DDRS Waiver Manual

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Section 10.1: Service Definition Overview This section of the manual lists service definitions for the services currently approved for the Home and Community Based Services (HCBS) waiver programs administered by the Division of Disability and Rehabilitative Services (DDRS). Each service definition includes the following information: A definition of the service. A list of reimbursable (allowable) activities for the service. Service standards Documentation standards Limitations A list of activities not allowed And in some cases, additional information or clarifications that are unique to the service Note that some services are not available under both waivers. Please refer to Sections 4.5 and 4.6 for the lists of available waiver services unique to each waiver. A chart (Table 10.2) containing procedure (billing) codes and modifiers as well as unit rates is found in Section 10.2. Additional Information Facility settings are defined as non-residential, non-integrated settings that take place within the same building(s) for the duration of the service rather than being out in the community. Community settings are defined as non-residential, integrated settings that are primarily out in the community where services are not rendered within the same building(s) alongside other nonintegrated participants. By March 17, 2019, all services will be compliant with the HCBS Final Rule settings requirements as outlined in Indiana’s Statewide Transition Plan. Section 10.2: Medicaid Waiver Services, Codes, and Rates Table 10.2 – Medicaid Waiver Services, Codes, and Rates for Community Integration and Habilitation Waiver (CIH Waiver) and Family Supports Waiver (FSW) Effective July 2016 See the Rate Charts at www.in.gov/fssa/ for the most recent information. 86
Medicaid Waiver Services, Codes, and Rates, Effective July 1, 2016 For Family Supports (FSW) Waiver and Community Integration and Habilitation (CIH) Waiver And Money Follows the Person – Community Integration and Habilitation (MFP-CIH) Grant Waiver Type Modifiers FSW CIH MFP- CIH INsite Code Service Description Natl. Code 1 2 3 4 Rate Unit/ Size Unit/$ Limit • • • ADS1 Adult Day Services, Level 1 S5101 U7 U5 U1 $21.95 .50/Day 2 Units/ Day • • • ADS2 Adult Day Services, Level 2 S5101 U7 U5 U2 $28.80 .50/Day 2 Units/ Day • • • ADS3 Adult Day Services, Level 3 S5101 U7 U5 U3 $34.29 .50/Day 2 Units/ Day • • • AS14 Adult Day Services, ¼ Hour, Level 1 S5100 U7 U5 U1 $1.38 .25/Hour 12 Units/Day • • • AS24 Adult Day Services, ¼ Hour, Level 2 S5100 U7 U5 U2 $1.80 .25/Hour 12 Units/Day • • • AS34 Adult Day Services, ¼ Hour, Level 3 S5100 U7 U5 U3 $2.14 .25/Hour 12 Units/Day • • • BMGO Behavior Management, Basic H0004 U7 U5 U2 $18.20 .25/Hour • • • BG1O Behavior Management, Level 1 H0004 U7 U5 U1 $18.20 .25/Hour • • CMGT Case Management T2022 U7 U5 $131.25 1.00/Month 1 Unit/Month • CMGT Case Management T2022 U7 U5 $125.00 1.00/Month 1 Unit/Month • • • CHIO Community Habilitation, Individual T2020 U7 U5 $23.67 1.00/Hour • • • CHG2 Community Habilitation, Group (2:1) T2020 U7 U5 U2 $8.48 1.00/Hour • • • CHG3 Community Habilitation, Group (3:1) T2020 U7 U5 U3 $8.48 1.00/Hour Community Habilitation, Group ( • • • CHG4 4:1) T2020 U7 U5 U4 $8.48 1.00/Hour • • • CHG6 Community Habilitation, Group (6:1) T2020 U7 U5 U6 $4.72 1.00/Hour • • • CHG8 Community Habilitation, Group (8:1) T2020 U7 U5 U8 $4.72 1.00/Hour Community Habilitation, Group T2020 1.00/Hour • • • CHGB (10:1) U7 U5 UB $4.72 • • CT Community Transition T2038 U7 U5 Individual 1.00/Unit $1,000 Lifetime • • EM1 Electronic Monitoring, 1 Participant A9279 U7 U5 UA $13.62 1.00/Hour • • EM2 Electronic Monitoring, 2 Participants A9279 U7 U5 U2 $6.81 1.00/Hour • • EM3 Electronic Monitoring, 3 Participants A9279 U7 U5 U3 $4.54 1.00/Hour • • EM4 Electronic Monitoring, 4 Participants A9279 U7 U5 U4 $3.41 1.00/Hour • • EMOI Environmental Modification, Install S5165 U7 U5 NU Individual 1.00/Unit $15,000 Lifetime Environmental Modification, • • EMOM Maintain S5165 U7 U5 U8 Individual 1.00/Unit $500/Year • • • INSP Equipment – Assess/Inspect/Train T1028 U7 U5 $17.99 .25/Hour • • • EXTS Extended Services T2025 U7 U5 UA $35.20 1.00/Hour • • • FBS Facility Based Support T1020 U7 U5 UA $1.85 1.00/Hour • • • FHIO Facility Habilitation, Individual T2020 U7 U5 UA $23.67 1.00/Hour • • • FHG2 Facility Habilitation, Group (2:1) T2020 U7 U5 UA U2 $8.48 1.00/Hour • • • FHG4 Facility Habilitation, Group (4:1) T2020 U7 U5 UA U4 $8.48 1.00/Hour • • • FHG6 Facility Habilitation, Group (6:1) T2020 U7 U5 UA U6 $4.72 1.00/Hour • • • FHG8 Facility Habilitation, Group (8:1) T2020 U7 U5 UA U8 $4.72 1.00/Hour • • • FHGB Facility Habilitation, Group (10:1) T2020 U7 U5 UA UB $4.72 1.00/Hour • • • FHGC Facility Habilitation, Group (12:1) T2020 U7 U5 UA UC $3.00 1.00/Hour • • • FHGD Facility Habilitation, Group (14:1) T2020 U7 U5 UA UD $3.00 1.00/Hour • • • FHG9 Facility Habilitation, Group (16:1) T2020 U7 U5 UA U9 $3.00 1.00/Hour • • • FCAR Family & Caregiver Training, Family S5111 U7 U5 Individual 1.00/Unit $2,000/Year Family & Caregiver Training, Non- • • • FCNF Family S5116 U7 U5 Individual 1.00/Unit $2,000/Year • • • Intensive Behavioral Intervention, IBI1 Level 1 H2020 U7 U5 U1 $104.60 1.00/Hour • • • Intensive Behavioral Intervention, IBI2 Level 2 H2020 U7 U5 U2 $25.00 1.00/Hour • • • MUTH Music Therapy H2032 U7 U5 U1 $10.78 .25/Hour • • • OCTH Occupational Therapy G0152 U7 U5 UA $17.99 .25/Hour • PAC Participant Assistance and Care T2033 U7 U5 $23.24 1.00/Hour • • • PRSI Personal Response System, Install S5160 U7 U5 $52.07 1.00/Unit 2 Units/CCB 87
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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
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personal beliefs and customs, ensur
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Section 5.1: Request for Applicatio
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Internet access, call toll free 1-8
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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 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: Section 10.24: Recreational Therapy
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
Page 129 and 130: Homeschooling, special education, a
Page 131 and 132: or before the fifteenth day of the
Page 133 and 134: o Medium (5:1 to 10:1) o Larger (la
Page 135 and 136: 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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