DDRS Waiver Manual

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Introduce relevant documentary evidence Establish all pertinent facts and circumstances Present any arguments without interference Question or refute any testimony or evidence presented by the other party, including the opportunity to confront and cross-examine any adverse witnesses Examine the appellant’s entire case record and all documents and records used by the DDRS/BDDS Service Coordinator or other District representative, the DDRS Central Office, or DDRS/BDDS Waiver Unit at the hearing The parties are advised at the close of the hearing that they will be informed in writing of the Administrative Law Judge’s decision. Note: See Section 8.9 and Section 8.10 of this manual. The State shall ensure that the appellant receives the State’s exhibits and the appellant shall ensure that the State receives any exhibits submitted by the appellant prior to the day of the hearing. Section 8.12: Continuance of Hearing If the Administrative Law Judge determines that further evidence is needed to reach a decision, the decision is delayed until such further evidence is obtained. The hearing may also be reconvened, if necessary, to obtain additional testimony. The parties will be notified of this and of the time and method for obtaining this evidence. Any evidence submitted must be copied and given to the opposite party, who then has the opportunity for rebuttal. Section 8.13: The Hearing Record The hearing record is an official report containing the transcript or recording of the testimony of the hearing, together with all papers and requests filed in the proceeding, and the decision of the Administrative Law Judge. Section 8.14: The Fair Hearing Decision A written copy of the Administrative Law Judge’s hearing decision is sent to all parties. The decision includes: The findings of fact and conclusions of law regarding the issue under appeal, and Supporting laws and regulations 74
In all cases, the decision of the Administrative Law Judge is based solely on the evidence introduced at the hearing and the appropriate federal and State laws and regulations. The Administrative Law Judge signs the decision, which also contains the findings of fact and the conclusion of law. The decision is to be explained to the appellant upon request. Section 8.15: Actions of the Administrative Law Judge’s Decision Unless an Agency Review is requested, the decision of the Administrative Law Judge shall be binding upon the DDRS or the Office of Medicaid Policy and Planning and is to be enacted. Section 8.16: Agency Review Any party may request an Agency Review if dissatisfied with the decision made by the Administrative Law Judge. The Agency Review request must be made in writing to the FSSA’s Office of Hearings and Appeals (OHA) or the ultimate agency authority, within 10 calendar days following receipt of the hearing decision. After an Agency Review is requested, the OHA or the ultimate agency authority will write to all parties to acknowledge receipt of the request and to provide information concerning the review. No new evidence will be considered during the Agency Review; however, any party may submit a written Memorandum of Law, citing evidence in the record, for consideration. The Secretary of the FSSA or the Secretary’s designee shall complete the agency review. The decision made at Agency Review will be sent to all appropriate parties. Section 8.17: Judicial Review The appellant, if not satisfied with the final action, may file a petition for judicial review in accordance with IC 4-21.5-5. Section 8.18: Lawsuit If a lawsuit is filed, all inquiries should be directed to the FSSA Office of General Counsel or the Attorney General’s Office. 75
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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
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Section 3: Additional Medicaid Prog
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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 and 70: Objective-based allocation (OBA): T
Page 71 and 72: administrative hearing must still b
Page 73: The person testifying should be the
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,
Page 121 and 122: programmed, constructive interactio
Page 123 and 124: 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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