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1 CHAPTER 513 Intellectual AND developmental disabilities W AIVER (IDDW ) BMS Provider Manual Page 1 Chapter 513 Intellectual and developmental disabilities Waiver (IDDW) Effective 4/1/2021 DISCLAIMER: This chapter does not address all the complexities of Medicaid policies and procedures, and must be supplemented with all State and Federal Laws and Regulation. Contact BMS Fiscal Agent for coverage, prior authorization requirements, service limitations and other practitioner information. TABLE OF CONTENTS SECTION PAGE NUMBER Background .. 8 Program Description .. 8 Provider Enrollment And Participation Requirements.

2 9 Bureau For Medical Services (BMS) Contractual Relationships .. 9 Pr ovider Enr ollment And Res pons ibilities .. 9 Criminal Background Checks .. 14 Office Criteria .. 14 Quality Improvement System (QIS) .. 15 Centers for Medicare And Medicaid Services (CMS) Quality Assurances .. 15 Quality Improvement Advisory (QIA) Council .. 16 IDDW Provider Reviews .. 16 Plan of Correction .. 17 Training and Technical Assistance .. 17 Self-Reviews .. 18 Utilization Guidelines for IDDW .. 18 Provider Agency Certification (Case Management-Only) .. 19 Staff Qualific ations and T raining R equir em ents .. 20 Behavior Support Professional (BSP) Agency Staff 21 Behavior Support Professional I (BSP I) Agency Staff Qualifications.

3 21 Behavior Support Professional II (BSP II) Agency Staff Qualifications .. 21 Crisis Services Agency Staff Qualifications .. 22 CHAPTER 513 Intellectual AND developmental disabilities W AIVER (IDDW ) BMS Provider Manual Page 2 Chapter 513 Intellectual and developmental disabilities Waiver (IDDW) Effective 4/1/2021 DISCLAIMER: This chapter does not address all the complexities of Medicaid policies and procedures, and must be supplemented with all State and Federal Laws and Regulation. Contact BMS Fiscal Agent for coverage, prior authorization requirements, service limitations and other practitioner information.

4 Dietary Therapist Agency Staff Qualifications .. 22 Facility-Based Day Habilitation Agency Staff Qualifications .. 22 Job Development Agency Staff Qualifications .. 22 Occupational Therapist Agency Staff Qualifications .. 22 Person-Centered Support Agency Staff Qualifications .. 22 Physical Therapist Agency Staff Qualifications .. 23 Pre-Vocational Agency Staff Qualifications .. 23 Qualified Support W orkers (QSW) Qualifications (Personal Options Only) .. 23 Respite Agency Staff Qualifications .. 24 Case Management Agency Staff Qualifications .. 24 Skilled Nursing Agency Staff Qualifications .. 24 Speech Therapist Agency Staff Qualifications.

5 25 Stand-By Intervention Agency Staff Qualifications .. 25 Supported Employment Agency Staff Qualifications .. 25 Transportation Services Agency Staff Qualifications .. 25 Repor ting Requir em ents .. 25 Doc um entation and R ecor d Retention R equirem ents .. 27 Eligibility and Enrollment .. 29 Applicant Eligibility and Enr ollm ent Pr oc ess .. 29 Application Process .. 29 Initial Eligibility Determination Process .. 29 Initial Medical Eligibility .. 31 Diagnosis .. 32 CHAPTER 513 Intellectual AND developmental disabilities W AIVER (IDDW ) BMS Provider Manual Page 3 Chapter 513 Intellectual and developmental disabilities Waiver (IDDW) Effective 4/1/2021 DISCLAIMER: This chapter does not address all the complexities of Medicaid policies and procedures, and must be supplemented with all State and Federal Laws and Regulation.

6 Contact BMS Fiscal Agent for coverage, prior authorization requirements, service limitations and other practitioner information. Functionality .. 32 Active Treatment .. 33 Initial Financial Eligibility .. 33 Determination of Initial Financial Eligibility .. 33 Slot Allocation Referral and Selection Process .. 34 Eligibility Effective 35 Annual R e-D eter m ination of Eligibilit y Process .. 35 Annual Re-Determination of Medical Eligibility .. 35 Annual Re-Determination of Financial Eligibility .. 36 Policy .. 36 Individual Pr ogr am Plan ( IPP) .. 36 The Interdisciplinary Team (IDT) .. 39 Seven-Day IDT Meeting .. 40 30-Day IDT Meeting.

7 41 Transfer/Discharge IDT Meeting .. 41 Critical Juncture IDT Meeting .. 42 Annual, Quarterly, and Six-Month IDT Meetings .. 42 Descr iption of Service Options .. 42 Traditional Service Option .. 43 Participant-Directed Service Option .. 44 Behavior Support Professional Services .. 48 Behavior Support Professional I and II (Traditional Option) .. 48 CHAPTER 513 Intellectual AND developmental disabilities W AIVER (IDDW ) BMS Provider Manual Page 4 Chapter 513 Intellectual and developmental disabilities Waiver (IDDW) Effective 4/1/2021 DISCLAIMER: This chapter does not address all the complexities of Medicaid policies and procedures, and must be supplemented with all State and Federal Laws and Regulation.

8 Contact BMS Fiscal Agent for coverage, prior authorization requirements, service limitations and other practitioner information. Behavior Support Professional I and II, Individual Program Planning (Traditional Option) .. 51 Crisis Services .. 52 Crisis Services (Traditional Option) .. 52 Extended Professional Services .. 53 Dietary Therapy (Traditional Option) .. 53 Occupational Therapy (Traditional Option) .. 55 Physical Therapy (Traditional Option) .. 56 Speech Therapy (Traditional Option) .. 57 Dietary Therapy (Participant-Directed Option, Personal Options Model) .. 59 Occupational Therapy (Participant-Directed Option, Personal Options Model).

9 60 Physical Therapy (Participant-Directed Option, Personal Options Model) .. 62 Speech Therapy (Participant-Directed Option, Personal Options Model) .. 63 Electronic 64 Electronic Monitoring (Traditional Option) .. 64 Environmental Accessibility Adaptations .. 67 Environmental Accessibility Adaptations Home (Traditional Option) .. 67 Environmental Accessibility Adaptations Vehicle (Traditional Option) .. 68 Environmental Accessibility Adaptations Home (Participant-Directed Option, Personal Options Model) .. 69 Environmental Accessibility Adaptations Vehicle (Participant-Directed Option, Personal Options Model) .. 71 Day Services.

10 72 Facility-Based Day Habilitation (Traditional Option) .. 72 CHAPTER 513 Intellectual AND developmental disabilities W AIVER (IDDW ) BMS Provider Manual Page 5 Chapter 513 Intellectual and developmental disabilities Waiver (IDDW) Effective 4/1/2021 DISCLAIMER: This chapter does not address all the complexities of Medicaid policies and procedures, and must be supplemented with all State and Federal Laws and Regulation. Contact BMS Fiscal Agent for coverage, prior authorization requirements, service limitations and other practitioner information. Pre-Vocational (Traditional Option).