DDRS Waiver Manual

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Copies of the CERT Guides, findings templates, and a process map are available on the DDRS/BQIS web page DDRS/BQIS web page under the Compliance Evaluation and Review Tool category. Indiana Code requires all residential habilitation, day program, and case management providers to be accredited (specific to Indiana programs) by any of the following accreditation entities: o The Commission on Accreditation of Rehabilitation Facilities (CARF), or its successor o The Council on Quality and Leadership in Supports for People with Disabilities (CQL), or its successor o The Joint Commission on Accreditation of Healthcare Organizations (JCAHO), or its successor o The ISO-9001 Quality Management System o An independent national accreditation organization approved by the secretary Residential and day program providers may choose to obtain accreditation for other waiver services that they are approved to provide, however this is not required. Some accreditation entities accredit the organization, whereas others allow providers to select the services they wish to accredit. The DDRS/BQIS will not conduct compliance reviews on any accredited services. This means if a provider chooses to accredit only some of its services, BQIS will continue to conduct provider compliance reviews on all of the provider’s non-accredited services. All services are reviewed at least once every three years, by BQIS or the accreditation entity of the provider’s choosing. Section 9.3: Incident Reports Incident Reporting The DDRS/BQIS is responsible for managing DDRS’s Incident Reporting System. Providers are responsible for reporting incidents through the State’s web-based system, the Incident Review and Follow-up Reporting Tool (IFUR). Reportable incidents are defined as: Any event or occurrence characterized by risk or uncertainty resulting in or having the potential to result in significant harm or injury to an individual or death of an individual. According to Indiana Administrative Code and DDRS policy, the following types of events are reportable: Alleged, suspected, or actual abuse, neglect, or exploitation of an individual. This includes physical, sexual, emotional/verbal, and domestic abuse. An incident in this category shall also be reported to Adult Protective Services or Child Protection Services as applicable. The provider shall suspend staff involved in an incident from duty pending investigation by the provider. Peer to peer aggression that results in significant injury. Death of an individual. A death shall also be reported to Adult Protective Services or Child Protection Services as applicable. If death is a result of alleged criminal activity, the death must be reported to law enforcement. 78
Structural or environmental issues with a service delivery site that compromise the health and safety of an individual. Fire that jeopardizes or compromises the health or welfare of an individual Elopement of an individual that results in evasion of required supervision as described in the ISP as necessary for the individual’s health and welfare. Missing person when an individual wanders away and no one knows where they are. Alleged, suspected or actual criminal activity by: a staff member, employee, or agent of a provider; or an individual receiving services. An emergency intervention for an individual resulting from a physical symptom, a medical or psychiatric condition, or any other event. Injury to an individual when the origin or cause of the injury is unknown and the injury requires medical evaluation or treatment. A significant injury to an individual, including but not limited to: o a fracture, o a burn greater than first degree, o choking that requires intervention, o bruises or contusions larger than three inches or lacerations requiring more than basic first aid, o any puncture wound penetrating the skin, o any pica ingestion requiring more than first aid A fall resulting in injury, regardless of severity of the injury. A medication error, except for refusal to take medications, including the following: o Medication given that was not prescribed or ordered for the individual, or wrong medication. o Failure to administer medication as prescribed, including: incorrect dosage, missed medication, wrong route, and failure to give medication at the appropriate time. o Medication error that jeopardizes an individual’s health and welfare and requires medical attention. Use of any aversive technique including but not limited to: o Seclusion, o Painful or noxious stimuli, o Denial of a health related necessity, o Other aversive technique identified by DDRS Policy. Use of any PRN (as needed/when necessary) medication related to an individual’s behavior. Use of any physical or mechanical restraint regardless of whether it was planned, was approved by a Human Rights Committee, or if there was informed consent. View the full incident reporting policy at http://www.in.gov/fssa/files/Incident_Reporting_and_Management.pdf 79
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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
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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 and 76: In all cases, the decision of the A
Page 77: Section 9.1: Overview The Family an
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
Page 127 and 128: 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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