DDRS Waiver Manual

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Section 9: Bureau of Quality Improvement Services Section 9.1: Overview Section 9.2: Provider Compliance Reviews Section 9.3: Incident Reports Section 9.4: Complaints Section 9.5: Mortality Reviews Sections 9.1 – 9.6 Section 9.6 National Core Indicator (NCI) Project Section 9.7: Statewide Waiver Ombudsman Return to Table Of Contents 76
Section 9.1: Overview The Family and Social Services Administration’s (FSSA’s) Bureau of Quality Improvement Services (BQIS) within the Division of Disability and Rehabilitative Services (DDRS) is responsible for developing and implementing quality improvement and quality assurance systems to assure the health and welfare of individuals receiving Medicaid Home and Community Based waiver services. The DDRS/BQIS activities include developing policy, conducting provider compliance reviews, complaint investigations, mortality reviews, and managing the State’s automated system for reporting incidents of abuse, neglect, and exploitation. Information about the DDRS/BQIS can be found at in.gov/fssa/ddrs on the Bureau of Quality Improvement page at in.gov/fssa/ddrs under Programs & Services. Section 9.2: Provider Compliance Reviews The DDRS/BQIS is responsible for assuring that the providers of Supportive Living Services are in compliance with Indiana Administrative Code and DDRS Policies, and therefore continue to meet the waivers’ qualifications to provide services. The DDRS/BQIS fulfills this oversight function by conducting provider compliance reviews. The Compliance Evaluation and Review Tool (CERT) is designed to capture provider compliance with Indiana Administrative Code and DDRS Policies in the following focus areas: The provider meets qualifications for waiver services being delivered; The provider has policies and procedures to ensure the rights of individuals, to direct appropriate services, and to support and manage employees; The provider maintains employee information confirming key health, welfare and training issues (this includes validating that the provider conducts criminal background checks) ; and Quality assurance and quality improvement. All providers are required to go through a provider compliance review within 12 months of being approved to provide waiver services. Depending on providers’ accreditation status specific to Indiana programs, providers may be required to go through subsequent provider compliance reviews at least once every three years. Provider compliance reviews take place onsite. Following the review, providers receive a report of findings and a request to develop a corrective action plan. The DDRS/BQIS validates that the corrective action plan is being implemented. There are two different versions of the CERT – one for non-direct, ancillary service providers, and another for all other types of providers. As DDRS continues to issue new policies the CERT will be updated accordingly. 77
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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
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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 and 74: The person testifying should be the
Page 75: In all cases, the decision of the A
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
Page 125 and 126: 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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