part 2

[Virtual Presenter] Good morning/afternoon/evening everyone. Today, we will be speaking to you about the case management services that are mandatory for individuals who participate in F-S-W and C-I-H waiver service programs administered by D-D-R-S. Case management is the only mandatory H-C-B-S waiver service for individuals who choose to participate in these programs. Individuals have a choice of C-M-Os and can select a case manager who provides a list of available service providers at any time. In this presentation, we will be discussing the roles and responsibilities of individuals who participate in F-S-W and C-I-H waiver service programs administered by D-D-R-S-, as well as the Office of Administrative Law Proceedings (O-A-L-P-) and its role in processing appeals from people receiving services within F-S-S-A programs, including Medicaid H-C-B-S Waiver programs. We will also be discussing the B-D-S policy and its requirements for individuals to actively and responsibly participate in the administration and management of their Medicaid H-C-B-S waiver supports and services. Thank you for your attention, and we look forward to discussing this topic with you further..

[Audio] We are excited to present the second slide of our presentation on individuals who participate in F-S-W and C-I-H waiver service programs administered by D-D-R-S-. Today, we will be discussing the important role of Case Management. Case Management is a mandatory H-C-B-S waiver service for individuals who choose to participate in these programs, and individuals must have Case Management services in order to access the other services provided by the waiver program. When selecting a case management organization or provider, individuals or their legal representatives must actively participate in the process. This includes choosing a C-M-O or care management agency from a list of DDRS-approved and IHCP-enrolled providers. For newly approved applicants, the list will be generated by the B-D-S--, while for current waiver participants, the list may be generated by the B-D-S or their current provider. Next, individuals or their representatives will have the opportunity to interview and select their case or care manager from the chosen organization. This is an important step as the individual and their case manager will work together to complete the service-planning process. It is crucial for individuals to actively participate in this process and provide all necessary information as it is essential for the proper administration and management of their waiver services. Additionally, if an individual wishes to change their waiver provider for any reason, they must follow the same process of selecting a new case or care manager. This ensures that the individual is involved in their own care and has a say in who provides their services. It is also important to note that the Office of Administrative Law Proceedings (O-A-L-P-) receives and processes appeals from individuals receiving services within F-S-S-A programs, including Medicaid H-C-B-S Waiver programs. This serves as a safeguard for individuals who may have concerns about their services. Finally, our policy at D-D-R-S requires individuals to actively and responsibly participate in the administration and management of their Medicaid H-C-B-S waiver supports and services. This means working collaboratively with our team and other entities with oversight responsibilities to ensure that the individual's needs are met and their services are delivered successfully. Thank you for listening to this section on Roles and Responsibilities in the DDRS HCBS Waivers. Up next, we will be discussing the selection and changes of waiver providers. Stay tuned!.

[Audio] We will discuss the roles and responsibilities of individuals who participate in F-S-W and C-I-H waiver service programs administered by D-D-R-S-. As we know, case management is a mandatory H-C-B-S waiver service for individuals who choose to participate in these programs. Individuals have the option to select a case manager who provides a list of available service providers at any time. Let's focus on risk management. As part of the DDRS HCBS Waivers program, individuals must actively participate in the administration and management of their Medicaid H-C-B-S waiver supports and services. Collaboration with the I-S-T and entities with oversight responsibilities is essential for successful service delivery. To support individuals in navigating risks and reducing negative outcomes, the program requires the development of a risk mitigation plan. This plan should be developed in consultation with the I-S-T and include one plan for each identified risk. It's important to note that all providers must implement the plan, and if a team member disagrees with the components of the plan, it should be discussed with the entire ISt Implementation of the risk mitigation plan requires that all support staff be trained on the plan, and adjustments to the plan are made as needed. At least annually, the team will discuss the continued need for the plan. The goal is not to remove all risks that may exist in everyday life but to support the individual in navigating risks to reduce negative outcomes and potential likelihood of the risk. Risk assessment and planning tools and additional guidance are available on the B-D-S Quality Assurance page at in.gov/fssa/ddrs. These resources include a person-centered risk management webinar recording (6/30/2021), a person-centered risk management PowerPoint (6/30/2021), a risk assessment and planning F-A-Q--, a risk issues identification tool (Word document), and a risk matrix. Now, let's talk about allowing representatives of the state into the individual's home. The individual (or the individual's legal representative, when indicated) must allow representatives from B-D-S--, B-D-S Quality Assurance designees, the selected C-M-O or care management agency, and any DDRS-contracted vendor into the individual's home for visits scheduled at least 72 hours prior. Additionally, H-C-B-S waiver case managers are required to complete unannounced visits with H-C-B-S waiver participants, and participants and/or their legal representatives are expected to allow and participate in these visits as a condition of participation in the H-C-B-S waiver program. Finally, let's talk about consequences for nonparticipation. If individuals (or their legal representative, when indicated) choose not to participate actively and responsibly in the administration and management of their Medicaid H-C-B-S waiver supports and services, the B-D-S may terminate the individual's H-C-B-S waiver participation. If the B-D-S decides to terminate the individual's H-C-B-S Waiver participation pursuant to this policy, the B-D-S must provide the individual (or the individual's legal representative, when indicated) with written notice of intent to terminate the individual's waiver services. Should a termination occur, the individual (or the individual's legal representative, when indicated) has a right to appeal the state's decision..

[Audio] Individuals who choose to participate in F-S-W and C-I-H waiver service programs administered by D-D-R-S must have case management services as it is a mandatory H-C-B-S waiver service. Individuals have the option to choose C-M-Os and can choose a case manager who provides a list of available service providers. It is crucial for individuals to select good providers when choosing a waiver provider. Individuals can make an informed choice by reading information, discussing alternatives with the case/care manager or an advocate, visiting an individual who is currently receiving waiver services, or meeting with various service providers. When meeting with providers or case/care managers, it is important to take notes and maintain accurate information. It is important for individuals to discuss the following with potential service providers during the selection process: what areas of service are absolute requirements, what makes the individual happy, what the individual wants to happen, what are the risks, what is the provider's experience working with individuals with disabilities or elders, how the provider would ensure the implementation of the PCISP, and what connections the provider has established in the community..

[Audio] Individuals who participate in F-S-W and C-I-H waiver service programs administered by D-D-R-S have the freedom to select a Certified Medicaid Organization (C-M-O--) and can choose a case manager who will provide a list of available service providers at any time. If individuals have any concerns or questions about the services they are receiving, they can appeal to the Office of Administrative Law Proceedings (O-A-L-P-). O-A-L-P will receive and process their appeal, and their decision will be binding. To ensure successful delivery of services, it is crucial for individuals to actively and responsibly participate in the administration and management of their Medicaid H-C-B-S waiver supports and services and collaborate with the Individual Support Team (I-S-T--) and entities with oversight responsibilities. When choosing a service provider, individuals should ask the right questions to ensure that the provider's mission aligns with their goals, is certified, accredited or licensed, has safety measures in place, ensures compliance with their rights, shares their goals and needs, and is connected to other programs that they may require. They should also inquire about the provider's complaint policies and procedures, how they handle behavior problems, medication management, smoking policies, and how they schedule and conduct planning meetings. Additionally, individuals should inquire about the provider's contact person, staffing, and how they handle emergencies. Before making a decision, individuals should gather as much information as possible about the provider by asking for references or speaking with other individuals who have used the provider's services. It is crucial to select a service provider who meets their needs and provides a list of available service providers at any time. Individuals should ask questions and gather as much information as possible before making a decision..

[Audio] We are discussing the mandatory H-C-B-S waiver service for individuals who choose to participate in F-S-W and C-I-H waiver service programs administered by D-D-R-S-. Individuals have the option to choose C-M-Os and can select a case manager who provides a list of available service providers at any time. The Office of Administrative Law Proceedings (O-A-L-P-) receives and processes appeals from people receiving services within F-S-S-A programs, including Medicaid H-C-B-S Waiver programs. The B-D-S policy requires individuals to actively and responsibly participate in the administration and management of their Medicaid H-C-B-S waiver supports and services, and successful service delivery depends on collaboration with the I-S-T and entities with oversight responsibilities. When looking for a supported living setting, individuals should consider the following issues: * How do the staff and housemates interact? Do they seem to respect and like each other? * Does the environment look comfortable? Is there enough to do? Are there concerns about behaviors or support in the home? * What kind of food is available and who selects it? Are choices encouraged and available? Are diets supervised? * Do people have access to banks, shops, restaurants and so on? How is transportation handled? Are trips to access these resources planned or do they occur as needed? * Is there a telephone available to housemates (with privacy)? Is the telephone accessible (equipped with large buttons, volume control other access features) if needed? * Does each person have their own bedroom? Is each person allowed to individually decorate the bedroom? * Do housemates seem to get along well? What happens when they don’t? * Are there restrictions on personal belongings? What are the procedures for lost personal items? Are personal items labeled? Are lost items replaced? * Are pets allowed? What are the rules regarding pets? * How much time is spent in active learning (neighborhood, home or community) and leisure activities? Is there a good balance with unstructured time? * Is there evidence that personal hygiene and good grooming (hair, teeth, nails and so on) are encouraged? * How are personal-needs items, clothing and so on, paid for? * Does each person have privacy when they want to be alone or with a special friend? * Does each person have the opportunity to belong to a church, club, community group and so on? * Do staff knock on doors and wait for a response before entering a private room? * What kind of rules are there within the living situation? What are the consequences for breaking rules? * Does each housemate have opportunities to pursue their own individual interests, or do they travel in a group with everyone doing the same thing, attending the same movie and so on?.

[Audio] We are pleased to present to you information about the F-S-W and C-I-H waiver service programs administered by D-D-R-S-. Our focus today is on the mandatory Case Management service that is required for individuals who choose to participate in these programs. Case Management is the only mandatory H-C-B-S waiver service for individuals who participate in F-S-W and C-I-H waiver service programs. Individuals have the flexibility to choose their Case Management Organizations (CMOs) and can select a case manager who provides a list of available service providers at any time. If you require assistance with Case Management, we urge you to contact the Office of Administrative Law Proceedings (O-A-L-P-). O-A-L-P is responsible for receiving and processing appeals from people receiving services within F-S-S-A programs, including Medicaid H-C-B-S Waiver programs. It is important to note that the B-D-S policy requires individuals to actively and responsibly participate in the administration and management of their Medicaid H-C-B-S waiver supports and services. This includes providing information for the purpose of administering and managing waiver services. If you receive requests for documentation from external entities, such as Indiana Vocational Rehabilitation (V-R---), the Disability Determination Bureau (D-D-B--), Social Security Administration (S-S-A--) or attorneys representing individuals in S-S-A cases, the case manager will review the B-D-S Portal to ensure all profile information, including legal status, is correct and up to date. The case manager will then submit the original request for documentation, including a signed release, to FSSA BDS Documentation Requests at BDSdocumentationrequests@fssa.in.gov. If you receive a subpoena, the case manager will review the B-D-S Portal to ensure all profile information, including legal status, is correct and up to date. The case manager will then submit the original request for documentation, including the subpoena, to FSSA BDS Documentation Requests at BDSdocumentationrequests@fssa.in.gov. For more information on Case Management, please refer to the Quality Guide for Case Managers and Case Management Organizations, found under the Resources tab of the B-D-S Portal. We appreciate your attention to this important topic and thank you for your participation in the F-S-W and C-I-H waiver service programs administered by D-D-R-S..

[Audio] We are presenting information on H-C-B-S waiver service programs administered by D-D-R-S-. We are on the tenth slide of our presentation, which is titled Individuals who participate in F-S-W and C-I-H waiver service programs administered by D-D-R-S must have Case Management services. Case Management is the only mandatory H-C-B-S waiver service for individuals who choose to participate in these programs. Individuals have a choice of Community Mental Health Organizations (CMOs) and can select a case manager who provides a list of available service providers at any time. The Office of Administrative Law Proceedings (O-A-L-P-) receives and processes appeals from people receiving services within F-S-S-A programs, including Medicaid H-C-B-S Waiver programs. For the Family Supports Waiver (F-S-W--) and Community Integrated Health (C-I-H--) Waiver, individuals must provide information for the purpose of administering and managing waiver services. Section 2 of our presentation includes information on Provider Information, which is applicable to all Home and Community-Based Services (H-C-B-S-) waivers administered by the Indiana Family and Social Services Administration (F-S-S-A-) Division of Disability and Rehabilitative Services (D-D-R-S-). For the Provider Application Process for F-S-W and C-I-H Waiver Applications, applicants must submit an electronic inquiry to the B-D-S Provider Services email at BDSProviderServices@fssa.in.gov as outlined in the Jan. 1, 2024, policy. If an incomplete application is received, it will be returned to the applicant with instructions to review the requirements and resubmit when the application is complete. An applicant submitting an incomplete application may resubmit an application one additional time during a calendar year. If B-D-S determines that all initial documentation requirements are met, the application is placed in provisional approval status. Prior to receiving final approval from B-D-S--, the applicant's leadership team as documented in the application must attend the B-D-S Leadership Training Series Initial Session within one year of the date of the provisional approval notice. If the application is in provisional approval status one year after the date provisional approval status was granted, it will be considered voluntarily withdrawn..

[Audio] Individuals who wish to participate in F-S-W and C-I-H waiver service programs offered by D-D-R-S have the option to select community-managed organizations (CMOs) and a case manager who can provide a list of available service providers at any time. This allows individuals to have greater control over the services they receive. Case management services are mandatory for individuals participating in these programs, and their successful delivery depends on collaboration with the individual support team (I-S-T--) and entities with oversight responsibilities. When applying for enrollment with the Indiana Medicaid agency, individuals must provide all necessary materials and complete the New Provider Application as instructed. B-D-S Provider Services reviews all application materials and issues a final determination. If approved, the applicant will receive all necessary materials for enrolling with the Indiana Medicaid agency. Applications that do not meet the requirements of Indiana Administrative Code 460 I-A-C 6, D-D-R-S policies, and other regulatory statutes will be denied by B-D-S Provider Services. The applicant will not be able to resubmit a New Provider Application for a period of two years from the date of denial. This denial is considered an administrative action and may be appealed. B-D-S Provider Services also evaluates the performance of F-S-W and C-I-H Waiver service providers and makes a reverification determination at least once every four years. This process assesses the provider's information, documentation, financial information, annual individual satisfaction survey results, and other relevant information. In summary, individuals who wish to participate in F-S-W and C-I-H waiver service programs offered by D-D-R-S have the option to select community-managed organizations (CMOs) and a case manager who can provide a list of available service providers at any time. Case management services are mandatory for individuals participating in these programs, and their successful delivery depends on collaboration with the individual support team (I-S-T--) and entities with oversight responsibilities. When applying for enrollment with the Indiana Medicaid agency, individuals must provide all necessary materials and complete the New Provider Application as instructed. B-D-S Provider Services evaluates the performance of F-S-W and C-I-H Waiver service providers and makes a reverification determination at least once every four years..

[Audio] Good morning, everyone. Today, I would like to speak to you about Case Management services for individuals participating in F-S-W and C-I-H waiver service programs administered by D-D-R-S-. Individuals who choose to participate in these programs must have Case Management services as per the regulations. Case Management is the only mandatory H-C-B-S waiver service for individuals who choose to participate in these programs. Individuals have a choice of C-M-Os and can select a case manager who provides a list of available service providers at any time. Residential and day program providers may choose to obtain accreditation for other waiver services they are approved to provide, though this accreditation is not required. Some accreditation entities accredit the organization, whereas others allow providers to select the services they wish to accredit. The process for reverifying C-I-H and F-S-W providers is outlined in the following D-D-R-S policies: Provider Reverification for Accredited Waiver Services (Revised Oct. 4, 2021) and Provider Reverification for Non-Accredited Waiver Services. Providers who fail to meet the requirements for reverification will receive a notice indicating that they are under a six-month approval and may be referred to the B-D-S Quality Assurance director for civil sanctions or a potential moratorium on new admissions. Additionally, providers who wish to qualify for administrative review of a D-D-R-S order can file a written petition for review that includes facts demonstrating that they are aggrieved or adversely affected by the action and entitled to review under any law filed with the director of the D-D-R-S within 15 calendar days after receiving notice of the sanctioning order. The petition must also be filed with the Office of Administrative Law Proceedings at the specified email or fax number. I hope this information is helpful. Thank you for your attention, and please feel free to ask any questions you may have..

[Audio] We would like to inform everyone that individuals who participate in F-S-W and C-I-H waiver service programs administered by D-D-R-S must have case management services. Case Management is the only mandatory H-C-B-S waiver service for individuals who choose to participate in these programs. Individuals have a choice of C-M-Os and can select a case manager who provides a list of available service providers at any time. The Office of Administrative Law Proceedings (O-A-L-P-) receives and processes appeals from people receiving services within F-S-S-A programs, including Medicaid H-C-B-S Waiver programs. The B-D-S policy requires individuals to actively and responsibly participate in the administration and management of their Medicaid H-C-B-S waiver supports and services, and successful service delivery depends on collaboration with the I-S-T and entities with oversight responsibilities. Section 2: Provider Information DDRS HCBS Waivers Section 2.3: Billing and Reimbursement for Waiver Services The following sections provide general information about billing and reimbursement for DDRS HCBS waiver services. All service providers must verify I-H-C-P eligibility for each member before initiating services. All potential H-C-B-S waiver participants must enroll in the IHCP. Individuals determined eligible for the CIH, FSW, H&W or T-B-I waiver must first be enrolled in Traditional Medicaid – a fee-for-service (F-F-S--) program with full Indiana Medicaid State Plan benefits – before the waiver benefit plan can be assigned in the Core Medicaid Management Information System (CoreMMIS). If a member does not have an active H-C-B-S waiver benefit plan and/or is not enrolled in an appropriate I-H-C-P Medicaid program on the date on which waiver services were provided, any claim submitted for those services may not be paid..

[Audio] We are pleased to present to you the Case Management service, which is mandatory for individuals who participate in Family Supports Waiver and Community Integration and Habilitation Waiver programs. Individuals have the option to choose from Community Management Organizations (CMOs) and can select a case manager at any time who will provide a list of available service providers. It is important to note that individuals must actively and responsibly participate in the administration and management of their Medicaid H-C-B-S Waiver supports and services, requiring collaboration with the Individual Support Team (I-S-T--) and entities with oversight responsibilities. We will now move on to the DDRS HCBS Waivers Section 2: Provider Information. One critical aspect of this section is the transfer-of-property penalty, which can incur when individuals receive certain services, including institutional services from nursing facilities and other medical institutions where members receive equivalent care, as well as the following H-C-B-S waiver programs: Community Integration and Habilitation (C-I-H--) Waiver, Family Supports Waiver (F-S-W--), Health and Wellness (H&W) Waiver, and Traumatic Brain Injury (T-B-I--) Waiver. The transfer-of-property penalty is a period during which a member who is transferring assets will be ineligible for Medicaid services, as required by federal guidelines. Providers can determine whether a member is in the transfer-of-property penalty period using IHCP EVS options, such as the I-H-C-P Portal or E-D-I transaction. Claims submitted for these services during a member’s transfer-of-property penalty period will be denied. The 21st Century Cures Act directs state Medicaid programs to require providers of personal care services and home health services to use an electronic visit verification (E-V-V--) system to document services rendered. For applicable services, federal law requires that providers use the E-V-V system to document the following information: Date of service, location of service, individual providing service, type of service, and individual receiving service, as well as the time the service begins and ends. In accordance with federal requirements, the I-H-C-P requires providers to use an E-V-V system to document designated personal care services, including applicable CIH, FSW, H&W, and T-B-I waiver services, rendered on or after Jan. 1, 2021. Providers may choose to use an E-V-V system other than Sandata. However, those providers will be required to export data from their alternate system to the Sandata “Aggregator” for integration with CoreMMIS. The Aggregator will capture E-V-V data from both Sandata users and from users of alternate E-V-V systems. Additional information and resources on E-V-V--, system specifications, services requiring E-V-V--, and training are available on the I-H-C-P Electronic Visit Verification page at in.gov/medicaid/providers. Thank you for your attention. If you have any questions, please feel free to contact me..

[Audio] We would like to discuss the case management services that individuals who participate in F-S-W and C-I-H waiver service programs administered by D-D-R-S must have. While case management is not mandatory for all individuals in these programs, it is the only mandatory H-C-B-S waiver service. Individuals have the choice of C-M-Os and can select a case manager who provides a list of available service providers at any time. When it comes to billing for H-C-B-S waiver services, there are a few important things to keep in mind. Professional claims can be submitted via the I-H-C-P Provider Healthcare Portal, the 837P electronic transaction, or paper copies of the CMS-1500 form. Providers must register on the I-H-C-P Portal before they can use it to submit claims, verify member eligibility, and maintain enrollment data. To submit a claim using the 837P electronic transaction, the provider must become an I-H-C-P trading partner. For assistance, contact the electronic data interchange (E-D-I--) technical assistance line at 800-457-4584 (option 3 and then option 3). It is important to note that the fiscal agent and the F-S-S-A recommend submitting claims electronically. When billing Medicaid waiver claims, the provider must consider the following: * The I-H-C-P does not reimburse for time spent by office staff billing claims. * Providers may bill only for services that were authorized on an approved service authorization and delivered to the member. * A claim may include dates of service within the same month. Claims may not be submitted with dates that span more than one month on the same claim..