previous POC/CCB and cover a 12 month period. If an Annual POC/CCB is not submitted or cannot be approved in a timely manner, the most recently 55
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 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: Your Appeal Right as an Applicant f
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
Page 93 and 94: Aversive techniques - any technique
Page 95 and 96: Services delivered to persons who d
Page 97 and 98: where services are not rendered wit
Page 99 and 100: Section 10.7: Community Based Habil
Page 101 and 102: Activities that do not foster the a
Page 103 and 104: The system to be installed must be
Page 105 and 106:
The monitoring base staff must have
Page 107 and 108:
Electronic Monitoring may not be us
Page 109 and 110:
Adaptations to service provider-own
Page 111 and 112:
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 (
Page 117 and 118:
The data may reside in multiple loc
Page 119 and 120:
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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