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. 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.

2 June 1, 2015. Published: September 8, 2015. Policies and Procedures as of Conversion to modular format, FSSA and HPE. 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. 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.

3 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. 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) .. 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 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 .. 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 .. 20. Section : Family Supports Waiver (FSW).. 20. Section : community Integration and Habilitation Waiver (CIH Waiver ).. 22. Section 5: Application and Start of Waiver Services .

5 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 .. 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. Section : Implementation of Objective- based Allocations .. 44. Section : Personal Allocation Review (PAR) and the Appeal Process.

6 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 .. 47. Section : Plan of Care/Cost Comparison Budget (POC/CCB) Updates and 49. Section : State Authorization of the Annual/Update Cost Comparison Budget .. 50. Section : Service Plan Implementation and 50. Section : Interruption/Termination of Waiver Services .. 51. Section : Waiver Slot Retention after Termination and Re-Entry .. 52. Section : Parents, Guardians, and Relatives Providing Waiver Services .. 53. Section 8: Appeal Process .. 55. Section : Appeal Request .. 55. Section : Group Appeals .. 56. Section : Time Limits for Requesting Appeals.

7 56. Section : The Hearing Notice .. 57. Section : Request for Continuance from the Appellant .. 57. Section : Review of Action .. 58. Section : Disposal of Appeal without a Fair Hearing .. 58. Section : The Fair Hearing .. 58. Section : Preparation for Hearing by Appellant .. 59. Section : Preparation for Hearing by the BDDS Service Coordinator or District representative, BDDS Waiver Unit, or the DDRS Central Office .. 60. Section : Conduct of the Hearing .. 60. Section : Continuance of Hearing .. 61. Section : The Hearing Record .. 61. Section : The Fair Hearing Decision .. 61. Section : Actions of the Administrative Law Judge's Decision .. 61. Section : Agency Review .. 62. Section : Judicial Review .. 62. Section : Lawsuit .. 62. Section 9: Bureau of Quality Improvement Services .. 63. Section : Overview .. 63. Section : Provider Compliance Reviews .. 63. Section : Incident Reports .. 64. Section : Complaints .. 65. Section : Mortality Reviews .. 66. Section : National Core Indicator (NCI) Project.

8 67. Section : Statewide Waiver Ombudsman .. 67. Section 10: Service Definitions and Requirements .. 69. Section : Service Definition 69. Section : Medicaid Waiver Services , Codes, and Rates .. 69. Section : Adult Day Services .. 74. Section : Behavioral Support Services .. 77. Section : Community-Based Habilitation Services Group .. 79. Section : Community-Based Habilitation Services Individual .. 82. Section : community Transition .. 84. Section : Electronic Monitoring .. 86. Section : Environmental 91. Section : Facility- based Habilitation Group .. 93. Section : Facility- based Habilitation Individual .. 96. Section : Facility- based Support Services .. 99. Section : Family and Caregiver Training .. 101. Section : Intensive Behavioral Intervention .. 103. Section : Music Therapy .. 106. vi Library Reference Number: PRPR10014. Published: August 24, 2017. Policies and procedures as of April 1, 2017. CoreMMIS updates as of February 13, 2017. Version: Table of Contents DDRS HCBS Waivers Section : Occupational Therapy.

9 108. Section : Personal Emergency Response System .. 110. Section : Physical Therapy .. 111. Section : Prevocational Services .. 113. Section : Psychological Therapy .. 117. Section : Recreational Therapy .. 119. Section : Rent and Food for Unrelated Live-in 121. Section : Residential Habilitation and Support (Hourly) .. 123. Section : 126. Section : Specialized Medical Equipment and Supplies .. 129. Section : Speech/Language Therapy .. 131. Section : Transportation (as Specified in the FSW) .. 133. Section : Transportation (as Specified in the CIH Waiver ) .. 135. Section : Workplace Assistance .. 137. Section : Case Management .. 140. Section : Participant Assistance and Care .. 145. Section : Structured Family Caregiving .. 148. Section : Wellness Coordination .. 151. Section : Extended Services .. 154. Section 10:34 RHS Daily .. 158. Section 11: RFA Policies .. 165. Section : Environmental Modification Policy .. 165. Section : Specialized Medical Equipment and Supplies .. 170.

10 Section : Vehicle Modification .. 175. Library Reference Number: PRPR10014 vii Published: August 24, 2017. Policies and procedures as of April 1, 2017. CoreMMIS updates as of February 13, 2017. Version: Section 1: Roles and Responsibilities Section : The Centers for Medicare & Medicaid Services (CMS). The Centers for Medicare & Medicaid Services (CMS), under the Department of Health and Human Services , is the federal agency that administers the Medicare and Medicaid programs that provide healthcare to the aged and indigent populations. In Indiana, the Medicaid program provides Services to indigent families, children, pregnant women, senior citizens, persons with disabilities, and persons who are blind. To provide home and Community-Based Medicaid Services as an alternative to institutional care, 1915(c) of the Social Security Act allows states to submit a request to the CMS to waive certain provisions in the Social Security Act that apply to state Medicaid programs: A Waiver of comparability of Services allows states to offer individuals in target groups Services that are different from those the general Medicaid population receives.