DDRS Waiver Manual

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Section 7.6: Service Plan implementation and Monitoring Case Managers are responsible for the implementation and monitoring of the service plan (inclusive of the Individualized Support Plan (ISP), Cost Comparison Budget POC/CCB) and, often, other non-funded services) and participant health and welfare. A minimum of one face-to-face contact between the case manager and the participant is required at least every 90 calendar days in the home of the participant, and as frequently as needed to support the participant. In each meeting, the participant’s Individual Support Team (IST) will review current concerns, progress and implementation of the service plan (plan of care). A 90-Day Checklist is utilized by the Case Manager and IST in order to systematically review the status of the POC/CCB, the ISP, any behavioral support program, choice and rights, medical needs, medications, including psychotropic medications (if applicable), seizure management (if applicable), nutritional/dining needs, incident review, staffing issues, fiscal issues, risk plans and any other issues which may be identified in regard to the satisfaction and health and welfare of the participant. The checklist is also used to verify that emergency contact information is in place in the home, including the telephone numbers for Adult Protective Services or Child Protective Services and the Bureau of Quality Improvement Services. Case Managers educate the participant by offering examples of when the emergency contact numbers should be called. The case manager is required to enter a case note for each encounter (at least one per month) with the participant indicating the progress and implementation of the service plan. The Case Manager also maintains regular contact with the participant, family/guardian and the provider(s) of services through home and community visits or by phone to coordinate care, monitor progress and address any immediate needs. During each of these contacts the Case Manager assesses the service plan implementation as well as monitors the participant's needs. The monitoring and follow up method used by the Case Manager include conversations with the participant, the parent/guardian, and providers to monitor the frequency and effectiveness of the services through team meetings and regular face-to-face and phone contacts. The case manager asks: Are the services being rendered in accordance with the plan of care? Are the service needs of the participant being met? Do participants exercise freedom of choice of providers? What is the effectiveness of the crisis and back up plans? Is the participant’s health and welfare being ensured? Do participants have access to non-waiver services identified in the plan of care including access to health services? The implementation and effectiveness of the plan of care is reviewed at least once every 90 calendar days in the 90-Day meetings of the IST meetings. At all times, full, immediate and unrestricted access to the individual data is available to the State, 60
including the DDRS Case Management Liaison position as well as other members of the DDRS Executive Management Team and FSSA’s Office of Medicaid Policy and Planning (OMPP). Service Problems: Problems regarding services provided to participants are targeted for follow up and remediation by the case management provider in the following manner: Case Managers conduct a face-to-face visit with each participant at least every 90 calendar days to review and update the 90 Day Checklist with the IST. Case Managers investigate the quality of participant services and indicate whether there are any problems related to participant services not being in place. This is recorded on the 90-Day Checklist. For each identified problem, they identify the timeframe and person responsible for corrective action, communicate this information to the IST, and monitor to ensure that corrective action takes place by the designated deadline. Case Manager supervisors, directors, or other identified executive management staff within each case management provider organization monitor each problem quarterly via a report from the State’s case management system to ensure that Case Managers are following up on, and closing out, any pending corrective actions for identified problems. At least every 90 calendar days, in conjunction with the 90 Day Checklist, Case Managers update the participant’s Individualized Support Plan (ISP) progress notes, to indicate if all providers and other team members are current and accurate in their implementation of plan activities on behalf of the participant. Any lack of compliance on the part of provider entities or other team members is noted within participant-specific case notes, flagged for follow-up and communicated to the noncompliant entity for resolution. Section 7.7: Interruption/Termination of Waiver Services An individual’s waiver services will be terminated when the individual: Voluntarily withdrawals Chooses institutional placement/entering Medicaid-funded long-term care facility Dies Needs services so substantial that the total cost of Medicaid services for the individual would jeopardize the waiver program’s cost-effectiveness No longer meets ICF/IID level of care criteria Is no longer eligible for Medicaid services No longer requires Home and Community-Based Services, or Is no longer intellectually or developmentally disabled Other examples of circumstances appropriate for interruption/termination may include a participant being arrested, in jail, awaiting trial, convicted/sentenced. 61
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2016 DDRS Waiver Manual Our Mission
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Section 1: Roles and Responsibiliti
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Section 7.5: State Authorization of
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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 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: o Children receiving adoption assis
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
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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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