part 12

[Virtual Presenter] Good morning/afternoon/evening ladies and gentlemen, and welcome to today's presentation on DDRS HCBS Waivers. We are delighted to have the opportunity to discuss with you the important requirements for remote support devices, emergency response drills, and incident reporting, as well as the many benefits of this non-invasive and flexible option for individuals and families to build life skills and independence..

[Audio] Remote support devices have become increasingly popular, providing individuals and families with flexibility and non-invasive options to build life skills and independence. However, it is important for providers to understand the limitations of these devices. Certain activities are not allowed under remote supports, including concurrent use with structured family caregiving services, monitoring direct care staff, and camera usage in bathrooms or bedrooms. Providers must meet specific criteria to be approved and enrolled as an active Medicaid provider and FSSA DDRS-approved, and comply with Indiana Administrative Code, 460 I-A-C 6. Remote support devices may serve as a potential replacement for P-A-C or R-H-S services under the F-S-W or C-I-H waiver, but they are not billable during the same time period. Providers must also comply with policies and procedures as of July 1, 2024. It is essential for providers to understand these requirements to effectively utilize remote support devices under DDRS HCBS waivers..

[Audio] We present the requirements for the use of remote support devices, emergency response drills, and incident reporting. These requirements offer a non-invasive and flexible option for individuals and families to develop life skills and independence..

[Audio] We are pleased to present to you on DDRS HCBS waivers. Our presentation today will focus on the requirements for utilizing remote support devices, emergency response drills, and incident reporting. First, we will discuss remote support devices. These devices are designed to assist individuals in performing daily tasks and activities. They can include a variety of devices, such as speech recognition software, hearing aids, and mobility devices. Next, we will discuss emergency response drills. These drills are designed to prepare individuals for emergency situations, such as natural disasters or other unexpected events. Finally, we will discuss incident reporting. This process involves the reporting of any incidents or accidents that occur while an individual is receiving DDRS HCBS waivers. In summary, DDRS HCBS waivers include essential requirements for the utilization of remote support devices, emergency response drills, and incident reporting. These requirements are designed to ensure the safety and well-being of individuals receiving DDRS HCBS waivers..

[Audio] We welcome you to our presentation on DDRS HCBS Waivers. These waivers have specific requirements for the use of remote support devices, emergency response drills, and incident reporting. They also provide a non-invasive and flexible option for individuals and families to develop life skills and independence..

[Audio] Individuals with developmental disabilities may require different levels of support based on their individual needs. The following Algo score/descriptors/ICAP/OBA are used to determine the necessary level of support for individuals with developmental disabilities: Level 0: Individuals with an Algo score of zero (0) are highly independent and require minimal support. They have no significant behavioral issues and only require minimal residential habilitation services. Level 1: Individuals with an Algo score of one (1) are moderately independent and may require some support. They may have behavioral needs that can be managed with medication or informal guidance from caregivers through the Medicaid State Plan services. They may also require day programming and light residential habilitation services for certain tasks, but can be left unsupervised for most of the day and night. Level 2: Individuals with an Algo score of two (2) are moderately independent but require frequent support. They may have behavioral needs that can be managed with medication or light therapy every one (1) to two (2) weeks. They do not need 24-hour support, but may require structure and routine throughout the day. They can sleep unsupervised but need support during the day. Level 3: Individuals with an Algo score of three (3) require full-time support for medical and/or behavioral needs that are not very intense. This support can be provided in a shared staff setting. Level 4: Individuals with an Algo score of four (4) require full-time support for medical and/or behavioral needs that are moderately intense. This support includes 24/7 staff interaction and requires line of sight supervision. This level can generally be managed in a shared staff setting. Level 5: Individuals with an Algo score of five (5) require full-time support with absolute line of sight supervision 24/7. Their needs are intense and they require the full attention of a caregiver at all times, with a one-to-one staff to individual ratio. This level is typically only necessary for individuals with very intense needs..

[Audio] At our presentation, we are discussing the requirements for utilizing remote support devices, emergency response drills, and incident reporting under DDRS HCBS waivers. We want to make it clear that these waivers offer a non-invasive and flexible option for individuals and families to build life skills and independence. We understand that some individuals may have exceptional needs that require more than one caregiver exclusively devoted to them for at least part of each day. We also recognize that there is a risk of harm to the individual and others without vigilant support. To ensure that individuals receive the appropriate level of care, we have selected the Inventory for Client and Agency Planning (I-C-A-P-) as the primary tool for individual assessment. The I-C-A-P assessment determines an individual's level of functioning for broad independence and general maladaptive factors. The I-C-A-P addendum, commonly referred to as the behavior and health factors, determines an individual's level of functioning on behavior and health factors. These two assessments determine an individual's overall Algo score, which can range from 0-6. We recognize that individuals with Algo scores between 0 and 6 are considered outliers representing those who are the lowest and the highest on both ends of the functioning spectrum. We understand that individuals who receive an Algo score of 5 may continue to receive the Algo 5 budget but may require additional oversight to ensure their safety and well-being. To build the allocations, we have designed a grid with the following tenets playing key roles: Focus on daytime programming, employment, community integration, and housemates. We have determined the objective-based allocation (O-B-A--) by combining the overall Algo score (determined by the I-C-A-P and I-C-A-P addendum), age, employment, and living arrangement. We want to make it clear that individuals designated as Algo 3, 4, or 5 and meeting criteria for R-H-S Daily services may choose to use R-H-S Daily. We also want to note that RHS-hourly services are available only under the C-I-H Waiver and are not available under the F-S-W--. We recommend that individuals and families review the policies and procedures for RHS-hourly services as of July 1, 2024, version 11.1, which can be found under Library Reference Number PRPR10014151. In conclusion, DDRS HCBS waivers include requirements for utilization of remote support devices, emergency response drills, and incident reporting, while also offering a non-invasive and flexible option for individuals and families to build life skills and independence. We believe that by focusing on daytime programming, employment, community integration, and housemates, we can build the allocations that are best suited for each individual's needs..

[Audio] We are pleased to present DDRS HCBS waivers, which provide individuals and families with a flexible and non-invasive option for building life skills and independence. These waivers require specific utilization of remote support devices, emergency response drills, and incident reporting. The Direct Support, Monitoring and Training (R-H-S--) program offers reimbursable activities, such as assistance with personal care, meals, shopping, errands, chore and leisure activities, and transportation (excluding transportation that is covered under the Indiana Medicaid State Plan). Direct service staff must be aware and active individuals in the development and implementation of PCISP, behavior support plans, and risk plans. Coordination and facilitation of medical and non-medical services to meet healthcare needs, such as physician consults, medications, development and oversight of a health plan, utilization of available supports in a cost-effective manner, and maintenance of each individual’s health record when the individual receiving R-H-S does not also use wellness coordination services, are also reimbursable activities. When wellness coordination services are used in addition to RHS-hourly services, the wellness coordinator is responsible for the development, oversight, and maintenance of a wellness coordination plan and the health-related risk plan. However, a comprehensive medical risk plan may substitute for the wellness coordination plan or individual risk plans. The registered nurse/licensed practical nurse (RN/LPN) determines the appropriate mode of training to be used for the direct support professional to ensure implementation of risk plans. Additionally, the RN/LPN ensures completion of training of the direct support professional to ensure implementation of risk plans. Group services/shared staffing is reimbursable at the unit rate divided by the number of individuals sharing R-H-S staffing. However, group services/shared staffing is not billable at a 1:1 ratio. All RHS-hourly documentation must include the following: services must be outlined in the PCISP, a data record of staff-to-individual service must document the complete date and time entry (including a.m. or p.m.), and all staff members who provide uninterrupted, continuous service in direct supervision or care of the individual must make one entry. If a staff member provides interrupted service (one hour in the morning and one hour in the evening), an entry for each unique encounter must be made. All entries should describe an issue or circumstance concerning the individual. We are committed to ensuring that individuals and families have access to the services they need to build life skills and independence. DDRS HCBS waivers provide individuals and families with a flexible and non-invasive option for achieving these goals while also meeting regulatory requirements..

[Audio] Providers are required to follow DDRS HCBS waivers in order to ensure the safety and well-being of individuals receiving H-C-B-S waiver services. These waivers entail the use of remote support devices, conducting emergency response drills, and reporting any incidents. They also provide a non-invasive and flexible option for individuals and families to develop life skills and gain independence. It is imperative for all providers to comprehend and adhere to the specific requirements outlined in Section 10 of the waivers, including staffing, documentation, and reporting. Furthermore, providers must ensure appropriate use of RHS-hourly services without any limitations. As professionals, it is crucial to meet all requirements for DDRS HCBS waivers in order to deliver safe and effective services to individuals and families. By complying with these requirements, we can collaborate towards creating a better future for those who require support and services..

[Audio] Our organization provides information on the DDRS HCBS waivers, which include the use of remote support devices, emergency response drills, and incident reporting. These waivers also offer a non-invasive and flexible option for individuals and families to develop life skills and gain independence. According to Section 10 of the DDRS HCBS waivers, F-S-W and C-I-H waivers specify the definitions and requirements for these services. It is not permitted to provide services to a minor by their parents, stepparents, or legal guardian, or to an individual by their spouse. Additionally, services are not allowed for individuals receiving structured family caregiving or children's foster care services, or for services available under the Indiana Medicaid State Plan. Providers must meet certain criteria to become DDRS-approved. This includes being an active Medicaid provider, complying with 460 I-A-C 6, and meeting qualifications for Residential Habilitation and Support Services, Criminal History Documentation, Insurance, Financial Status, Health Care Coordination Services, Staff Training and Training, Transportation Services, and Transportation Supports. Additionally, providers must follow any applicable B-D-S service standards, guidelines, policies, and/or manuals, as well as FSSA DDRS policies and this module, which can be accessed from the I-H-C-P Provider Reference Modules page at in.gov/medicaid/providers. It is crucial to understand these waivers and their requirements in order to ensure that individuals receive the necessary support and services to build life skills and gain independence..

[Audio] We are pleased to announce that the DDRS HCBS waivers have been updated to include new requirements for the use of remote support devices, emergency response drills, and incident reporting. These updates provide a non-invasive and flexible option for individuals and families to build life skills and independence. We believe that these changes will greatly benefit individuals and families who may require additional support in navigating the community. In order to maintain the highest quality of care, our R-H-S providers are required to obtain accreditation by at least one of the following organizations: CARF, CQL, JCAHO, NCQA, ISO-9001, Council on Accreditation, or an independent national accreditation organization approved by the F-S-S-A Secretary. We recognize the importance of accessing high-quality services and are committed to ensuring that our providers meet these standards. Our daily Residential Habilitation and Support (RHS daily) services are available under the C-I-H Waiver and are tailored to assist with the acquisition, retention, or improvement of skills related to living in the community. These services help maintain current levels of functioning and support, provide ongoing coordination of care, and ensure that new or additional needs are identified and addressed by the person-centered planning team. We want to note that RHS-daily services are only available under the C-I-H Waiver and not under the F-S-W--. Additionally, there are policies and procedures in place to ensure the safety and well-being of individuals who receive R-H-S services. We are proud to be at the forefront of these advancements and are committed to providing the highest quality of care to our clients..

[Audio] We are an author and voiceover script writer of this presentation on DDRS HCBS Waivers. Our focus is on ensuring that individuals have access to the support and resources they need to lead fulfilling lives. We believe that DDRS HCBS Waivers are a crucial non-invasive and flexible option for individuals and families to build life skills and independence. To be eligible for R-H-S daily services, individuals must have an Algo score of 3, 4, or 5 on their objective-based allocation (O-B-A--), live with housemates and use a shared staffing model, or live outside their family home. We have designed a grid to build our allocations based on the following tenets: focus on daytime programming, employment, community integration, and housemates. Our reimbursable activities include assistance with acquiring, enhancing and building natural supports, working with the individual to meet the goals they have set for themselves on their PCISP, and training the individual to enhance their homemaking skills, meal preparation, household chores, money management, shopping, communication skills, social skills, and positive behavior..

[Audio] We are discussing the provisions of the DDRS HCBS waivers. These provisions require the use of remote support devices, emergency response drills, and incident reporting. They offer a flexible option for individuals and families to build life skills and independence. The waivers have specific provisions for transportation, wellness services, and maintenance of health records. Remote support services are only allowable when billed as a component of R-H-S daily. When wellness coordination services are used in addition to RHS-daily services, the wellness coordinator is responsible for the development, oversight, and maintenance of a wellness coordination plan and the health-related risk plan. The RN/LPN is responsible for determining the appropriate mode of training for direct support professionals to ensure implementation of risk plans. The RN/LPN also ensures completion of training of the direct support professional to ensure implementation of risk plans. Additionally, the waivers include service standards, such as addressing needs identified in the person-centered planning process and complementing but not duplicating habilitation services provided in other settings. Additionally, the individual must be present and receive R-H-S daily services for at least a portion of any day the provider bills as a day of R-H-S daily service. Finally, the waivers have documentation standards, such as requiring a minimum of one daily note for each day the individual is present and receiving R-H-S daily services, with appropriate elements, documenting one or more distinct actions or behaviors as outlined in the Reimbursable Activities section. The R-H-S daily service provider must be able to demonstrate through relevant time keeping records or other similar documentation which staff members were working during the R-H-S daily service provided upon audit, or upon request by the state or its contracted agents..

[Audio] We will discuss the specific guidelines and limitations for DDRS HCBS waivers. These waivers allow individuals and families to develop life skills and gain independence through non-invasive and flexible options. We will focus on service definitions and requirements for the F-S-W and C-I-H waivers. Providers must comply with 460 IAC 6 and provide quarterly summaries as specified by B-D-S--. Additionally, we will discuss the requirements for monthly, quarterly, and/or annual outcome data that must be reported as specified by B-D-S and uploaded to the state's case management system's library. Reimbursable waiver-funded residential habilitation services provided by a paid relative and/or legal guardian have limitations. These services cannot exceed a total of 40 hours per week per paid caregiver, and the individual receiving services must be present and receive daily R-H-S services for at least a portion of the day that the provider is billing for. Remote support services are included in the daily rate of R-H-S services, and providers must adhere to all remote support service standards as defined within the definition. Providers cannot bill for R-H-S daily reimbursement during times when staff or paid caregivers are asleep. Only awake and engaged staff can be counted for reimbursement. Providers may only bill for R-H-S daily reimbursement when an individual is admitted to an acute care hospital for inpatient medical care or surgery, or for acute medical conditions or injuries, adhering to all conditions specified in Section 2.3 for claims. Thank you for your attention and participation in this presentation. We hope you now have a better understanding of the requirements and limitations for the DDRS HCBS waivers. Please feel free to reach out if you have any further questions or concerns..