Home and Community-Based Services Waiver s

1 ,'. INDIANA HEALTH COVERAGE PROGRAMS. PROVIDER REFERENCE MODULE. Division of Disability and Rehabilitative Services home and Community-Based Services Waivers LIBRARY REFERENCE NUMBER: PRPR10014. PUBLISHED: AUGUST 24, 2017. POLICIES AND PROCEDURES AS OF APRIL 1, 2017. VERSION: Copyright 2017 DXC Technology, All Right Reserved Revision History Version Date Reason for Revisions Completed By Policies and Procedures as of Initial Release FSSA. November 1, 2012. Published: June 10, 2013. Policies and Procedures as of Scheduled review FSSA and HP.

2 December 1, 2013. Published: April 23, 2014. Policies and Procedures as of Scheduled review FSSA and HP. June 1, 2014. Published: November 6, 2014. Policies and Procedures as of Scheduled review FSSA and HP. December 1, 2014. Published: February 24, 2015. Policies and Procedures as of Updates to Section 6, including FSSA and HP. December 1, 2014 updated tables Published: May 12, 2015. Policies and Procedures as of Scheduled review FSSA and HP. June 1, 2015. Published: September 8, 2015. Policies and Procedures as of Conversion to modular format, FSSA and HPE.

3 October 1, 2015 scheduled review Published: February 25, 2016. Policies and Procedures as of Scheduled review, updates to FSSA and HPE. April 1, 2016 section numbering due to Published: June 21, 2016 removal of Services in certain sections. Policies and Procedures as of CoreMMIS updates FSSA and HPE. April 1, 2016. CoreMMIS updates as of: February 13, 2017. Published: April 13, 2017. Policies and Procedures as of Scheduled review FSSA and DXC. April 1, 2016 DDRS updates DDRS. CoreMMIS updates as of: Legislative Mandate DDRS.

4 February 13, 2017 Clarification of TPL for OMPP. Published: August 24, 2017 HCBS FSSA Audit/SUR. Updated BMR Section CMS guidance OMPP/DDRS. based on bulletin on FSSA website released in 2016. Rate chart updates to match IHCP bulletin from 2016. Added in Third Party Library Reference Number: PRPR10014 iii Published: August 24, 2017. Policies and procedures as of April 1, 2017. CoreMMIS updates as of February 13, 2017. Version: DDRS HCBS Waivers Table of Contents Version Date Reason for Revisions Completed By Liability Language FSSA Audit Language Statewide Transition Plan date updated iv Library Reference Number: PRPR10014.

5 Published: August 24, 2017. Policies and procedures as of April 1, 2017. CoreMMIS updates as of February 13, 2017. Version: Table of Contents Section 1: Roles and Responsibilities .. 1. Section : The Centers for Medicare & Medicaid Services (CMS) .. 1. Section : FSSA's Division of Disability and Rehabilitative Services (DDRS) .. 1. Section : The Bureau of Developmental Disabilities Services (BDDS).. 2. Section : The Bureau of Quality Improvement Services (BQIS) .. 2. Section : FSSA's Office of Medicaid Policy and Planning (OMPP).

6 2. Section : Case Management Agencies .. 3. Section : FSSA's Division of Family 3. Section : Waiver Service Providers .. 3. Section : Hearings and Appeals .. 4. Section : Participant and Guardian Information .. 4. Section 2: Provider Information .. 9. Section : Approval Process .. 9. Section : Requirements for Providers of Case Management .. 10. Section : Requirements for All Providers (Excluding Case Management) .. 10. Section : Provider Reapproval .. 11. Section : Claims and Billing .. 12. Financial Oversight.

7 13. Waiver Audits .. 13. FSSA Audit Oversight .. 14. Medicaid Fraud Control Audit Overview .. 14. Section 3: Additional Medicaid Information .. 17. Section : Other Program Information .. 17. Section : Medicaid Prior Authorization and Funding Streams .. 17. Section 4: Intellectual/Developmental Disabilities Services 19. Section : Medicaid Waiver Overview .. 19. Section : State Definition of Intellectual/Developmental Disability .. 19. Section : Cost Neutrality .. 20. Section : Coordination with Medicaid State Plan Services .

8 20. Section : Family Supports Waiver (FSW).. 20. Section : community Integration and Habilitation Waiver (CIH Waiver ).. 22. Section 5: Application and Start of Waiver Services .. 25. Section : Request for Application .. 25. Section : Medicaid Eligibility .. 25. Section : Initial Level of Care Evaluation .. 25. Section : Waiting List for the Family Supports Waiver .. 26. Section : Targeting Process for the Family Supports Waiver .. 28. Section : Entrance into the community Integration and Habilitation Waiver Program.

9 29. Section : Initial Plan of Care/Cost Comparison Budget (POC/CCB) Development .. 32. Section : State Authorization of the Initial POC/CCB .. 32. Section : Initial Service Plan Implementation .. 34. Section 6: Objective- based Allocation (OBA) .. 37. Section : OBA Overview and Development .. 37. Section : ICAP Assessment and Algo Level Development .. 37. Section : Algo Level Descriptors per 460 IAC 13 .. 38. Section : Translating Algo Level into a Budget Allocation .. 39. Section : Budget Review Questionnaire (BRQ) and Budget Modification Review (BMR)41.

10 Section : Implementation of Objective- based Allocations .. 44. Section : Personal Allocation Review (PAR) and the Appeal Process .. 44. Library Reference Number: PRPR10014 v Published: August 24, 2017. Policies and procedures as of April 1, 2017. CoreMMIS updates as of February 13, 2017. Version: DDRS HCBS Waivers Table of Contents Section 7: Monitoring and Continuation of Waiver Services .. 47. Section : Level of Care Re-Evaluation .. 47. Section : Medicaid Eligibility Re-Determination .. 47. Section : Annual Plan of Care/Cost Comparison Budget (POC/CCB) Development.