DDRS Waiver Manual

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Signature that includes at least the last name and first initial of the direct care staff person making the entry. Electronic signatures are permissible when in compliance with the Uniform Electronic Transactions Act (IC 26-2-8). Upon request, all data elements must be made available to auditors, quality monitors, Case Managers, and any other government entity. *The data may reside in multiple locations but must be clearly and easily linked to the participant or the standard will not be met. As applicable, monthly/quarterly reports must be uploaded to Advocare by the chosen service provider on or before the fifteenth day of the following month For Group Services Upon request, the provider must be able to verify, in a concise format, that the ratio for each claimed time frame of service did not exceed the maximum allowable ratio, whether or not all group participants use a waiver funding stream. Limitations The following limitations apply to Community-Based Habilitation-Group Services: The following are limitations on group sizes: o Small groups (4:1 or smaller) o Medium groups (5:1 to 10:1) Habilitation services reimbursement does not include reimbursement for the cost of the activities in which the individual is participating when they receive skills training, such as the cost to attend a community event. Activities Not Allowed The following activities are not allowed under Community-Based Habilitation Services – Group: Services that are available under the Rehabilitation Act of 1973 or PL 94-142. Skills training for any activity that is not identified as directly related to an individual habilitation outcome. Activities that do not foster the acquisition and retention of skills. Services furnished to a minor by parent(s), stepparent(s), or legal guardian. Services furnished to a participant by the participant’s spouse. Services rendered in a facility. Group size in excess of 10:1. 98
Section 10.7: Community Based Habilitation – Individual Service Definition Community-Based Habilitation Services − Individual services 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. Note: Community settings are defined as non-residential, integrated settings that are primarily out in the community where services are not rendered within the same buildings alongside other non-integrated participants Reimbursable Activities. Reimbursable Activities Reimbursable activities include the following: Monitoring, training, education, demonstration, or support to assist with the acquisition and retention of skills in the following areas: Leisure activities and community/public events (for example, integrated camp settings) Educational activities Hobbies Unpaid work experiences (for example, volunteer opportunities) Maintaining contact with family and friends Training and education in self-direction designed to help participants achieve one or more of the following outcomes: Develop self-advocacy skills Exercise civil rights Acquire skills that enable self-control and responsibility for services and supports received or needed Acquire skills that enable the participant to become more independent, integrated, or productive in the community Service Standards Community-Based Habilitation Services must be reflected in the ISP. Services must address needs identified in the person-centered planning process and be outlined in the ISP. Documentation Standards Community-Based Habilitation Services – Individual documentation must include services outlined in the ISP: Need for service continuation and justification of goals is to be evaluated annually and reflected in the ISP In addition to compliance with documentation requirements outlined in 460 IAC 6, the following data elements are required for each service rendered: Name of participant served 99
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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,
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If an individual declines the offer
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waiver slot when it appears that th
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Five calendar days to interview and
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The individual or guardian has sign
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Section 6: Objective Based Allocati
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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 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: where services are not rendered wit
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
Page 137 and 138: The following activities are not al
Page 139 and 140: maintaining natural supports, physi
Page 141 and 142: tool for individual assessment. The
Page 143 and 144: o o o o o Individuals receiving RHS
Page 145 and 146: (C) requires minimal residential ha
Page 147 and 148: 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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