Application for a §1915(c) Home and Community- Based ...

1 Application for a 1915(c) home and community - Based services WaiverPURPOSE OF THE HCBS waiver PROGRAMThe Medicaid home and community - Based services (HCBS) waiver program is authorized in 1915(c) of the Social Security Act. The program permits a state to furnish an array of home and community - Based services that assist Medicaid beneficiaries to live in the community and avoid institutionalization. The State has broad discretion to design its waiver program to address the needs of the waivers target population. waiver services complement and/or supplement the services that are available to participants through the Medicaid State plan and other federal, state and local public programs as well as the supports that families and communities Centers for Medicare & Medicaid services (CMS) recognizes that the design and operational features of a waiver program will vary depending on the specific needs of the target population, the resources available to the state, service delivery system structure, state goals and objectives, and other factors.

2 A State has the latitude to design a waiver program that is cost-effective and employs a variety of service delivery approaches, including participant direction of for a Renewal to a 1915(c) home and community - Based services Waiver1. Major ChangesDescribe any significant changes to the approved waiver that are being made in this renewal Application : Application for 1915(c) HCBS waiver : - Jul 16, 2020 Page 1 of 34406/17/2020 Appendix A Section 3 Use of Contracted Entities modified description of the responsibilities of the Quality Assurance/Quality Improvement (QA/QI) contractor to include complaint investigation, provider re-approval, and data driven review. Section 6 Assessment Methods and Frequency modified BQIS frequency of meetings and other responsibilities regarding oversight and monitoring of the QA/QI contractor.

3 Changes were made to the performance measures in the Quality Improvement section: o Several performance measures that had been in this Appendix were moved from to their respective appendices per the CMS Region V Quality Review Final Report on the Family Supports waiver (dated 3/29/19). Measure AA re-numbered 1 ; the data source was updated. Measure AA re-numbered 2 ; the data source was updated. Measure AA re-numbered 3 ; the data source was updated. o The following measures were moved out of Appendix A: Measure AA was moved to Appendix B Measure AA was moved to Appendix D o Previous measures AA , AA , and AA were removed due to being duplicative of other performance measures. Section Methods for Remediation/Fixing Individual Problems removed information about performance measures no longer in Appendix A.

4 Appendix B Section B-2 Individual cost limit removed no longer applicable language. The tables in section B-3 were updated to reflect current participant figures and capacity figures. Section B-3-c Reserved waiver capacity - added a third purpose to this section for a child of an active member or veteran of the armed forces of the United States or the National Guard. Changes were made to the performance measures in the Quality Improvement section: o Measure LOC re-numbered 1. Changes were made to the frequency of data aggregation and analysis. o Measure LOC removed per the CMS Region V Quality Review Final Report on the Family Supports waiver (dated 3/29/19). o The following performance measures that were moved from Appendix A are now included in the Quality Improvement: Level of Care section of Appendix B-6: Previous measure AA moved from Appendix A and re-numbered 2.

5 The data source was updated. Previous measure LOC removed due to overlap with measure LOC Previous measure LOC re-numbered 3 and the data source was updated. Previous measure LOC re-numbered 4 and the data source was updated. Section b. Methods for Remediation/Fixing Individual Problems updated to reflect information about performance measures added to Appendix B. Appendix B-7 Freedom of choice: Updated to reflect current processes for acquiring and documenting waiver participants freedom of choice. Appendix C Section C-2. modified description of Indiana s abuse registry screening process. Made changes to performance measures in the Quality Improvement section: o Measure QP re-numbered 1 ; the data source was updated.

6 O Measure QP re-numbered 2 ; modified to measure number and percent of providers who submitted a signed DDRS Medicaid waiver Provider Agreement upon renewal. o Measure QP re-numbered 3 ; the data source was updated. o Measure QP re-numbered 5 ; the data source was updated. Section b. Methods for Remediation/Fixing Individual Problems - updated to reflect performance measure changes made in Appendix C. Updated frequency of data aggregation and analysis. Section f. Open Enrollment of Providers added provider re-approval processes developed and posted to the provider website in September 2017. Section C-3 o Updated the Indiana Administrative Code (IAC) citations and titles in the provider qualifications section of every service description.

7 O Made some edits to every service description for clarity and readability, and to align with current waiver service terminology. o Added two new services to provide consistency between the services included in the community Integration and Habilitation (CIH) and FS Waivers: Application for 1915(c) HCBS waiver : - Jul 16, 2020 Page 2 of 34406/17/2020 Environmental modifications the definition and limitations are identical to the service definition and limitations for the same service in the CIH waiver ; Remote supports the definition is similar to the service definition for the same service in the CIH waiver . For FSW participants, there is a limitation of $500 of remote supports available outside of the annual cap.

8 O Updated the service definitions for the following statutory services to better align with current Indiana policy and practice: Adult day services Case management Prevocational services Respite o Updated the service definitions for the following other services to better align with current Indiana policy and practice: Behavioral support services Family and caregiver training Intensive behavioral intervention Music therapy Specialized medical equipment and supplies Transportation o Created a new definition under other services for day habilitation (effective 8/1/2020) replacing community - Based habilitation (group and individual) and facility- Based habilitation (group and individual). The new definition for day habilitation is intended to give more flexibility to waiver participants and providers as it includes language allowing the services to be provided to waiver participants in a variety of settings in the community or in a facility owned or operated by a DDRS-approved provider.

9 Added language to clarify that the large group ratio size of 11:1 to 16:1 applies only to a facility setting. Added language that FSSA/DDRS-approved day habilitation service providers include community - Based habilitation service providers and facility- Based habilitation service providers. Cited the 7/31/2020 termination date of community - Based habilitation group, community - Based habilitation individual, facility- Based habilitation group, and facility- Based habilitation individual services . o Family and caregiver training: Increased reimbursement limit to $5000/year. Added reimbursable activities and two activities that are not allowed to the description to provide clarity for service providers and participants regarding what is allowable or not.

10 O Participant Assistance and Care furnished to an adult waiver participant by a paid relative and/or legal guardian caregiver may not exceed a total of 40 hours per week per caregiver. The decision to use a paid relative and/or legal guardian caregiver must be documented in the individual s PCISP must be done in a manner consistent with Section of the Indiana Health Coverage Programs Provider Reference Module for DDRS home and community Based Waivers. Section C-5 updated to reflect Indiana s Statewide HCB Settings transition plan as submitted to CMS (dated October 2018). Appendix D Section D-1 o Updated to reflect Indiana s person-centered service planning development process with details regarding Charting the LifeCourse (CTLC) Framework.