part 14

[Virtual Presenter] We are thrilled to share with you details about transportation services and vehicle modifications. Our presentation will provide an in-depth look at the For the Family Supported Waiver (F-S-W--), including its services, annual cap, and annual limits. We will outline the activities that are permitted and not permitted under transportation services, as well as the qualifications required for transportation providers. Furthermore, we will discuss the requirements for vehicle modifications services under the F-S-W and C-I-H Waiver. Thank you for joining us today, and we hope this information is helpful to you..

[Audio] We are discussing transportation services provided under the Family Supported Waiver (F-S-W--) and Community Integrated Health (C-I-H--) Waiver. These services have limitations and criteria that providers must meet to be approved. We also touch on vehicle modifications services available under these waivers, which are subject to specific guidelines and requirements. It's important to note that the information provided on this slide is specific to the F-S-W and C-I-H Waivers and may not be applicable to other waiver programs or services..

[Audio] We are here to discuss the transportation services provided for individuals with disabilities in Indiana. The F-S-W is a program that allows for the payment of transportation services within a certain annual cap of $26482. However, there are certain restrictions on what transportation services can be used for. For example, transportation services cannot be used to meet medical transportation needs that are already available under the Indiana Medicaid State Plan or in conjunction with structured family caregiving services available under the Community Integrated Health (C-I-H--) Waiver. Additionally, transportation services cannot be used to transport individuals to places where they are not required to go, such as to a place of worship or to a recreational activity..

[Audio] Transportation services are crucial components of the F-S-W and C-I-H Waivers. These services offer individuals with the means to access community-based services. For the F-S-W--, transportation services are covered under an annual cap of $26482, and there are annual limits for each level of non-medical waiver transportation. However, certain activities are not allowed under transportation services. For example, transportation services cannot be used to meet medical transportation needs already available under the Indiana Medicaid State Plan or in conjunction with structured family caregiving services available under the C-I-H Waiver. Additionally, transportation services provided by the parent of a minor child participant or the spouse of a participant are not allowed. To ensure the safety and effectiveness of these services, providers must meet specific criteria, such as being an active Medicaid provider, being FSSA DDRS-approved, complying with Indiana Administrative Code, and complying with any applicable B-D-S service standards, guidelines, policies, and manuals. In addition to transportation services, the F-S-W and C-I-H Waivers also include vehicle modifications services to accommodate the needs of individuals with disabilities. These modifications must follow specific guidelines to ensure safety and effectiveness. A cap of $15000 is available for one vehicle per every 10-year period for an individual’s household. In addition to the applicable cap, $1000 will be allowable annually for repair, replacement, or an adjustment to an existing modification that was funded by a Home and Community-Based Services (H-C-B-S-) waiver. There are certain activities that are not allowed under vehicle modifications, such as modifications/adaptations that have not been approved on a Request for Approval to Authorize Services (R-F-A--) form, as well as examples/descriptions of modifications/items not covered, such as repair or replacement of modified equipment damaged or destroyed in an accident, alarm systems, auto loan payments, insurance coverage, driver’s license, title registration or license plates, emergency road service, routine maintenance and repairs related to the vehicle itself, specialized medical equipment or home modification items, and leased vehicles. To ensure the safety and quality of vehicle modifications, providers must meet specific criteria, such as being enrolled as an active Medicaid provider, being FSSA DDRS-approved, complying with Indiana Administrative Code, and complying with any applicable B-D-S service standards, guidelines, policies, and manuals. Providers rendering waiver-funded services must also obtain/maintain Indiana licensure, where licensure is required..

[Audio] We will be discussing transportation and wellness coordination services offered under the For the Family Supported Waiver (F-S-W--) and Community Integrated Health (C-I-H--) Waiver. Transportation services are available up to an annual cap of $26482 under the F-S-W--, and there are annual limits for each level of non-medical waiver transportation. However, certain activities are not allowed under transportation services, such as using it to meet medical transportation needs already available under the Indiana Medicaid State Plan, using it in conjunction with structured family caregiving services available under the C-I-H Waiver, and providing it by the parent of a minor child participant or the spouse of a participant (LRIs). Providers must meet certain criteria, including being an active Medicaid provider, being FSSA DDRS-approved, complying with Indiana Administrative Code, and complying with any applicable B-D-S service standards, guidelines, policies, and/or manuals. Wellness Coordination services are available under the C-I-H Waiver to assist individuals in managing their health care needs. These services are specifically designed for individuals requiring the assistance of an RN or L-P-N to properly coordinate their medical needs. There are three levels of support, with Tier I requiring a face-to-face visit once a month with an RN or L-P-N and consultations/reviews based on the individual’s current healthcare needs. Tier II requires a face-to-face visit twice a month with an RN or L-P-N and consultations/reviews based on the individual’s current healthcare needs. Tier I-I-I requires a face-to-face visit once a week with an RN or L-P-N and consultations/reviews based on the individual’s current healthcare needs. The necessity for Wellness Coordination services is typically reserved for individuals assessed with health scores of 5 or higher through the state’s objective-based allocation process. Individuals assessed with health scores of 0-4 would not require assistance of an RN or L-P-N to coordinate medical needs. Wellness Coordination services are available only under the C-I-H Waiver and are not available under the FSW, H&W, or T-B-I waivers. Reimbursement is available for Wellness Coordination services only when the following circumstances are present: the individual requires assistance in coordinating medical needs beyond what can be provided through routine doctor/healthcare visits, Wellness Coordination services are specifically included in the individual’s PCISP, and the member has a Wellness Coordination plan..

[Audio] We offer transportation services to participants under the Family Supported Waiver (F-S-W--) with a yearly restriction of $26482 and limitations on how much can be spent on non-medical transportation for each level. Non-medical transportation services are not allowed to be used for certain activities, such as meeting medical transportation needs already available under the Indiana Medicaid State Plan, using them in conjunction with structured family caregiving services offered under the Community Integrated Health (C-I-H--) Waiver, or providing them by the parent of a minor child participant or the spouse of a participant. To offer these services, providers must meet certain requirements, including being an active Medicaid provider, being FSSA DDRS-approved, complying with Indiana Administrative Code, and complying with any applicable B-D-S service standards, guidelines, policies and/or manuals..

[Audio] We will discuss transportation and workplace assistance services provided under the Family Supported Waiver (F-S-W--) and Community Integrated Health (C-I-H--) Waivers. Transportation services are paid for within an annual cap of $26482, and there are annual limits for each level of nonmedical waiver transportation. However, certain activities are not allowed under transportation services, such as using it to meet medical transportation needs already available under the Indiana Medicaid State Plan, using it in conjunction with structured family caregiving services available under the C-I-H Waiver, and providing it by the parent of a minor child participant or the spouse of a participant. To be eligible for transportation services, providers must meet certain criteria, such as being an active Medicaid provider, being FSSA DDRS-approved, complying with Indiana Administrative Code, and complying with any applicable B-D-S service standards, guidelines, policies and/or manuals. Additionally, providers must document what level of consultation/visits has been deemed necessary or appropriate for the individual, as outlined in the PCISP. It's also important to note that wellness coordination services must address needs identified in the person-centered planning process and be outlined in the PCISP. The provider of wellness coordination will provide a written report to pertinent parties at least quarterly, and 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. Within the wellness coordination plan, the provider must document what level of consultation/visits has been deemed necessary or appropriate for the individual. In terms of workplace assistance services, these provide a range of personal care services and/or supports during paid competitive community employment hours and in a competitive community employment setting to enable waiver individuals to accomplish tasks that they would normally do for themselves if they did not have a disability. Assistance may take the form of hands-on assistance (actually performing a personal care task for the individual) or prompting the individual to perform a personal care task. Workplace Assistance services may be provided on an episodic or on a continuous basis..

[Audio] Under the For the Family Supported Waiver (F-S-W--), transportation services and workplace assistance services are available. These services have certain restrictions such as not using them to meet medical transportation needs available under the Indiana Medicaid State Plan, not using them in conjunction with structured family caregiving services available under the Community Integrated Health (C-I-H--) Waiver, and not providing transportation services by the parent of a minor child participant or the spouse of a participant. To be eligible for these services, providers must meet certain criteria such as being an active Medicaid provider, FSSA DDRS-approved, complying with Indiana Administrative Code, and complying with any applicable B-D-S service standards, guidelines, policies, and/or manuals. Additionally, there are service standards and documentation standards that apply to Workplace Assistance services. These services should complement but not duplicate Day Habilitation services being provided in other settings and may only be delivered in the employment setting. No physician’s prescription or authorization is required for Workplace Assistance services, and the documentation for these services must include the following data elements for each service rendered: the name of the individual served, the I-H-C-P Member ID of the individual, the name of the provider, the service rendered, the time frame of the service, the date of the service including the year, the primary location of service delivery, and a brief activity summary of the service rendered..

[Audio] We are here to discuss transportation services available for individuals with disabilities under the For the Family Supported Waiver (F-S-W--) and the Community Integrated Health (C-I-H--) Waiver. These waivers allow for transportation services to be paid for within an annual cap of $26482, and there are annual limits for each level of nonmedical waiver transportation. However, certain activities are not allowed under transportation services, such as using it for medical transportation needs that are already available under the Indiana Medicaid State Plan, using it in conjunction with structured family caregiving services available under the C-I-H Waiver, and providing it by the parent of a minor child participant or the spouse of a participant (LRIs). To be eligible for transportation services, providers must meet certain criteria, including being an active Medicaid provider, being FSSA DDRS-approved, complying with Indiana Administrative Code, and complying with any applicable B-D-S service standards, guidelines, policies and/or manuals. Additionally, providers must provide a description by direct care staff of any issue or circumstance concerning the individual, including significant medical or behavioral incidents or any other situation that may be uncommon for the individual. This description must include the last name and first initial of the direct care staff person making the entry, and must be made available to auditors, quality monitors, case managers, and any other government entity upon request. It is important to note that there are limitations on Workplace Assistance services, which are used to provide transportation services for individuals with disabilities in the workplace. The allowed ratio is one client to one staff, and reimbursement is available only during the individual's hours of paid, competitive community employment. Additionally, certain activities are not allowed under Workplace Assistance, such as providing services to a minor child by the parents, stepparents, or legal guardian, and providing services to an individual by that individual's spouse..

[Audio] We are pleased to share information about the For the Family Supported Waiver (F-S-W--) and transportation services. Under the F-S-W--, transportation services are covered up to an annual cap of $26482, and there are annual limits for each level of non-medical waiver transportation. It is important to be aware that certain activities are not permitted under transportation services, including using it to fulfill medical transportation requirements already available under the Indiana Medicaid State Plan, utilizing it in conjunction with structured family caregiving services available under the Community Integrated Health (C-I-H--) Waiver, and providing it by the parent of a minor child participant or the spouse of a participant (LRIs). Providers must adhere to specific criteria, including being an active Medicaid provider, being FSSA DDRS-approved, complying with Indiana Administrative Code, and complying with any applicable B-D-S service standards, guidelines, policies, and manuals. The presentation also covers vehicle modification services for the F-S-W and C-I-H Waiver. It is important to note that Workplace Assistance is not to be used for advocating for the individual, staff time in traveling to and from a work site, and will not be reimbursed when provided by the parent of a minor child participant or the spouse of a participant (also known as LRIs). Providers must meet the following criteria: be enrolled as an active Medicaid provider, be FSSA DDRS-approved, comply with Indiana Administrative Code, insurance, financial status of providers, requirements for direct care staff, staff training and training, transportation services provider qualifications, transportation supports provider qualifications, and 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. In summary, transportation services under the F-S-W are subject to certain limitations and provider qualifications. It is crucial for providers to meet these criteria to ensure that transportation services are provided safely and effectively. Thank you for your attention..

[Audio] Welcome valued attendees. We are currently on slide number 11 out of 14 in our presentation about the Family Supported Waiver (F-S-W--) transportation services. Today, we will be discussing the R-F-A policies that pertain to home modifications, specialized medical equipment and supplies, and vehicle modifications services in order to provide a better understanding of these services. Section 11.1 of the R-F-A policies addresses the use of the required Request for Approval to Authorize Services form for authorization of these services for both the F-S-W and C-I-H waivers. This policy, which was implemented on July 16, 2020, replaces all previous policies related to authorizing Home Modifications. It is important to note that policy updates are currently in process. The Home Modifications services covered under the F-S-W and C-I-H waivers include minor physical adaptations to the home as specified in the individual's service authorization. These modifications are intended to support the individual's independence and safety in their home environment, such as ramps, grab bars, and other accommodations to aid in daily activities. Our policies for home modifications adhere to the guidelines outlined in the Code of Federal Regulations, and align with the goals of both the C-I-H and F-S-W waivers to promote community integration and support individuals with disabilities in living independently. We would like to remind attendees that these policies have been in effect since December 1, 2007, and any previous policies related to these services are no longer valid. We are continuously working to update and improve our policies to better serve our participants and provide the best possible care. Thank you for your attention and please feel free to ask any questions during the Q&A session at the end of the presentation. We appreciate your participation and look forward to discussing the remaining topics with you..

[Audio] This section will cover the policies related to the Request for Application (R-F-A--) for the D-D-R-S Home and Community-Based Services (H-C-B-S-) Waivers. It should be noted that the funding provided by these waivers only includes basic modifications that are deemed medically necessary for the individual. This means that any requests for items or upgrades beyond basic medical need will not be approved. For instance, if a bathroom modification is necessary, but the individual or family wants higher-end materials, such as tiled flooring, a decision must be made whether to use waiver funds for the basic modification or to cover the additional cost for the desired upgrade. This applies to all modifications under the waivers, including vehicle modifications. As the state is responsible for ensuring that each modification is the most cost-effective and conservative means to meet the individual's accessibility needs in their home, it is not acceptable to submit bids that combine waiver funding with private funds to cover the costs of desired upgrades. This applies to all modifications, including home ownership. Providers must adhere to specific criteria in order to offer these waiver services, including being an active Medicaid provider and being approved by FSSA DDRS. They must also comply with the Indiana Administrative Code and any applicable B-D-S service standards, guidelines, policies, and manuals. It is our responsibility to ensure that the funds provided for transportation services under the Family Supported Waiver (F-S-W--) are used appropriately within the annual cap of $26482. There are also annual limits for each level of non-medical waiver transportation. It should be noted that transportation services cannot be used for medical transportation needs that are already covered under the Indiana Medicaid State Plan, or in conjunction with structured family caregiving services available under the Community Integrated Health (C-I-H--) Waiver. Additionally, transportation services cannot be provided by the parent of a minor child participant or the spouse of a participant (LRIs). We appreciate your attention to these policies surrounding the DDRS HCBS Waivers, specifically in regards to transportation and vehicle modifications. Let's continue to work together to ensure the best use of these funds and accessibility for individuals under these waivers..

[Audio] Welcome to slide number 13. In this presentation, we will be discussing the transportation services provided under the Family Supported Waiver (F-S-W--). These services have an annual cap of $26482 and additional limits based on the level of nonmedical waiver transportation needed. It is crucial to note that these services cannot be used for medical transportation that is already available under the Indiana Medicaid State Plan or in conjunction with structured family caregiving services available under the Community Integrated Health (C-I-H--) Waiver. Furthermore, transportation services cannot be provided by the parent of a minor child participant or the spouse of a participant, also known as L-R-I-s-. In order to provide these services, providers must meet certain criteria, including being an active Medicaid provider, being FSSA DDRS-approved, and complying with Indiana Administrative Code, as well as any applicable B-D-S service standards, guidelines, policies, and/or manuals. Moving on to Section 11, R-F-A Policies for DDRS HCBS Waivers, we will specifically be looking at Table 5 – Bid Itemization Example – Home Modifications. This table outlines the scope of work, labor and material costs, and related expenses for various home modifications. These modifications can include a 15-inch ramp, widening of front and bathroom doors to 36 inches, installation of an A-D-A toilet, and building permits as needed. The total cost for all modifications will be listed as $$$$. However, please note that requests for modifications at two or more locations can only be approved at the discretion of the state division director or state agency designee. Additionally, modifications may be denied if the documentation does not support residential stability and/or the specific service requested. It is crucial to adhere to the established federal, state, local, and Family and Social Services Administration (F-S-S-A-) standards, as well as A-D-A requirements when making home modifications. This ensures that the modifications are of direct medical or remedial benefit to the individual. Thank you for your attention, and please continue to the next slide for more information on home modifications..

[Audio] We are here to discuss the reimbursement and coverage requirements for vehicle modifications under the DDRS HCBS Waivers Section 11: R-F-A Policies. In order to comply with F-S-S-A and our division, service providers must understand the guidelines and policies outlined. All expenses related to the modification must be documented and submitted for reimbursement. This includes modifications that comply with F-S-S-A and division-specific guidelines, are allowable under Medicaid waiver guidelines, are not covered by the Rehabilitation Act of 1973, and are included in the individual's approved P-C-I-S-P or service authorization. These modifications must also be authorized on the R-F-A and linked to the P-C-I-S-P or service authorization, included on a state-approved and signed service authorization, completed by an approved Medicaid waiver service provider, and completed in accordance with building permits. It is important to note that justification and documentation are required to demonstrate the necessity of the modification for the individual's specific needs. For example, certain modifications, such as adaptive door openers and locks, may be covered if deemed necessary for the individual's situation. We understand that these guidelines and requirements may seem overwhelming, but they are in place to ensure individuals receive the necessary modifications to improve their quality of life. We appreciate your attention and compliance with these policies..