DDRS Waiver Manual

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The notice of scheduled hearing is sent out so that it reaches the appellant at least 10 calendar days before the hearing. Note: Please contact the Administrative Law Judge (ALJ) from FSSA’s Office of General Counsel or the Office of Hearings and Appeals for all questions and issues related to scheduling a hearing. The DDRS and the BDDS cannot schedule hearings. Neither party should contact the ALJ prior to the scheduled hearing date to discuss case-specific information without the other party being included/notified. Section 8.5: Request for Continuance from the Appellant A written request for a continuance is to be directed to the Office of Hearings and Appeals or the Office of General Counsel’s Administrative Law Judge (ALJ). Good cause must exist for a continuance to be granted. “Good cause” is defined as a valid reason for the appellant’s inability to be present at the scheduled hearing, such as being unable to attend the hearing because of A serious physical or mental condition An incapacitating injury A death in the family Severe weather conditions that make it impossible to travel to the hearing Unavailability of a witness whose evidence cannot be obtained otherwise Other similar causes If good cause exists and a continuance is granted, the hearing will be rescheduled. Note: Please contact the Office of Hearings and Appeals for all questions or issues related to scheduling a hearing, or the Office of General Counsel’s Administrative Law Judge (ALJ) regarding continuances. The DDRS and BDDS cannot reschedule hearings. Neither party should contact the ALJ prior to the scheduled hearing date to discuss specific information without the other party being included/notified. Section 8.6: Review of Action When an appeal request is received, a designated State staff within the appropriate units (BDDS Service Coordinator or District representative, DDRS Central Office or DDRS/BDDS Waiver Unit) should review the proposed action to determine whether the proposed action is appropriate. Upon request, the designated State staff provides the individual (or representative) the opportunity for an informal conference and an opportunity to review the evidence prior to the hearing. Individuals should be advised that an informal conference prior to the hearing is optional and in no way delays or replaces the administrative hearing. The conference may lead to an informal resolution of the dispute. An 70
administrative hearing must still be held unless the individual (or representative) in writing withdraws the request for a hearing. Section 8.7: Disposal of Appeal without a Fair Hearing An appeal request may be disposed of without holding a fair hearing in the following situations: If, after review of the appellant’s situation, the BDDS Service Coordinator and/or the DDRS Central Office realizes that the proposed action or action taken is incorrect, adjusting action may be taken. If the appellant wishes to withdraw the appeal, he/she is to be assisted by the BDDS Service Coordinator and/or the DDRS Central Office in promptly notifying the Office of Hearings and Appeals or Office of General Counsel’s Administrative Law Judge in writing of the decision. No pressure is to be exerted on the appellant to withdraw the appeal. The withdrawal must be acknowledged in writing and it is only with the receipt of a signed voluntary withdrawal statement from the appellant that the appeal is to be dismissed. An appeal is abandoned when the appellant (or representative), without good cause, does not appear at a scheduled hearing. The appeal will be dismissed and both parties will be notified. Section 8.8: The Fair Hearing An administrative hearing is a review of actions of a BDDS Service Coordinator, Case Manager, DDRS Central Office, or DDRS/BDDS Waiver Unit regarding issues relating to the Family Supports Waiver or the Community Integration and Habilitation Waiver. An Administrative Law Judge, who is an employee of the Family and Social Services Administration, Office of Hearings and Appeals or Office of General Counsel, is designated to hold the hearing and to issue findings of fact, conclusions of law, and a decision related to the appeal request. A hearing allows the dissatisfied appellant an opportunity to present his or her grievance and to describe the circumstance and needs in his or her own words. An attorney or another individual of his choice may represent the individual. A designated State staff within the appropriate units (BDDS Service Coordinator or District representative, DDRS Central Office or DDRS/BDDS Waiver Unit) will attend the hearing and present evidence supporting the action under appeal. Section 8.9: Preparation for Hearing by Appellant As the appellant prepares for the hearing, the appellant (or representative) is to be given an opportunity to: 71
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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
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Information Sharing The Individual
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Here are some tips on what to discu
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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 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: Objective-based allocation (OBA): T
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
Page 115 and 116: 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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DDRS Waiver Manual

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