DDRS Waiver Manual

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
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