Home and Community-Based Services Waivers

1 INDIANA HEALTH COVERAGE programs . PROVIDER REFERENCE MODULE. Division of Aging home and Community-Based Services Waivers LIBRARY REFERENCE NUMBER: PRPR10013. PUBLISHED: AUGUST 8, 2017. POLICIES AND PROCEDURES AS OF APRIL 1, 2017. CoreMMIS UPDATES AS OF FEBRUARY 13, 2017. VERSION: Copyright 2017 DXC Technology Revision History Version Date Reason for Revision Completed By Policies and Procedures as of Initial release FSSA. January 1, 2013. Published: June 10, 2013. Policies and Procedures as of Semiannual review FSSA and November 1, 2013 DXCW aiver Published December 19, 2013 Analyst Policies and Procedures as of Semiannual review FSSA and May 1, 2014 DXCW aiver Published August 5, 2014 Analyst Policies and Procedures as of Semiannual review FSSA and November 1, 2014 DXCW aiver Published January 8, 2015 Analyst Policies and Procedures as of Semiannual review FSSA and May 1, 2015 DXCW aiver Published July 16, 2015 Analyst Policies and Procedures as of Update to modular style, FSSA and DXC.

2 October 1, 2015 semiannual review Published February 25, 2016. Policies and Procedures as of Semiannual review FSSA and DXC. April 1, 2016. Published June 28, 2016. Policies and procedures as of CoreMMIS updates FSSA and DXC. April 1, 2016. CoreMMIS updates as of February 13, 2017. Published: March 23, 2017. Policies and procedures as of Semiannual review FSSA and DXC. April 1, 2017. CoreMMIS updates as of February 13, 2017. Published: August 8, 2017. Statewide Transition Plan CMS 1500 updates Third Party Liability OGC exclusionary list Library Reference Number: PRPR10013 iii Published: August 8, 2017. Policies and procedures as of April 1, 2017. CoreMMIS updates as of February 13, 2017.

3 Version: Table of Contents Section 1: Introduction .. 1. Overview .. 1. Indiana Health Coverage programs waiver Provider Responsibilities .. 1. Provider Responsibilities Specific to the waiver Program .. 4. waiver Provider Application and 4. waiver Provider Enrollment .. 5. DA waiver Provider Information Updates .. 7. Section 2: Claims and Billing .. 9. Overview .. 9. Eligibility for HCBS waiver Services Affects 9. waiver Authorization .. 9. Billing Instructions .. 10. Claim Tips and Reminders .. 10. Claim Voids and Replacements .. 11. Division of Aging HCBS waiver Rates .. 11. Section 3: Quality Assurance/Quality Improvement .. 15. Quality Monitoring .. 15.

4 Incident 16. Complaint Resolution .. 17. Mortality Review .. 17. Quality Reviews .. 18. Quality Improvement Strategy Process .. 18. Section 4: Financial Oversight .. 21. waiver Audits .. 21. FSSA Audit Oversight .. 21. Medicaid Fraud Control Audit Overview .. 21. Section 5: Division of Aging Waivers .. 23. Overview .. 23. Level of Care (LOC) .. 23. Aged & Disabled waiver .. 24. Traumatic Brain Injury waiver (TBI) .. 25. Section 6: Case Management .. 27. For Aged & Disabled (A&D) and Traumatic Brain Injury (TBI) Waivers .. 27. Case Management Monitoring Standards .. 28. Section 7: Service Definitions .. 33. Service Definition 33. Adult Day Services .. 33. Adult Family Care.

5 36. Assisted Living .. 40. Attendant Care .. 42. Behavior Management/Behavior Program and Counseling .. 45. Case Management .. 46. community Transition .. 50. Environmental 52. Environmental Modification Assessment .. 58. Healthcare Coordination .. 60. home -Delivered Meals .. 62. Homemaker Services .. 63. Library Reference Number: PRPR10013 v Published: August 8, 2017. Policies and procedures as of April 1, 2017. CoreMMIS updates as of February 13, 2017. Version: DA HCBS Waivers Table of Contents Nutritional Supplements .. 65. Personal Emergency Response System .. 66. Pest Control .. 67. Residential- based 69. Respite Services .. 71. Specialized Medical Equipment and Supplies.

6 73. Structured Day 77. Structured Family Caregiving .. 78. Supported 80. Transportation .. 82. Vehicle Modifications .. 84. Section 8: Provider Help .. 89. INsite Communication Instructions .. 89. Helpful Websites .. 89. Helpful Contact Numbers .. 89. Communications .. 91. vi Library Reference Number: PRPR10013. Published: August 8, 2017. Policies and procedures as of April 1, 2017. CoreMMIS updates as of February 13, 2017. Version: Section 1: Introduction Overview Section 1915(c) of the Social Security Act permits states to offer, under a waiver of statutory requirements, an array of home and Community-Based Services (HCBS) that an individual needs to avoid institutionalization.

7 These programs allow the state of Indiana's Medicaid program to provide Services that would ordinarily be provided only in an institution in an individual's home or other community setting. Individuals must qualify for institutional care to be eligible for home and Community-Based Services . The term waiver refers to waiving of certain federal requirements that otherwise apply to Medicaid program Services . For example, home and Community-Based Services or Waivers are not Medicaid entitlement programs . The Family and Social Services Administration (FSSA) has overall responsibility for the waiver programs ;. day-to-day administration and operation of individual waiver programs is delegated to divisions within FSSA.

8 The Division of Aging (DA) offers two waiver programs : The Aged & Disabled (A&D) waiver The Traumatic Brain Injury (TBI) waiver Individuals and their families may find additional information courtesy of the Indiana Governor's Council for People with Disabilities website at Indiana Health Coverage programs waiver Provider Responsibilities Complete information on provider enrollment, eligibility, and responsibilities is available in the Provider Enrollment provider reference module at IHCP Provider Agreement Medicaid-enrolled HCBS waiver providers are enrolled in the Indiana Health Coverage programs (IHCP). and have executed an IHCP Provider Agreement with the FSSA.

9 This agreement states that the provider will comply, on a continuing basis, with all the federal and State statutes and regulations pertaining to the IHCP, including the waiver programs ' rules and regulations. The IHCP Provider Agreement is included in the enrollment application; see the HCBS waiver Provider Enrollment section of this module for details. By signing the agreement, the provider agrees to follow the information provided in the IHCP Provider Reference Modules, as amended periodically, including the Division of Aging home and Community-Based Services Waivers module, as amended periodically, as well as all provider bulletins, banners, and notices.

10 All amendments to the IHCP Provider Reference Modules, including the Division of Aging home and Community-Based Services Waivers module, and all applicable Indiana Administrative Codes (IACs), Rules, and Regulations are binding on publication. The Division of Aging home and Community-Based Services Waivers module and all publications are available online on the Provider Reference Materials page at The information is made available to assist all those who administer, manage, and participate in the A&D. and TBI waiver programs . The information and direction in this module replaces all previous HCBS waiver documents. Current HCBS waiver requirements can be found in the CMS approved applications and the Aging Rule, 455 IAC 2.