DDRS Waiver Manual

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“related/relative” implies any of the following natural, adoptive and/or step relationships, whether by blood or by marriage, inclusive of half and/or in-law status: 1) Aunt (natural, step, adopted) 2) Brother (natural, step, half, adopted, in-law) 3) Child (natural, step, adopted) 4) First cousin (natural, step, adopted) 5) Grandchild (natural, step, adopted) 6) Grandparent (natural, step, adopted) 7) Nephew (natural, step, adopted) 8) Niece (natural, step, adopted) 9) Parent (natural, step, adopted, in-law) 10) Sister (natural, step, half, adopted, in-law) 11) Spouse (husband or wife) 12) Uncle (natural, step, adopted) All of the following must be met before a relative may be considered to be a provider: The relative must be at least 18 years of age; The relative is employed by or a contractor of an agency that is approved by FSSA/DDRS to provide care under the waiver; The relative meets the appropriate provider standards (per 460 IAC 6) for the service(s) being provided; The decision for the relative to provide services to a waiver participant is part of the person-centered planning process, which indicates that the relative is the best choice of persons to provide services from the DDRS-approved provider agency, and this decision is recorded and explained in the Individualized Support Plan (ISP); There is detailed justification as to why the relative is providing service; The decision for a relative to provide service(s) is evaluated periodically (for example, at least annually) to determine if it continues to be in the best interest of the waiver participant; Payment is made only to the DDRS-approved Medicaid enrolled waiver provider agency in return for specific services rendered; and The services must be rendered one-on-one with the participant or in shared settings with group sizes allowable per specified waiver service definitions and documented as acceptable by all relevant Individual Support Teams. Authorization for shared or group services must be reflected on and documented via the approved NOA for each group participant. With the exception of groups of waiver participants as noted above, the relative may not be responsible for others (including their other children or family members) nor engaged in other activities while providing services. NOTES: Regarding Participant Assistance and Care (PAC) and to Residential Habilitation and Supports 64
(RHS) under the Community Integration & Habilitation Waiver, the weekly total of reimbursable waiver-funded services furnished to a waiver participant by any combination of relative(s) and/or legal guardian(s) may not exceed 40 hours per week. 65
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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
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Section 1.1: The Centers for Medica
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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 and 60: o Children receiving adoption assis
Page 61 and 62: including the DDRS Case Management
Page 63: When the individual “Re-Enters”
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
Page 113 and 114: 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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