DDRS Waiver Manual

Complete, submit, and follow up on incident reports in a timely fashion using the State-approved
process, including notifying the family/guardian of the incident outcome, all of which must be
verifiable by documented supervisory oversight and monitoring of the Case Management agency.
Monitor participants’ health and welfare.
Monitor participants’ satisfaction and service outcomes.
Monitor claims submitted through the approved Medicaid Management Information System (MMIS)
and pertaining to waiver-funded services.
At minimum, the Case Management agency must provide a 60-day notice to the participant (and to
his or her legal guardian, if applicable) prior to the termination of Case Management services.
Upon request of the participant and/or his or her legal guardian, if applicable, the participant’s most
recently selected Case Management agency must provide a pick list of alternate DDRS-approved
Case Management provider agencies and assist the participant in selecting a new provider of Case
Management.
Noting the participants’ have right to select and transition to a new provider of Case Management services at
any time, only one Case Management provider agency may bill for the authorized monthly unit of Case
Management services during any given month. With the state’s approval of the participant’s POC/CCB, a
single prior authorization of the monthly Case Management service unit will be sent from the administrative
agency (DDRS) to the contractor of the MMIS. Therefore, it is recommended that transitions from one Case
Management agency to another occur on the first day of the month. When transitions occur on other days of
the month, the two providers of Case Management services must determine which provider agency will bill
and whether one agency owes the other a portion of the monthly fee. Providers will handle any such
transactions and/or arrangements amongst themselves, with both (or all) provider agencies being held
responsible for documenting these transactions in regard to future financial audits.
Documentation Standards
Case Managers must perform and document at least one meaningful activity on behalf of the individual
waiver participant each calendar month.
Preferred practice calls for activity to be documented via case note within 48 hours of a Case Management
activity or event. At a minimum, a case note must be completed within seven calendar days of an activity or
event.
Section 10.6: Community Based Habilitation – Group
Service Definition
Community-Based Habilitation Services - Group are services provided outside of the participant’s home that
support learning and assistance in the areas of self-care, sensory/motor development, socialization, daily
living skills, communication, community living, and social skills. Community-based activities are intended to
build relationships and natural supports.
Community settings are defined as non-residential, integrated settings that are primarily in the community
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