part 15

[Virtual Presenter] We are pleased to present this slide deck which outlines the policies and procedures for home modifications under the DDRS HCBS Waiver program. This program offers a range of modifications, including stair lifts, single-room air conditioners/air purifiers, widening doorways, and replacing windows. It is important to note that any modifications provided through the H-C-B-S waiver are subject to a yearly maintenance limit of $500. Any modifications or items not listed above will need to be reviewed and approved by the state division director or state agency designee. Let us explore each of these modifications individually. Firstly, we will discuss stair lifts. These will be provided if they are necessary for the individual to access areas of their home in order to receive direct medical or remedial benefits, as stated in their service authorization and P-C-I-S-P under the C-I-H Waiver. Next, we will examine single-room air conditioners or air purifiers. These will be provided if they are necessary for the individual's medical or remedial needs, as documented by a prescription from their primary care physician. It is important to note that the size of the air conditioner must be suitable for the room it is intended to cool. For the modification of widening doorways, this will be done for the purpose of safe egress. Exterior modifications are limited to one per individual primary residence, only when there are no other accessible doors available. Interior modifications, on the other hand, may include bedroom, bathroom, and/or kitchen doorways, with the option of a pocket door if there is not enough space for a traditional swinging door. Finally, for any necessary window replacements, we will be using plexiglass or other shatterproof materials for safety purposes. Thank you for your attention to this information regarding the DDRS HCBS Waiver program and its policies and procedures for home modifications. If you have any further questions or concerns, please do not hesitate to reach out to the state division director or state agency designee for assistance..

[Audio] The DDRS HCBS Waiver program is designed to provide individuals with disabilities the opportunity to reside comfortably and securely in their own homes. The program allows certain home modifications to be made to enhance accessibility and functionality. The policies and procedures for home modifications under the DDRS HCBS Waiver program will be outlined on slide 2. These modifications include stair lifts, single-room air conditioners/air purifiers, widening doorways, and replacing windows. The completed modifications will be reviewed by the state division director or state agency designee to ensure the best fit for each individual. Maintenance for modifications provided through the H-C-B-S Waiver is limited to $500 annually, and any modifications or items not listed above will be reviewed and a decision will be made by the state division director or state agency designee. Examples of non-covered modifications and items include central air conditioning, routine home maintenance, and standard home fixtures. Moving on to section 11, we will discuss the R-F-A (Request for Approval) policies for the DDRS HCBS Waivers. Swimming pools, spas, or hot tubs are not covered under the program. Additionally, video monitoring systems, adaptive switches or buttons for entertainment, employment, or education devices, and home security systems are also not included in the modifications. Modifications that create living space or facilities where they did not previously exist, such as installing a bathroom in a garage or basement, are not covered. Similarly, duplicating existing accessibility, such as a second accessible bathroom or second means of egress, is also not included. Any adaptations that have not been approved on a Request for Approval to Authorize Services form will not be covered. Lastly, please note that individuals living in foster homes, group homes, assisted living facilities, or homes for special services, which includes any licensed residential facility, are not eligible for home modifications under the DDRS HCBS Waiver program. The responsibility for such modifications rests with the facility owner or operator..

[Audio] There are two waivers under the DDRS HCBS program that impact the use of Specialized Medical Equipment and Supplies: the Community Integration and Habilitation (C-I-H--) Waiver and the Family Supports Waiver (F-S-W--). This subsection focuses on the waiver policy notification and the authority that guides the policy. The Clarification of the Specialized Medical Equipment and Supplies Policy impacts these two waivers. The effective date for this policy is December 1st, 2007, and it replaces all previous policies related to the authorization of Specialized Medical Equipment and Supplies. Individuals enrolled in the DDRS HCBS Waiver program need Specialized Medical Equipment and Supplies, such as sensory items, seizure detection devices, G-P-S tracking devices, and other electronic devices that are not currently specified as covered or reimbursable under the waiver or current R-F-A policy. These items can be electronically submitted for consideration under Specialized Medical Equipment and Supplies via the Request for Approval to Authorize Services form. For modifications provided through a H-C-B-S waiver, maintenance is limited to $500 annually. Any modifications or items not listed in the waiver policy will be reviewed and a decision will be made by the state division director or state agency designee. The policies and procedures in place are designed to ensure the safety and well-being of individuals enrolled in the H-C-B-S waiver program. The state division director or state agency designee will carefully review each request for specialized medical equipment and supplies to ensure that it is necessary and beneficial for the individual's overall health and independence. Thank you for your attention to this important section of the presentation..

[Audio] Section 11 of the DDRS HCBS Waivers outlines the policies and procedures for Request for Authorization (R-F-A--) and reimbursement for home modifications. When a person requests a specific brand for a modification, they are limited to the Indiana Medicaid State Plan covered service/brand. This means that reimbursement for the requested item will be based on the Indiana Medicaid State Plan fee schedule. If the requested item is not covered under the Indiana Medicaid State Plan, it will not be reimbursed. To learn more about coverage under the Indiana Medicaid State Plan, please refer to Indiana Administrative Code 405 I-A-C 5-19. All requests for items to be purchased through a Medicaid waiver must include documentation of an Indiana Medicaid State Plan PA request and decision. Specialized Medical Equipment and Supplies will only be authorized if they are determined to be medically necessary and have a direct medical or remedial benefit for the waiver individual. This determination takes into account several factors, including cost-effectiveness and individualized, specific needs that are not in excess. Additionally, for items over $1000, three bids must be obtained. If this is not possible, it must be documented..

[Audio] This section of our presentation focuses on the policies for home modifications under the DDRS HCBS Waiver program. We will discuss the documentation standards and reimbursement guidelines for these modifications. First, we will discuss the documentation requirements for home modifications. This includes a service authorization, a physician's prescription or clinical evaluation, and a P-C-I-S-P under the F-S-W or C-I-H Waiver. Additionally, if applicable, the Indiana Medicaid State Plan prior authorization request and decision must be included. We will also discuss the reimbursement process for Specialized Medical Equipment and Supplies. Reimbursement is available for these supplies if they meet certain criteria, such as adhering to the service and documentation standards outlined in this policy, being allowed under current Medicaid waiver guidelines, not being available under the Rehabilitation Act of 1973, and being included in the individual's approved P-C-I-S-P and service authorization. It is important for providers to ensure that the service and documentation standards are met before requesting reimbursement. Thank you for listening to this section on the R-F-A policies for the DDRS HCBS Waivers. We will now move on to Section 12 of our presentation..

[Audio] Our presentation today will cover the policies and procedures for home modifications offered through the DDRS HCBS Waiver program. The program provides a variety of modifications including stair lifts, air conditioners/purifiers, doorways, and windows. To ensure the modifications match the home's color, style, and design, they will be carefully reviewed. The maintenance for these modifications is limited to $500 per year. Any modifications or items not listed above will undergo a review for approval. In regards to R-F-A policies, we also offer self-help devices, such as tables and reachers, prescribed by physical or occupational therapists. Additionally, strollers are available upon request for individuals who require them for transportation but do not need a full-time mobility device. Our manual wheelchairs can also be provided for safe mobility, with an annual maintenance limit of $1000. Posture and feeding chairs, prescribed by a physician or therapist, are also available. It's important to note that while not currently covered, special items such as sensory equipment, seizure detection devices, and G-P-S trackers can be considered for coverage through the Request for Approval to Authorize Services form. Lastly, please be aware that items such as hospital beds, mattresses, therapy equipment, and electronics, including CD players and cameras, are not covered under the waiver or R-F-A policy..

[Audio] As the presenter, we are gathered here to discuss the policies and procedures for home modifications covered under the DDRS HCBS Waiver program. These modifications include stair lifts, single-room air conditioners/air purifiers, widened doorways, and window replacements. The completed modifications will be closely reviewed by the state division director or state agency designee to ensure they match the color, style, and design of the original home as closely as possible. However, maintenance for these modifications is limited to $500 annually. Any modifications or items that are not listed, such as central air conditioning, routine home maintenance, and standard home fixtures, will also be reviewed and decided upon by the state division director or state agency designee. Moving on to the R-F-A policies for DDRS HCBS Waivers, we cover a wide range of items and equipment under this service. This includes adaptive switches and buttons, exercise equipment, furniture, appliances, indoor and outdoor play equipment, and positioning devices. Additionally, items that can be authorized through the Indiana Medicaid State Plan are also covered. However, any equipment or items that are purchased or obtained by the individual, their family members, or other nonwaiver providers are not covered unless specifically authorized through this service. In rare circumstances, a new or unexpected item may be presented for consideration as a covered item under this service. In order to do so, a written proposal justifying the need for the item must be submitted to the FSSA OMPP for further review and consideration by the F-S-S-A Policy Governance Board. The proposal should be directed to the Director of Agency Coordination and Integration at the Office of Medicaid Policy and Planning. These are the necessary steps to obtain coverage for any new or unanticipated items under this service..

[Audio] This presentation focuses on slide 8, where we will discuss the policies and procedures for home modifications under the DDRS HCBS Waiver program. These modifications are vital for individuals with disabilities to safely navigate their homes and access their communities. Our objective is to ensure that these modifications are closely matched to the color, style, and design of the individual's home. The state division director or state agency designee will make the decision on these modifications. Any modifications or items not included in our program will also be assessed and decided upon by the state division director or state agency designee. These may include central air conditioning, routine home maintenance, and standard home fixtures. Moving on to section 11 of our policy, each division is required to implement a Quality Assurance Plan to ensure appropriate authorizations are being granted. In the case of any inappropriate authorizations, the following actions may be taken: a corrective action plan, reimbursement to Medicaid, or a loss of decision-making authority. Section 11.3 specifically addresses vehicle modifications for the F-S-W and C-I-H Waivers. This policy clarification, in accordance with 42 CFR 441.302, affects both the Community Integration and Habilitation (C-I-H--) Waiver and the Family Supports Waiver (F-S-W--). This policy was implemented on December 1, 2007, and replaces all previous policies related to the authorization of vehicle modifications. Vehicle Modifications, or V-M-O-D-, refer to the addition of adaptive equipment or structural changes to a motor vehicle that allow individuals with disabilities to safely transport in a vehicle. These modifications are necessary to increase an individual's ability to function in a home and community-based setting, ensuring accessibility for individuals with mobility challenges. This concludes our presentation on the DDRS HCBS Waiver program and its policies. Thank you for your attention..

[Audio] Section 11 of the presentation addresses the R-F-A policies for the DDRS HCBS Waiver program. This section discusses the significant topic of choosing a provider for home modifications. It is vital that the individual has the freedom to select from approved or certified providers who will submit bids or estimates for this service. It is worth noting that the provider with the lowest bid will be selected, unless the case manager provides a well-justified written explanation as to why a provider with a higher bid should be chosen. This process ensures fairness and transparency. Moving on to the requirements for vehicle modifications, it is imperative that all modifications are approved by the H-C-B-S waiver program before services are provided. This is to guarantee that the modifications meet the necessary standards and regulations. Additionally, any vehicle modification requests must meet the following criteria: firstly, the modification must be based on and tailored to meet the individual's specific needs. This means that only one vehicle per individual's household may be modified. Moreover, the vehicle must be less than 10 years old and have less than 100000 miles on the odometer. This is to ensure that the modified vehicle is safe and reliable for the individual. Lastly, all vehicle modifications must be deemed medically necessary and/or have direct medical or remedial benefits for the waiver individual. This determination will take into account the cost-effectiveness and individualized approach of the modification, as well as ensuring that it is not excessive. Thank you for your attention to these crucial policies for the DDRS HCBS Waiver program. We are committed to providing the best care for individuals with disabilities, and these policies and procedures help us ensure that their needs are met in an equitable and efficient manner..

[Audio] During our presentation, we will now discuss Section 11, which outlines the policies and procedures for home modifications in the DDRS HCBS Waiver program. These modifications, such as stair lifts, single-room air conditioners/air purifiers, widening doorways, and replacing windows, are essential for ensuring the safety and accessibility of individuals with disabilities. It is important to note that the completed modifications will be carefully reviewed and approved by the state division director or state agency designee in order to match the color, style, and design as closely as possible. Additionally, it is crucial for all modifications provided through the H-C-B-S waiver to be properly maintained. Therefore, there is a limitation of $500 annually for maintenance expenses. Please be aware that any modifications or items not listed above will also require review and approval by the state division director or state agency designee. This includes non-covered examples such as central air conditioning, routine home maintenance, and standard home fixtures. Moving on to the next section, we will discuss the documentation standards for the R-F-A (Request for Approval to Authorize Services). According to our policy, the identified direct benefit or need must be documented within the PCISP/service authorization, as well as a physician's prescription and/or clinical evaluation when necessary. When submitting the R-F-A--, it is important to include the following information: ownership of the vehicle to be modified or the relationship of the vehicle owner to the individual, make, model, mileage, and year of the vehicle, a signed and approved R-F-A--, a signed and approved PCISP/service authorization, and receipts for all authorized expenses related to the modification. Furthermore, any necessary documentation to comply with F-S-S-A and division-specific guidelines and policies must also be included. Reimbursement is available for modifications that meet the service and documentation standards outlined in this policy, are allowable under current Medicaid waiver guidelines, and not covered under the Rehabilitation Act of 1973, as amended. These modifications must also be included in the individual's approved PCISP/service authorization and authorized on the R-F-A--, linked to the PCISP/service authorization..

[Audio] Section 11 of our presentation covers the R-F-A policies for DDRS HCBS waivers, specifically for home modifications such as stair lifts, air conditioners/purifiers, widened doorways, and window replacements. It's important to note that these modifications must meet the state's standards for color, style, and design, and will be reviewed by either the state division director or state agency designee. We understand that maintenance for these modifications may be a concern, so for any needs exceeding $500 per year, our case managers will work with other funding sources and community agencies to find a solution. If the cost of services exceeds the annual limit, we request that parts and labor funded through the waiver be itemized separately from those funded through nonwaiver sources for transparency in our accounting. Lastly, any requests for items or modifications not previously listed must be reviewed and decided upon by the state division director or state agency designee, including CB radios, cell phones, alarm systems, auto loan payments, insurance coverage, and routine maintenance for the vehicle. Please note that this list is not exhaustive and may be updated in the future. Thank you for your attention during this portion of our presentation. Proceed to section 12 for more information on our policies and procedures..

[Audio] Section 12 discusses the Health and Wellness (H&W) and Traumatic Brain Injury (T-B-I--) waivers. The purpose of today's presentation is to provide an overview of the policies and procedures for home modifications under the DDRS HCBS Waiver program. These modifications include stair lifts, single-room air conditioners/air purifiers, widening doorways, and replacing windows. It is acknowledged that these modifications play a crucial role in helping individuals with disabilities maintain their independence and safety at home. It is important to note that for the completed modifications, efforts will be made to match the color, style, and design as closely as possible. The state division director or state agency designee will review and make a decision about these modifications. However, the maintenance for modifications provided through a H-C-B-S waiver is limited to $500 annually. It should also be noted that any modifications or items not mentioned above will be reviewed and decided upon by the state division director or state agency designee. Examples of non-covered modifications and items include central air conditioning, routine home maintenance, and standard home fixtures. Moving on to Section 12.1, the eligibility requirements for the H&W and T-B-I waivers will be highlighted. In order to receive Home and Community-Based Services (H-C-B-S-) waiver coverage, individuals must meet the qualifications for an institutional level of care (L-O-C--) and be enrolled in the Indiana Health Coverage Programs (I-H-C-P-). Additional requirements may apply, depending on the specific waiver program. It is worth noting that until 2025, the Area Agencies on Aging (AAAs) will serve as the entry points for the H&W and T-B-I waivers. The initial functional eligibility and level of care (L-O-C--) assessment will be carried out by the A-A-A-s-. Additionally, the Division of Disability & Rehabilitative Services (D-D-R-S-) within the Indiana Family and Social Services Administration (F-S-S-A-) also supports the Health and Wellness (H&W) and Traumatic Brain Injury (T-B-I--) Waiver, along with the Family Supports Waiver (F-S-W--) and Community Integration and Habilitation (C-I-H--) Waiver. For more information about the services available under the F-S-W and C-I-H Waivers, please refer to Section 10: Service Definitions and Requirements for F-S-W and C-I-H Waivers, as well as Section 11: R-F-A Policies. These sections, along with Sections 1-9, also contain specific information..

[Audio] Section 12 of the DDRS HCBS Waivers focuses on eligibility requirements for the Health and Wellness (H&W) and Traumatic Brain Injury (T-B-I--) Waivers. These waivers have specific criteria that must be met in order for individuals to qualify. For the H&W Waiver, the key requirement is meeting the criteria for nursing facility (N-F---) level of care. For the T-B-I Waiver, individuals must meet either NF level of care criteria or intermediate care facility for individuals with intellectual disabilities (ICF/IID) level of care criteria, as outlined in the Indiana Administrative Code 405 I-A-C 1-3-1. Under Indiana law, nursing facilities can receive reimbursement for eligible individuals who require skilled or intermediate nursing care. This includes daily skilled nursing services ordered by a physician, as well as intermediate nursing care for stable or recovering patients. In order to be eligible for the H&W Waiver, individuals must also be functionally eligible, meaning they have a medical need for services such as skilled nursing care, personal care, and home modifications. These modifications, which include stair lifts, air conditioners, widened doorways, and window replacements, will be carefully reviewed by the state division director or agency designee to ensure they match the aesthetic of the home. It should be noted that maintenance for these modifications is limited to $500 per year, and any non-covered items, such as central air conditioning or routine home maintenance, will be reviewed and decided upon by the state division director or agency designee. In conclusion, the DDRS HCBS Waivers have specific requirements for the H&W and T-B-I Waivers, including level of care and functional eligibility, in order for individuals to qualify. Thank you for your attention during this presentation..