part 13

[Virtual Presenter] Hello everyone and welcome to our presentation on DDRS HCBS Waivers. In this presentation, we will be discussing the requirements for providers of DDRS HCBS Waivers, including qualifications, compliance with various regulations, and the need for accreditation from approved organizations. Let's start with the qualifications required for providers. To be eligible for a DDRS HCBS Waiver, providers must be enrolled as an active Medicaid provider and be DDRS-approved. In addition, providers must comply with various regulations related to residential habitation and support services, documentation of criminal histories, insurance, financial status, health care coordination services, direct care staff, transportation services, and B-D-S service standards. In terms of accreditation, providers must obtain and maintain accreditation from at least one of the approved organizations, such as the Commission on Accreditation of Rehabilitation Facilities (C-A-R-F-), the Council on Quality and Leadership In Supports for People with Disabilities, the Joint Commission on Accreditation of Healthcare Organizations (J-C-A-H-O), the National Committee for Quality Assurance, the ISO-9001 human services quality assurance (Q-A---) system, the Council on Accreditation, or an independent national accreditation organization approved by the F-S-S-A Secretary. Thank you for your attention, and we look forward to discussing these requirements in more detail in the following slides..

[Audio] Our presentation will focus on the specifications for Respite services under the F-S-W and C-I-H Waiver. Respite services are accessible to individuals who are unable to care for themselves and are provided on a short-term basis. These services can be provided in the individual’s home or place of residence, in the respite caregiver’s home, in a camp setting, in a DDRS-approved Day Habilitation facility, or in a nonprivate residential setting. Respite nursing care (R-N---) or Respite nursing care L-P-N--) services may only be delivered when skilled care is necessary, as documented in the PCISP. It is crucial to remember that Respite must be documented in the PCISP, and providers must adhere to the service standards outlined in our presentation. We hope that these requirements will help ensure the safe and effective delivery of Respite services to individuals in need..

[Audio] We will be discussing qualifications, compliance with regulations, and the need for accreditation from approved organizations for providers of DDRS HCBS Waivers. When it comes to service definitions and requirements for F-S-W and C-I-H Waivers, there are certain documentation standards that must be followed. A service note can include multiple discrete services, as long as discrete services are clearly identified. A service note must include the individual name, I-H-C-P Member ID of the individual, date of service, provider rendering service, and primary location of services rendered. Additionally, an activity summary for each block of time this service is rendered must exist and must include duration, service, a brief description of activities, significant medical or behavioral incidents requiring intervention, or any other situation that is uncommon for the individual. A staff signature must be present for each block of time claimed on a service note. A new entry is not required unless a different discrete service is provided. As applicable, monthly/quarterly reports must be uploaded to the document library of the state's case management system by the chosen service provider on or before the 15th day of the following month. For Group Services, the provider must be able to verify, in a concise format, that the ratio for each claimed time frame of service did not exceed the maximum allowable ratio, whether or not all group individuals use a waiver funding stream. Electronic signatures are acceptable if the provider has a log on file showing the staff member's electronic signature, actual signature, and printed name. It's important to note that waiver-funded Respite services may not be rendered in a nursing facility. The following activities are not allowed under Respite: reimbursement for room and board, services provided to an individual living in a licensed facility-based setting, the cost of registration fees or the cost of recreational activities, when the service of structured family caregiving is being furnished to the individual or when the individual is in children's foster care, other family members may not receive care or support from the provider while Respite is being provided/billed for the waiver individuals, Respite used as day/child care, Respite care is not intended to be provided on a continuous, long-term basis as part of daily services that would enable the unpaid caregiver to go to work or to attend school, and Respite care shall not be used to provide services to an individual while the individual is attending school. Thank you for listening, and we hope this information has been helpful. Please refer to PRPR10014 for more information on policies and procedures as of July 1, 2024, version 11.1..

[Audio] We are currently discussing the requirements for providers of DDRS HCBS Waivers. In this section of the presentation, we will be focusing on Section 10: Service Definitions and Requirements for F-S-W and C-I-H Waivers. Firstly, it is essential to note that respite care should not be used to replace skilled nursing services that should be provided under the Indiana Medicaid State Plan. Additionally, respite care must not duplicate any other service being provided under the individual’s PCISP. Services furnished to a minor by a parent, stepparent, or legal guardian, and services furnished to an individual by the individual’s spouse are also prohibited. In terms of provider qualifications, providers must be enrolled as an active Medicaid provider and be FSSA DDRS-approved. They must also comply with Indiana Administrative Code, 460 I-A-C 6, which includes requirements for documentation of criminal histories, insurance, and financial status of providers. Providers must also comply with any applicable B-D-S service standards, guidelines, policies, and/or manuals. Where licensure/certification is required, providers rendering waiver-funded services must obtain/maintain Indiana-specific licensure/certification. For L-P-Ns and RNs, this means meeting requirements set forth in IC 25-23. For home health agencies, this means meeting requirements set forth in IC 16-27-1 for Home Health Agency, IC 25-23-1 for RN and LPN; IC 16-27-1.5 for Home Health Aide, Registered. Moving on to Section 10.28, we will discuss specialized medical equipment and supplies for the F-S-W and C-I-H waiver. These include devices, controls, or appliances specified in the P-C-I-S-P that enable individuals to increase their ability to perform activities of daily living or to perceive, control, or communicate with the environment in which they live. It is crucial for providers to understand these requirements and ensure that they are in compliance with them to provide the best possible care for their Medicaid clients. Thank you for your attention to this section of the presentation..

[Audio] Hello everyone, I will be discussing the requirements for providers of Specialized Medical Equipment and Supplies under DDRS HCBS Waivers. These waivers are designed to provide additional services to individuals who require specialized medical equipment and supplies. To be a provider of Specialized Medical Equipment and Supplies, you must meet certain qualifications. Firstly, you must be licensed and certified to provide these services. You must also have a team of trained professionals who are knowledgeable about the equipment and supplies they are providing. In addition to qualifications, providers must also comply with various regulations. These regulations ensure that the services provided are safe, effective, and meet the needs of the individuals receiving them. Providers must follow all applicable laws and regulations, including those related to patient safety, privacy, and confidentiality. Another requirement for providers of Specialized Medical Equipment and Supplies is accreditation from approved organizations. Providers must be accredited by organizations that have been approved by the state of Indiana. These organizations set standards for the equipment and supplies provided and ensure that they are of high quality and meet the needs of the individuals receiving them. Now, let's move on to Section 10 of the DDRS HCBS Waivers: Service Definitions and Requirements for F-S-W and C-I-H Waivers. This section outlines the items necessary for life support or to address physical conditions, as well as ancillary supplies and equipment necessary to the proper functioning of such items. Additionally, it describes other durable and nondurable medical equipment not available under the Indiana Medicaid State Plan that is necessary to address individual functional limitations. When providing Specialized Medical Equipment and Supplies, providers must approve all items before they are rendered. This ensures that the equipment and supplies are of direct medical or remedial benefit to the individual and meet applicable standards of manufacture, design, and installation. It's important to note that Specialized Medical Equipment and Supplies services are available under the F-S-W and C-I-H Waivers. Sensory items, seizure detection devices, G-P-S tracking devices, and other electronic devices that are not currently specified as items covered or reimbursable in the waiver or current R-F-A policy may be electronically submitted for consideration. For information on Specialized Medical Equipment and Supplies services available under the H&W and T-B-I Waivers, please refer to Section 12.26. Reimbursable activities under Specialized Medical Equipment and Supplies services include items necessary for life support, adaptive equipment and supplies, ancillary supplies and equipment needed for the proper functioning of Specialized Medical Equipment and Supplies, durable medical equipment not available under Indiana Medicaid State Plan, and nondurable medical equipment not available under Indiana Medicaid State Plan. Providers are responsible for offering interpreter services if needed by the individual. Per the Introduction to the I-H-C-P provider reference module, providers make available free aids and services to people with disabilities to communicate effectively with the provider, including qualified interpreters, written information in other formats, and free language services to people whose primary language is not English. Finally, providers are responsible for following all applicable service standards. Equipment and supplies must be of direct medical or remedial benefit to the individual, and all items shall meet applicable standards of manufacture, design, and installation. In conclusion, providers of Specialized Medical Equipment and Supplies must be licensed and certified, comply with various regulations, and be accredited by approved organizations. They must also follow all applicable service standards when providing Specialized Medical Equipment and Supplies. By following these requirements, providers can ensure that they are providing high-quality services that meet the needs of the individuals receiving them. Thank you for your attention. If you have any questions, please feel free to ask..

[Audio] We would like to welcome everyone to the DDRS HCBS Waiver presentation. Today, we will discuss the requirements for providers of DDRS HCBS Waivers, including qualifications, compliance with regulations, and the need for accreditation from approved organizations. We request you to review the following: Service Definitions and Requirements: * Any individual item exceeding $500 requires an evaluation by a qualified professional such as a physician, nurse, occupational therapist, physical therapist, speech and language therapist, or rehabilitation engineer. * Annual maintenance service is available and is limited to $1000 per year. If the need for maintenance exceeds $1000, the case manager will work with other available funding streams and community agencies to fulfill the need. Documentation Standards: * Specialized Medical Equipment and Supplies documentation must include the following: plus Identified need in P-C-I-S-P and the service authorization plus Identified direct medical benefit for the individual plus Documentation of the request for Indiana Medicaid State Plan PA plus Documentation of the reason of denial of Indiana Medicaid State Plan PA plus Signed and approved Request for Approval to Authorize Services (State Form 45750) Limitations: * Service and repair up to $1000 per year are permitted for maintenance and repair of previously obtained specialized medical equipment that was funded by a H-C-B-S waiver. If the need for maintenance exceeds $1000, the case manager will work with other available funding streams and community agencies to fulfill the need. * Specialized Medical Equipment and Supplies has a lifetime cap of $15000 under the Family Supports Waiver (F-S-W--). * Specialized Medical Equipment and Supplies has no lifetime cap under the Community Integration and Habilitation (C-I-H--) Waiver Activities Not Allowed: * Equipment and services that are available under the Indiana Medicaid State Plan * Equipment and services that are not of direct medical or remedial benefit to the individual * Equipment and services that are not reflected in the PCISP * Equipment and services that do not address needs identified in the person-centered planning process * Equipment and services that have not been approved on a Request for Approval to Authorize Services (R-F-A--) form * Service provided by the parent of a minor child participant or the spouse of a participant (also known as LRIs) In conclusion, providers of DDRS HCBS Waivers must comply with various regulations and requirements to ensure that their services are of direct medical or remedial benefit to the individual and are reflected in the person-centered planning process. It is important to follow the documentation standards and limitations to ensure that the services are provided in a timely and efficient manner. Thank you for your attention, and we hope that you have found this presentation informative..

[Audio] We are here today to discuss the qualifications for providers in Indiana. For provider qualifications, we require that providers be enrolled as an active Medicaid provider and be FSSA DDRS-approved. They must also comply with any applicable B-D-S service standards, guidelines, policies, and manuals, including FSSA DDRS policies and this module, accessible from the I-H-C-P Provider Reference Modules page at in.gov/medicaid/providers. We have specific requirements for the provision of Speech/Language Therapy services under the F-S-W and C-I-H Waivers. These services are only provided to individuals ages 21 and over by a licensed speech pathologist under 460 I-A-C 6. Reimbursable activities under Speech/Language Therapy services include screening, assessment, and direct therapeutic intervention and treatment for speech and hearing disabilities such as delayed speech, stuttering, spastic speech, aphasic disorders, injuries, lip reading or signing, or the use of hearing aids. Our goal is to ensure that providers of DDRS HCBS Waivers in Indiana meet the highest standards of quality and compliance. We hope that this presentation has provided a comprehensive understanding of the requirements for providers in Indiana. Thank you for your attention..

[Audio] Good afternoon everyone, and welcome to our presentation on DDRS HCBS Waivers. Today, we will be discussing the service definitions and requirements for F-S-W and C-I-H Waivers, as well as the service standards for Speech/Language Therapy. Speech/Language Therapy services are provided to individuals who have been examined by a certified audiologist or a certified speech therapist and have recommended a formal speech and language program. The need for such services must be documented by an appropriate assessment and authorized in the individual’s PCISP. To be eligible for Speech/Language Therapy services, individuals must have a certified audiologist or a certified speech therapist examine them and recommend a formal speech and language program. The need for such services must be documented by an appropriate assessment and authorized in the individual’s PCISP. Speech/Language Therapy services documentation must include the following: documentation of an appropriate assessment, services provided under both the Indiana Medicaid State Plan and the waiver outlined in the PCISP, BDS-approved provider, appropriate credentials for the service provider, attendance record, therapist logs and/or chart detailing services provided, dates and times, and documentation in compliance with 460 IAC 6 Supported Living Services and Supports requirements. As applicable, monthly/quarterly reports must be uploaded to the document library of the state’s case management system by the chosen service provider on or before the 15th day of the following month. It's important to note that individuals under the age of 21 should access Speech/Language Therapy services through EPSDT. One hour of billed therapy service must include a minimum of 45 minutes of direct patient care/therapy, with the balance of the hour spent in related patient services. This waiver service is only provided to individuals ages 21 and over. All medically necessary Speech/Language Therapy services for children under the age of 21 are covered in the Indiana Medicaid State Plan benefit pursuant to the E-P-S-D-T benefit. In conclusion, providers of DDRS HCBS Waivers must meet certain qualifications, comply with various regulations, and be accredited from approved organizations. Speech/Language Therapy services must adhere to specific service standards, including documentation requirements and limitations for individuals under the age of 21. Thank you for your attention, and we look forward to continuing our presentation..

[Audio] Welcome to our presentation. Today, we will be discussing the requirements for providers of DDRS HCBS Waivers. These waivers are designed to provide additional funding for services and programs that are not covered by traditional Medicaid. To be eligible for a DDRS HCBS Waiver, providers must enroll as an active Medicaid provider, be DDRS-approved, and comply with various regulations, including Indiana Administrative Code, 460 I-A-C 6, Indiana licensure, and any applicable B-D-S service standards and policies. It is important to note that certain activities are not allowed under Speech/Language Therapy, including therapy services delivered in a nursing facility, and services provided by the parent of a minor child participant or the spouse of a participant. We also need to discuss structured family caregiving for the C-I-H Waiver. This means a living arrangement in which an individual lives in the private home of a principal caregiver who may be a nonfamily member (foster care) or a family member who is not the individual's spouse, the parent of the individual who is a minor, or the legal guardian of the minor. To be eligible for a DDRS HCBS Waiver, providers must meet all of these requirements. These waivers can provide important funding for programs and services that are not covered by traditional Medicaid, and can help to improve the overall quality of care for individuals in need..

[Audio] We are here today to discuss the requirements for DDRS HCBS Waivers, specifically regarding service definitions and requirements for F-S-W and C-I-H Waivers. Individuals who are guardians of adult individuals are allowed to provide Structured Family Caregiving with the agreement of the Individualized Support Team (I-S-T--). Necessary support services are provided by the principal caregiver (family caregiver) as part of Structured Family Caregiving. Only agencies may be Structured Family Caregiving providers, with the Structured Family Caregiving settings being approved, supervised, trained, and paid by the approved agency provider. To ensure compliance with the program, the provider agency must conduct two visits per month to the home – one by a registered nurse (R-N---) or licensed practical nurse (L-P-N--) and one by a Structured Family Caregiving home manager. The provider agency must keep daily notes that can be accessed by the state. Additional Information: Structured Family Caregiving services described in this section are available under the C-I-H Waiver. Structured Family Caregiving is not available under the FSW. There are three service levels of Structured Family Caregiving each with a unique rate. The Algo score assigned to the individual will determine the appropriate level of Structured Family Caregiving service and reimbursement to be used in the person-centered individualized support plan (P-C-I-S-P) at the individual’s next annual anniversary date. Reimbursable activities under Structured Family Caregiving services include personal care and services, homemaker or chore services, attendant care and companion care services, medication oversight, support by a substitute caregiver who has met all principal caregiver qualifications, transporting the participant when indicated in the PCISP, and other appropriate supports as described in the PCISP..

[Audio] We understand that structured family caregiving services are an essential component of DDRS HCBS Waivers. Providers must ensure compliance with regulations and accreditation from approved organizations. These services include training and ongoing support to the family caregiver/foster parent, and ensuring the safety and well-being of the individual through regular inspections of the environment. The provider must ensure that structured family caregiving services are reflected in the PCISP, and the services must address the needs identified in the person-centered planning process. The provider must also approve any providers of respite care chosen by the family or individual, and determine the total amount per month paid to the family caregiver. The agency's administrative/supervision fee is determined by the remaining total amount, and includes the following duties: publishing written policies and procedures regarding structured family caregiving support services, maintaining financial and service records to document services provided to the individual, establishing criteria for the acceptance of the family caregiver or foster parent, providing initial training and ongoing training, consultation, and supervision to the family caregiver/foster parent, and ensuring the safety and well-being of the individual by inspection of the environment. The structured family caregiving services documentation must include written policies and procedures, including for screening and accepting family caregivers/foster parents, maintenance of financial and service records to document services provided to the individual, provision of training to family caregivers according to agency policies/procedures, and reimbursement of the family caregiver/foster parent. Under structured family caregiving services, families must provide the following documentation: one dated entry per day detailing an issue concerning the individual, tying those into measurable progress toward the individual's outcome (as identified in the PCISP), and including any significant issues concerning the individual..

[Audio] We are here today to discuss the expectations and qualifications for providers offering DDRS HCBS Waivers. Our presentation will provide an overview of the definitions and requirements for the F-S-W and C-I-H Waivers, as well as any limitations and activities that are not permitted. Furthermore, we will address the qualifications needed for providers, including enrollment as an active Medicaid provider, FSSA DDRS-approval, compliance with Indiana Administrative Code, and insurance. Provider training and staff qualifications must also meet specific standards, guidelines, policies, and manuals. Lastly, licensure is required for providers delivering waiver-funded services. Our presentation aims to inform providers about the requirements and expectations for providing DDRS HCBS Waivers services in Indiana..

[Audio] We will be discussing the requirements for providers of Transportation services for F-S-W and C-I-H Waivers. Transportation services are critical for individuals with disabilities as they enable them to access non-medical community services, resources, destinations, or places of employment, as well as maintain or improve their mobility within the community. To ensure compliance with regulations and maintain quality standards, providers of Transportation services must adhere to certain requirements. Transportation services are available under the F-S-W and C-I-H Waiver, and there is no prohibition against using Transportation services to get to or from a place of employment, provided this is reflected in the PCISP. Transportation may be used to reach any non-medical destination or activity outlined within the PCISP. There are three levels of Transportation services: Level 1, Level 2, and Level 3. Level 1 transportation involves a private, commercial or public transit vehicle that is not specially equipped. Level 2 transportation involves a private, commercial or public transit vehicle specially designed to accommodate wheelchairs. Level 3 transportation involves a vehicle specially designed to accommodate an individual who for medical reasons must remain prone during transportation. Providers of Transportation services must document the level of Transportation service needed in the PCISP. Reimbursable activities under Transportation services include two one-way trips per day to or from a non-medical community service or resource or place of employment as specified on the P-C-I-S-P and provided by an approved provider of R-H-S--, Day Habilitation, Adult Day Services, or Transportation services. Bus passes or alternate methods of transportation may be used for Level 1 or Level 2. Bus passes may be purchased on a monthly basis or on a per-ride basis, whichever is most cost-effective in meeting the individual’s transportation needs as outlined in the PCISP. It is important to note that Transportation services described in this section are available under the F-S-W and C-I-H Waiver. Transportation may be used in conjunction with other services, including Day Habilitation and Adult Day Services, but this service will not be reimbursed when provided by the parent of a minor child participant or the spouse of a participant (also known as LRIs). In summary, providers of Transportation services for F-S-W and C-I-H Waivers must adhere to certain requirements and documentation standards to ensure compliance with regulations and maintain quality standards. Transportation services are critical for individuals with disabilities and play an important role in enabling them to access non-medical community services, resources, destinations, or places of employment, as well as maintain or improve their mobility within the community..

[Audio] We are currently discussing qualifications and requirements for providers offering DDRS HCBS Waivers. To be eligible, providers must follow specific regulations, receive accreditation from approved organizations, and meet service definition and requirement standards for F-S-W and C-I-H Waivers. Transportation services are subject to PCISP, and documentation must include a service note with the individual/waiver individual name, I-H-C-P Member ID, date of service, provider rendering service, pick-up point, and destination. If contract transportation is used, log and invoice support must be provided. No person is excluded from participating in nonmedical waiver transportation services, and annual limits are applied. Thank you for your attention..