part 16

[Virtual Presenter] Dear colleagues, today we will be discussing the requirements for service plans for individuals with Health and Wellness (H&W) and Traumatic Brain Injury (T-B-I--) in the H&W and T-B-I Waivers section. These waivers are a part of the DDRS HCBS Waivers and are specifically designed to provide services and supports for individuals with disabilities. One vital aspect of the service plan is that it must be centered around the individual. This means that it should reflect the individual's strengths, preferences, clinical and support needs, goals, and desired outcomes. It should also include a list of services and supports, both paid and unpaid, that will help the individual achieve their goals. Another essential consideration in the service plan is the chosen living situation of the individual. The individual must have a say in where they reside, as this reflects their independence and autonomy. Additionally, the service plan must address and minimize any potential risks to ensure the individual's safety and well-being. It is important that the service plan is finalized and mutually agreed upon by informed consent, and distributed to the individual and all involved parties. This helps to ensure that everyone is working towards the same goals for the individual. The responsibility of creating the service plan falls on the service coordinator, unless the individual has been in a nursing facility for at least 90 days. In that case, the A-A-A--, through their qualified care managers, will take on the responsibility. It is worth noting that if an individual is later determined to be eligible for Supplemental Security Income (S-S-I--), they will automatically be enrolled in the I-H-C-P-. However, if they are later found eligible for Social Security Disability Income (S-S-D-I-), they will need to reapply. In this case, the S-S-A disability determination will be accepted as long as they meet the other eligibility requirements. Overall, the service plan is a crucial tool in providing necessary services and supports for individuals with H&W and T-B-I--. It is a collaborative effort that takes into account the individual's needs, preferences, and goals to ensure their safety and well-being. Thank you for your attention, and let's now move on to discussing the next section..

[Audio] Slide number 2 out of 14 discusses the requirements for service plans for individuals included in the DDRS HCBS Waivers who have Health and Wellness (H&W) or Traumatic Brain Injury (T-B-I--). The service plan is a crucial part of providing quality care and support for these individuals. It is essential for the plan to consider their strengths, preferences, clinical and support needs, goals, desired outcomes, and necessary services and supports for their well-being. The plan must also address any potential risks and provide measures to minimize them. It is vital for the plan to be easily understandable by the individual and their caregivers. Once the plan is completed and agreed upon with informed consent, it is distributed to the individual and involved parties. All services must adhere to a written care plan approved by the D-D-R-S-. The service coordinator is responsible for completing the plan, unless the participant has been in a nursing facility for at least 90 days. Now, let's dive into the details of service plan approval. Once approved by the Family and Social Services Administration (F-S-S-A-), an authorization is granted, providing necessary details for each approved waiver-funded service, such as the number of units, provider name, and billing code with modifiers. The service coordinator must transmit this information to the waiver database. It is important to note that claims will be denied if there is no authorization in the database or if an unapproved code is billed. Providers are prohibited from rendering or billing services without an approved authorization. If there are any discrepancies in the authorized or rendered services, it is the provider's responsibility to inform the service coordinator. Moving on, let's briefly discuss member eligibility for the Health and Wellness Waiver, which is specifically for Medicaid-eligible individuals under 59 with a disability. Its purpose is to provide an alternative to nursing facility admission..

[Audio] Slide 3 discusses Section 12, which focuses on Health and Wellness (H&W) and Traumatic Brain Injury (T-B-I--) Waivers. The purpose of this section is to outline the requirements for service plans for individuals enrolled in these waivers. The service plan is a critical aspect of the waiver program and must include the individual's strengths, preferences, clinical and support needs, goals and desired outcomes, services and supports, risk factors, and measures to minimize them. It should also be easily understandable for the individual and all parties involved. Once finalized, the service plan must be agreed upon with informed consent and distributed to the individual and others involved. All services must be provided according to a written care plan that is approved by the D-D-R-S-. The service coordinator is responsible for completing the service plan, except in cases where the participant has been in a nursing facility for at least 90 days. Moving on, the various services covered under the DDRS HCBS Waivers include Attendant Care, Care Management, Caregiver Coaching, Community Transition, Home and Community Assistance, Home-Delivered Meals, Home Modification Assessment, Home Modifications, Integrated Health Care Coordination (I-H-C-C-), Nutritional Supplements, Participant-Directed Home Care Service (P-D-H-C-S), Personal Emergency Response System (P-E-R-S-), Pest Control, Skilled Respite, Specialized Medical Equipment and Supplies, Structured Family Caregiving, Transportation, and Vehicle Modifications. Next, we will discuss who is eligible to receive services under the Traumatic Brain Injury Waiver. The primary goal of this waiver is to ensure that individuals with a traumatic brain injury receive appropriate services based on their needs and the needs of their families. To be eligible, individuals must require institutional care if not for the provision of these services. Indiana defines T-B-I as a trauma that has occurred as a closed or open-head injury caused by an external event that results in damage to brain tissue, with or without injury to other body organs. Some examples of external agents include mechanical or events that result in interference with vital functions. Thank you for your attention to this section. In the next slide, we will provide more detailed information about the services covered under the H&W Waiver..

[Audio] This is slide number four of our presentation on the requirements for service plans for individuals with H&W and T-B-I in the H&W and T-B-I waivers section. As previously mentioned, the service plan for these individuals must include their strengths, preferences, clinical and support needs, goals and desired outcomes, services and supports, risk factors, and measures to minimize them. Additionally, the plan must be understandable to the individual and others involved and be finalized and agreed upon with informed consent before being distributed. Moving on, the services available under the T-B-I waiver include Adult Day Services, Adult Family Care, Assisted Living, Attendant Care, Behavior Management/Behavior Program and Counseling, Care Management, Community Transition, Home and Community Assistance, Home-Delivered Meals, Home Modification Assessment, Home Modifications, Integrated Health Care Coordination, Nutritional Supplements, Personal Emergency Response System (P-E-R-S-), Pest Control, Residential-Based Habilitation, Skilled Respite, Specialized Medical Equipment and Supplies, Structured Day Program, Structured Family Caregiving, Supported Employment, Transportation, and Vehicle Modifications. In section 12.2, we will discuss the certification, enrollment, and responsibilities for providers of home and community-based services for the H&W and T-B-I waivers. The process for becoming a provider for these waivers is overseen by the Division of Disability and Rehabilitative Services (D-D-R-S-) and begins with the Family and Social Services Administration (F-S-S-A-). Thank you for joining us on this slide where we discussed the services available under the T-B-I waiver and the process for becoming a provider. Our discussion will continue on the next slide..

[Audio] We will now discuss the requirements for service plans for individuals with Health and Wellness (H&W) and Traumatic Brain Injury (T-B-I--) in the H&W and T-B-I Waivers section, which is slide number 5 out of 14. These plans are crucial for providing personalized care and support to those in need. The service plan must include the individual's strengths, preferences, clinical and support needs, goals and desired outcomes, services and supports, risk factors, and measures to minimize them. It is important that this plan is easily understandable for both the individual and anyone involved in their care. Furthermore, the plan must be finalized and agreed upon with informed consent and distributed to the individual and all others involved. It should be noted that all services must be provided according to a written care plan approved by the D-D-R-S. Moving on to the next section, Section 12: Health and Wellness (H&W) and Traumatic Brain Injury (T-B-I--) Waivers, it is the responsibility of the FSSA OMPP to enroll and certify providers for these waivers starting from July 1, 2024. If you wish to become a provider for these waivers, you will need to complete an application through the OMPP HCBS Certification Portal. In order to be certified, providers must submit all required documentation for each service they wish to offer. This portal is used for certifying new providers, adding services for existing providers, and making changes in ownership. However, please note that an application for certification may be denied if the provider does not meet the necessary requirements. Similarly, an application may be rejected if required documentation or information is missing. In such cases, a letter will be sent to notify the applicant and advise on necessary actions for resubmission. It is important to understand that an application for certification will only be approved by the Provider Certification team if all requirements are met. Let us move on to the next slide..

[Audio] Our presentation today focuses on the requirements for service plans for individuals with H&W (health and wellness) and T-B-I (traumatic brain injury) in the H&W and T-B-I Waivers section. We are currently on slide number 6 out of 14. It is crucial to select the correct provider classification when applying for enrollment in the I-H-C-P (Indiana Health Coverage Programs). This will ensure proper enrollment and the ability to provide services to individuals with H&W and T-B-I--. The three available classifications for H-C-B-S (Home and Community Based Services) providers are billing provider, group provider, and rendering provider. A billing provider is responsible for billing for services provided and is typically a sole practitioner. A group provider must have multiple members linked to the group. A rendering provider is linked to a group and cannot bill for services themselves. It is important to note that for T-B-I or H&W waiver group enrollments, all rendering providers and the group itself must be certified by the FSSA OMPP (Family and Social Services Administration Office of Medicaid Policy and Planning). When applying for enrollment in the I-H-C-P waiver program, providers must also designate their provider type and specialty. This ensures that individuals' needs are matched with the appropriate provider. Specialty and subspecialty designations are important for H-C-B-S services as they indicate the provider's specific area of expertise and the services they are able to provide. If applying by mail instead of online, the provider classification will determine which enrollment packet the waiver provider should complete. This includes the I-H-C-P Waiver Billing Provider Enrollment and Profile Maintenance Packet, the I-H-C-P Waiver Group and Clinic Provider Enrollment and Profile Maintenance Packet, and the I-H-C-P Waiver Rendering Provider Enrollment and Profile Maintenance Packet. By selecting the correct provider classification and designations for provider type and specialty, we can ensure that individuals with H&W and T-B-I receive the best possible care and support. Thank you for listening and please stay tuned for the next slide where we will discuss the service plan requirements in more detail..

[Audio] Next, let us discuss Section 12 of our presentation, which focuses on Health and Wellness (H&W) and Traumatic Brain Injury (T-B-I--) waivers. Within the DDRS HCBS waivers, we will be addressing the specific requirements for service plans for individuals with H&W and T-B-I--. These plans are crucial as they outline the individual's strengths, preferences, clinical and support needs, goals, desired outcomes, services and supports, and measures to minimize any risk factors. It is essential that these plans are easily comprehensible not only to the individual but also to others involved. They must also be finalized and agreed upon with informed consent and distributed to all parties involved. Now, let us move on to the enrollment process. Our I-H-C-P staff members carefully examine the provider enrollment packet to ensure its completeness according to specific guidelines. If all the information is accurately completed and approved, the provider's information will be entered into the I-H-C-P CoreMMIS system. For those who submit their enrollment application through the I-H-C-P Portal, the information will be automatically transferred into CoreMMIS. Once approved, a provider letter will be generated to notify the agency that they are now a Medicaid-enrolled H-C-B-S waiver provider. This letter will include their assigned I-H-C-P Provider ID and enrollment information. We strongly encourage providers to review this letter to verify the accuracy of their enrollment. However, if a provider's enrollment packet requires correction or is missing required documentation, our I-H-C-P Provider Enrollment Unit will contact them through telephone, email, or mail. This is to communicate what needs to be corrected, completed, and submitted before we can process their enrollment. In the case of missing or incomplete information, the entire packet will be returned. This concludes this section of our presentation. Thank you for your attention..

[Audio] Let's proceed to Slide 8 out of 14, where we will cover the criteria for service plans for individuals with H&W and T-B-I in the H&W and T-B-I Waivers section. As we know, these service plans must encompass the individual's strengths, preferences, clinical and support requirements, goals and desired outcomes, services and supports, risk factors, and methods to minimize them. Additionally, it is crucial to note that the plan must be finalized and agreed upon with informed consent and shared with all those involved in the individual's care. Moving forward, I would like to bring your attention to the DDRS HCBS Waivers Section 12: Health and Wellness (H&W) and Traumatic Brain Injury (T-B-I--) Waivers. It is imperative for all providers to be mindful of the List of Excluded Individuals and Entities (L-E-I-E-), maintained by the HHS-OIG. This database provides information about parties who are prohibited from participating in federal healthcare programs, such as Medicare and Medicaid. The leie database is accessible to the public on the Exclusions Program page at oig.hhs.gov, where it can be searched online or downloaded. The online searchable Exclusions Database allows for identification of currently excluded individuals or entities by name. In the event of a match, the searcher can verify the accuracy of the match using a Social Security number (S-S-N--) or employer identification number (E-I-N--). Alternatively, the downloadable version of the database can be compared against an existing database maintained by a provider. However, it does not contain S-S-Ns or E-I-Ns like the online format. As a condition of enrollment, all current and potential I-H-C-P providers are required to take necessary measures to determine whether their employees and contractors are excluded individuals or entities. This includes screening all employees and contractors against the leie. It is vital for providers to agree to comply with these obligations to safeguard the well-being of individuals with H&W and T-B-I--. Thank you for your attention. Let's move on to the next slide..

[Audio] This section will discuss the necessary requirements for individuals with Health and Wellness (H&W) and Traumatic Brain Injury (T-B-I--) within the H&W and T-B-I Waivers section. These service plans are a crucial aspect of the DDRS HCBS Waivers. It is vital to note that any updates made by waiver providers must first be submitted to FSSA OMPP and must have a new Waiver Service Certification Letter before being sent to the IHCP. The system responsible for storing member eligibility information, service plans, service authorizations, level-of-care information, and case notes entered by H&W care managers or T-B-I care managers is known as CaMSS. This system also contains a provider database, maintained by F-S-S-A staff, that provides current information on the certification status of waiver providers. It is extremely important that the information in CaMSS is always up-to-date, as provider selection profiles are created from this system. Any changes to provider information must be made by contacting the I-H-C-P waiver/provider analyst at FSSAproviderapp@fssa.in.gov. If the provider is licensed by the Indiana Department of Health (I-D-O-H-), it is also necessary to inform the I-D-O-H of any changes to the provider's name, address, or telephone number. It is the responsibility of the service coordinator to complete the service plan, unless the participant has been in a nursing facility for at least 90 days. The service plan must include the individual's strengths, preferences, clinical and support needs, goals and desired outcomes, services and supports, risk factors, measures to minimize them, and be understandable to the individual and others involved. The plan must be finalized and agreed upon with informed consent and distributed to the individual and others involved. All services must be provided according to a written care plan approved by the D-D-R-S-. It is crucial to maintain accurate and up-to-date information in CaMSS for the service plan to be approved and for services to be provided. Thank you for your attention to these important details. Please ensure that all updates regarding providers are communicated and that the CaMSS system remains current at all times..

[Audio] This section will discuss the necessary requirements for service plans for individuals with H&W and T-B-I in the H&W and T-B-I Waivers. It is crucial to note that these plans must be comprehensive and thorough to ensure that individuals receive the appropriate care and support. The service plan must include the individual's strengths, preferences, clinical and support needs, goals and desired outcomes, services and supports, as well as risk factors and measures to minimize them. Furthermore, it must be easily understandable for both the individual and all involved parties. Once the service plan is finalized, it must be agreed upon with informed consent and distributed to the individual and other relevant parties. All services must be provided in accordance with a written care plan, which must be approved by the D-D-R-S-, in order to guarantee high-quality and suitable care for individuals. Moving on to the topic of criminal history checks, it is our agency's responsibility to maintain these checks in our files and they are available upon request. We also conduct checks on licensed professionals through the Indiana Professional Licensing Agency (I-P-L-A-). In addition, direct care staff undergo checks against the nurse aide registry at the I-P-L-A to verify that any unlicensed employees or agents involved in the direct provision of services have no findings entered into the registry. This is done with the utmost concern for the safety and well-being of our members. The I-P-L-A is responsible for maintaining the nurse aide registry and, as stated in 455 I-A-C 2, General Requirements, providers are required to obtain and submit a current document from the nurse aide registry to verify that any unlicensed employees involved in the direct provision of services have no findings entered into the registry. This process is crucial in ensuring the quality of care our members receive. We take these checks and requirements very seriously in order to protect the safety and well-being of our members. Thank you for your attention to this matter. We will now proceed to the next section of our presentation..

[Audio] This presentation covers slide number 11 and provides an overview of the necessary requirements for service plans in the H-C-B-S waivers section for individuals with H&W and T-B-I--. The focus of this section is to ensure that the service plan includes all necessary components for quality care for these individuals. It is important to finalize the service plan with informed consent and distribute it to all involved parties. The plan should encompass the individual's strengths, preferences, clinical and support needs, goals, desired outcomes, and specific services and supports required. It should also address risk factors and include measures to minimize them. The plan must be easily understandable for the individual and those involved in their care. All services provided must follow a written care plan approved by the D-D-R-S to ensure safe and effective delivery. The service coordinator is responsible for completing the service plan, unless the individual has been in a nursing facility for at least 90 days. Moving on to section 12, we will discuss the Health and Wellness (H&W) and Traumatic Brain Injury (T-B-I--) waivers within the DDRS HCBS waivers. Providers can update their information with the I-H-C-P through the I-H-C-P Provider Healthcare Portal or by mail, using the appropriate enrollment packet or profile maintenance form from the Update Your Provider Profile page at in.gov/medicaid/providers. The new Waiver Service Certification Letter must be included with the update. In section 12.3, we address Quality Assurance/Quality Improvement. The B-D-S Quality Assurance Services team and authorized vendors are responsible for developing and implementing quality improvement and quality assurance systems to ensure the health and welfare of individuals receiving Medicaid Home and Community-Based Services (H-C-B-S-) waiver services. This includes developing policies, conducting provider compliance reviews, investigating complaints, reviewing mortality, and managing the state's automated system for reporting incidents of abuse, neglect, and exploitation. For more information about the B-D-S Quality Assurance Services, please visit the Programs & Services section on the in.gov/fssa/ddrs website..

[Audio] In our presentation, we will now move on to slide number 12 where we will discuss the necessary service plans for individuals with H&W and T-B-I in the H&W and T-B-I Waivers section. These service plans must include the individual's strengths, preferences, clinical and support needs, goals and desired outcomes, services and supports, risk factors, and measures to minimize them. It is crucial to note that the plan must not only be understandable to the individual, but also to others involved in their care. Once finalized and agreed upon, informed consent must be obtained and the plan must be distributed to all involved parties. Additionally, all services must be provided according to a written care plan approved by the D-D-R-S-. In certain situations, such as when a family member or caregiver of the participant is arrested, there is a major disturbance or threat to public safety created by the participant, or when restraints are used, all waiver service providers must report the incident through the web-based Incident and Follow-Up Reporting (I-F-U-R-) tool. If web access is unavailable, incidents can be reported via email at BDSIncidentReports@fssa.in.gov. Furthermore, providers are required to report any known or suspected abuse, neglect, or exploitation of an adult to Adult Protective Services (A-P-S--). The statewide A-P-S system has a 24-hour hotline for reporting, and reports can also be made to the local A-P-S or county prosecutor's office. For more information about A-P-S--, please visit the Adult Protective Services page at in.gov/fssa. In conclusion, it is crucial that we adhere to these reporting requirements to ensure the safety and well-being of our participants..

[Audio] Section 12 discusses the importance of Health and Wellness (H&W) and Traumatic Brain Injury (T-B-I--) Waivers for individuals with these conditions. These waivers require the development of service plans for each individual, which should include their strengths, preferences, clinical and support needs, goals and desired outcomes, services and supports, risk factors, and measures to minimize them. It is crucial that these plans are understandable to both the individual and others involved. Therefore, the plan must be finalized and agreed upon with informed consent and distributed to all relevant parties. To ensure that these plans are followed, all services must adhere to a written care plan approved by the D-D-R-S-. The responsibility for completing the service plan falls on the service coordinator, unless the individual has been in a nursing facility for at least 90 days. In case of any issues or concerns regarding an individual's care, the Bureau of Developmental Disabilities Services (B-D-S--) recommends individuals to first contact their case manager for resolution. If this is unsuccessful, the individual can file a complaint with the B-D-S--. The complainant can choose to remain anonymous if desired. Upon receiving a complaint, the B-D-S will review and categorize it as urgent or critical, and assign a complaint investigator to investigate within a specified timeframe. In certain situations, the B-D-S may need to involve other agencies, such as A-P-S--, D-C-S--, or local law enforcement, to ensure the individual's health and welfare. It is important to note that most complaint investigation activities are conducted without prior notice. However, in some cases, advanced scheduling may be necessary for activities like interviews with individuals who may have information about the issue, to ensure their availability. The nature of the complaint will determine the specific investigation methods used..

[Audio] Our presentation on the requirements for service plans for individuals with H&W and T-B-I in the H&W and T-B-I Waivers section has reached its final slide. As we have discussed, it is crucial for the service plan to consider the individual's strengths, preferences, clinical and support needs, goals and desired outcomes, services and supports, risk factors, and measures to minimize them. It should also be easily understood by the individual and everyone involved and must be finalized and agreed upon with informed consent and shared with all parties. However, our responsibilities do not end there. All services provided must have a written care plan that is approved by the D-D-R-S-. Moving on, let's examine some statistics regarding apparent cause/expected deaths in individuals receiving services under the DDRS HCBS Waivers. These may include medical conditions, hospice care, known chronic or terminal diseases, and nursing facility stays longer than seven days. The causes could also be natural, such as passing away in sleep or being found deceased at home. To evaluate and enhance our services, the Quality Improvement director or designated staff prepares the final recommendations of the Mortality Review Committee (M-R-C--) and presents them at the Quality Improvement Committee. The M-R-C plays a crucial role in assessing the effectiveness of implemented recommendations to reduce death rates, hospitalizations, and critical incidents. They also conduct trend analysis and implement systemic interventions when necessary. Furthermore, the M-R-C publishes reports on the deaths of individuals receiving services, highlighting any trends and patterns identified by the mortality reviews. This not only aids in improving our services but also keeps the public informed. Another crucial aspect of our services is the role of the statewide waiver ombudsman. Their responsibility is to receive, investigate, and attempt to resolve complaints and concerns from individuals receiving H-C-B-S waiver services. If you have any complaints, you can contact the statewide waiver ombudsman through the toll-free number 800-622-4484 (Option 2) or 317-232-7134, or by emailing LongTermCareOmbudsman@ombudsman.in.gov. The role of the statewide waiver ombudsman is of utmost importance as it ensures that the rights and needs of individuals receiving services are protected..