part 19

[Virtual Presenter] We are delighted to present our Care Management services under Medicaid waivers. Providers who are the parents of a minor child participant, spouse of a participant, attorney-in-fact (or P-O-A--) of a participant, H-C-R of a participant, or legal guardian of a participant are not eligible for reimbursement. Please refer to the detailed provider qualifications for Care Management services. Prior to billing, a care manager must have completed the care management curriculum to become a Medicaid certified care manager. To be eligible, education and work experience requirements include being continuously employed as a care manager by an Area Agency on Aging (A-A-A--) since June 30, 2018, having a registered nurse license, and a bachelor's degree in social work, psychology, counseling, gerontology, nursing, or health and human services; or having a bachelor's degree in any field with a minimum of two years full-time, direct service experience with the elderly or disabled. A master's degree in social work, psychology, counseling, gerontology, nursing, or health and human services may substitute for the required minimum of two full-time direct services experience. An associate degree in nursing or any field with a minimum of four years full-time, direct service experience with the elderly or disabled may also be accepted. We hope this information is helpful and look forward to providing our Care Management services to eligible participants..

[Audio] We are here to discuss the qualifications for care management services under the DDRS HCBS Waivers. The waivers are designed to support individuals with health and wellness and traumatic brain injury needs. Provider qualifications are crucial in ensuring that care management services are delivered effectively. Providers must have the necessary licenses and certifications, adhere to other standards, and meet specific qualifications. For caregiver coaching, we will discuss the definition of the service and the requirements for providing it. Caregiver coaching is a training and support service for unpaid caregivers of waiver participants with cognitive impairments and dementia. Caregivers will be equipped with the necessary skills to manage the participant's medical conditions and associated behavioral health needs. We will also discuss other standards required for care management services, such as financial information, documentation of qualifications, and maintenance of records of services provided. It is important to note that care management services will only be reimbursed for eligible participants under specific qualifications, including completing the care management curriculum and having relevant education and work experience. Additionally, providers cannot be reimbursed if they are the parent of a minor child participant, spouse of a participant, attorney-in-fact (or P-O-A--) of a participant, H-C-R of a participant, or legal guardian of a participant. In conclusion, care management services are an essential component of the DDRS HCBS Waivers. Providers must meet specific qualifications, and caregiver coaching is available to support unpaid caregivers of waiver participants with cognitive impairments and dementia. We.

[Audio] We are on slide 3 in our presentation on Care Management services for eligible participants. To be reimbursed, participants must complete the care management curriculum and have relevant education and work experience. Additionally, the provider cannot be the parent of a minor child participant, spouse of a participant, attorney-in-fact (or P-O-A--) of a participant, H-C-R of a participant, or legal guardian of a participant. Now let's discuss DDRS HCBS Waivers, which are available to any and all caregivers who are not served through Structured Family Caregiving. The waiver participant will receive additional waiver services outside of what the unpaid caregiver delivers. This service allows family caregivers who are not eligible to participate in Structured Family Caregiving to access support. The goal of the caregiver coach and behavior management service is to address the caregiver's needs as far as training and education on how to best support the person. Technology will be used between the agency performing caregiver coaching and behavior management and the unpaid caregiver. If the unpaid caregiver needs assistance with the technology, the assigned caregiver coach will visit with the unpaid caregiver to provide a tutorial. Caregiver coaching is a service targeted toward the unpaid caregiver to support their needs in order for the unpaid caregiver to continue supporting the waiver participant. The caregiver coach will assess strengths and goals as well as any health and safety risks of the unpaid caregiver, such as burnout or compassion fatigue, or that the unpaid caregiver is concerned about, related to the waiver participant. These strengths, goals, health and safety concerns will be documented in the person-centered service plan along with interventions to ensure health and safety. The interventions will be assessed during each biweekly visit between caregiver coach and unpaid caregiver, and modified as needed as well as updates to the service coordinator about health and safety concerns and interventions. Through additional guidance to providers and care managers, the B-D-S will clarify that the emergency/crisis plan should be developed among all parties (waiver care manager, participant, caregiver, caregiver coach, and behavior management provider). This way, the participant and the participant's circle of support will have the same knowledge and understanding of the participant's backup plan, and emergency plan, and will support the participant in implementing that plan if needed. If there are modifications to the plan, all parties shall be involved in the plan changes as well as aware of the changes. The B-D-S will provide an example plan to both care managers and providers in guidance. Because the waiver participant receives services through the Health and Wellness (H&W) waiver as well as the Indiana Medicaid State Plan, the medically complex needs will be addressed through those services. Additionally, there are often times when unpaid caregivers render those services (if the provider is not available). The caregiver coach will identify with the unpaid caregiver the supports being rendered on an informal basis, by the unpaid caregiver to support the waiver participant. These services will be documented in the unpaid caregiver's person-centered service plan. The caregiver coach will review the services with the unpaid caregiver and care manager on a biweekly basis (or as communicated by the unpaid caregiver if more than biweekly). If the unpaid caregiver has questions or concerns about service delivery, the caregiver coach will provide training and education about delivery and/or connect with the participant, participant's waiver care manager, and other providers to ensure services are rendered as specified by the participant. Covered Services: * Initial consultation for assessment of the caregiver to determine initial coaching needs, and understand the caregiver's goals, values, needs and strengths. * Caregiver Coaching provided in the community of the participant,.

[Audio] We discuss Care Management services that will be reimbursed based on certain qualifications. In order to be eligible for reimbursement, the provider must not be the parent of a minor child participant, spouse of a participant, attorney-in-fact (or P-O-A--) of a participant, H-C-R of a participant, or legal guardian of a participant. Service standards must be followed for Caregiver Coaching. Caregiver Coaching services are family-centered, individualized, and informed by an assessment of each caregiver’s goals, values, needs, and strengths. A caregiver coach with expertise working with unpaid caregivers will conduct a caregiver assessment and deliver ongoing education and coaching. The service may be delivered telephonically and through H-I-P-A-A secure electronic communication platforms. Providers must capture any caregiver communications received through an electronic communication platform to facilitate the sharing of relevant information with care managers. The service is designed to equip unpaid caregivers with the skills to manage the participant’s medical conditions and associated behavioral health needs related to a cognitive impairment and/or dementia. The caregiver coach will assist the caregiver and participant in creating a crisis management/emergency plan to address the person and environment. The plan will be reviewed and updated on a monthly basis and provided to emergency contacts and backup caregivers..

[Audio] We are pleased to introduce our Care Management services. These services will only be reimbursed for eligible participants with specific qualifications. In order to be eligible for reimbursement, participants must complete the care management curriculum and have relevant education and work experience. Additionally, providers cannot be the parent of a minor child participant, spouse of a participant, attorney-in-fact (or P-O-A--) of a participant, H-C-R of a participant, or legal guardian of a participant. Our Caregiver Coaching services are designed to support and empower caregivers to provide the best possible care to their loved ones. We understand the importance of providing appropriate educational content and employing caregiver coaches with the experience and qualifications appropriate to the needs of each family. Therefore, we have set certain restrictions and limitations for our Caregiver Coaching services. Firstly, structured family caregiving agencies may be service providers, but caregiver coaches must be employed by these agencies with the appropriate experience and qualifications. Secondly, educational content delivered by provider agencies to caregivers and delivery methods must be appropriate to the needs of lay caregivers. Finally, there are maximum billable quarter hours units per month, which is 32. We would like to clarify that certain activities are not allowed or reimbursed under Caregiver Coaching. Caregiver coaching services will not duplicate services provided under the Indiana Medicaid State Plan or any other waiver service. Separate payment will not be made for structured family caregiving. Additionally, caregiver coaching service will not be reimbursed when provided by a parent of a minor child participant or the spouse of a participant (also known as L-R-I-s-) as outlined in C-2-d and C-2-e of the H&W Waiver. We believe that our Caregiver Coaching services can provide valuable support and resources to caregivers, and we are committed to providing high-quality services that meet the needs of our participants. Thank you for your attention, and we are happy to answer any questions you may have..

[Audio] In order to be eligible for reimbursement, participants must complete the care management curriculum and have relevant education and work experience. Any providers who are the parent of a minor child participant, spouse of a participant, attorney-in-fact (or P-O-A--) of a participant, H-C-R of a participant, or legal guardian of a participant will not be reimbursed. Now, let's move on to a closer examination of the DDRS HCBS Waivers Section 12. For Community Transition services, the participant's own home is defined as any dwelling that is owned, leased, or rented by them, including a house, apartment, condominium, trailer, or other type of lodging. All community transition items are considered the property of the participant receiving the service. Any approved community transition expenditures, such as security deposits, application fees, essential (not luxury) furnishings, moving expenses, setup fees, deposits for utilities or services, health and safety assurances, and one-time cleaning prior to occupancy, can be reimbursed through the local Area Agency on Aging (A-A-A--) or an OMPP-approved provider. These reimbursements will be based on applicable receipts and verification of the services being delivered. In order to receive community transition services, a written service plan must be created through the person-centered planning process. If the participant lacks government-issued identification items that are necessary for securing housing or utilities, the costs associated with obtaining these items will also be covered under community transition services..

[Audio] We are presenting the documentation standards and limitations for Community Transition services under the Health and Wellness (H&W) and Traumatic Brain Injury (T-B-I--) waivers. These services are an essential part of the care management services provided under these waivers. It is crucial for care managers to follow the documentation standards and limitations in order to ensure efficient and effective delivery of these services. The documentation standards require care managers to document the need for Community Transition services and any reasonable furnishings or setup expenses requested by the participant in the service plan. They must also keep records of all expenditures and provide receipts. If the care manager requests the maximum lifetime cap of $1500 but not all funds are used, they must update the service plan to reduce the amount and prevent over-reimbursement by Medicaid. Moving on to the limitations for Community Transition services, reimbursement is limited to a one-time use and a lifetime cap of $1500 for setup expenses. These services can only be provided if they are deemed reasonable and necessary in the service plan, and the individual is unable to cover the expenses themselves or obtain them from other sources. It is important to note that certain activities, such as apartment or housing expenses, food, household appliances, recreational items, and allergen control, are not allowed to be covered by Community Transition services. Furthermore, federal financial participation will not be billed for until after the individual leaves the institution and becomes eligible for the waiver. It is also not reimbursed if provided by a parent or spouse of the participant. In summary, Community Transition services are a critical part of care management services..

[Audio] The qualifications for Community Transition services under Health and Wellness (H&W) and Traumatic Brain Injury (T-B-I--) waivers are being presented. These services aim to support participants in their homes with instrumental activities of daily living (I-A-D-L-) when they are unable to meet their needs or when their caregiver cannot help them. To become an approved provider, community transition service agencies must fulfill specific requirements. This includes having a valid license or certification from a recognized healthcare organization and following FSSA-approved standards for Community Transition Service Agencies. In addition to these general requirements, providers must also meet specific qualifications for H&W/TBI waivers. These include financial information, liability insurance, transportation arrangements, professional qualifications and requirements, documentation of qualifications, maintenance of personnel records, adoption of personnel policies, operations manual, maintenance of records of services provided, individual's personal file, site of service delivery, and other relevant qualifications. We hope this information is helpful and encourages you to consider these requirements when selecting a provider for your community transition service needs. Thank you for your attention..

[Audio] Slide number 9 out of 14 in the presentation titled "Care Management Services" is now displayed. This slide contains information on the service standards that must be followed for care management services. These standards are crucial in ensuring the safe and effective delivery of care management services. The slide begins with a list of allowable activities that can be provided as part of care management services. These activities include assistance with meal planning and preparation, essential errands and unassisted transportation, correspondence and bill paying, minor pet care, and outdoor tasks such as raking leaves, snow removal, lawn mowing, and weeding. These activities are all important in supporting the well-being of participants. Following this, the slide outlines the documentation standards that must be adhered to for care management services. This includes documenting the need for Home and Community Assistance, the frequency of need, and the specific type of assistance required. The Home and Community Assistance providers are also responsible for documenting the data record of services provided, including the date and time of service, specific tasks carried out, notification to the participant's care manager, time spent traveling and completing the errand, and the signature of the employee providing the service. Lastly, it is stated that each staff member who directly provides care or supervises care for the participant must make at least one entry per day, describing any issues or circumstances pertaining to the participant. This helps to ensure that all aspects of the participant's care are carefully monitored and recorded. Overall, adherence to these service standards is crucial in providing participants with the necessary care and support they need to lead healthy and fulfilling lives..

[Audio] The Health and Wellness (H&W) and Traumatic Brain Injury (T-B-I--) Waivers in Section 12 of the DDRS HCBS Waivers outline the qualifications for reimbursement of Care Management services. These qualifications include completing the care management curriculum and having relevant education and work experience. Providers must not fall under certain categories, such as being the parent of a minor child participant, spouse of a participant, attorney-in-fact (or P-O-A--) of a participant, H-C-R of a participant, or legal guardian of a participant. The participant or designated participant representative must sign off on service delivery documentation. Home and Community Assistance services are not allowed to provide hands-on assistance with Activities of Daily Living (ADLs), assisted transportation to community activities or errands, or to household members other than the participant. The owner of the organization must not fall under certain categories, such as being a parent of a minor child participant, spouse of a participant, attorney-in-fact (or P-O-A--) of a participant, H-C-R of a participant, legal guardian of the participant, or a member of the participant's household. Home and Community Assistance services cannot be provided to participants already receiving Adult Family Care, Structured Family Caregiving, or Assisted Living services. Home and Community Assistance services will not be reimbursed if they are provided by the parent of a minor child participant or the spouse of a participant (also known as LRIs), as outlined in C-2-d and C-2-e of the Health and Wellness and Traumatic Brain Injury waivers. Providers must meet the qualifications outlined in Table 17 in our library reference number PRPR10014, published on September 9th. We appreciate your attention to these important guidelines to ensure the best care for eligible participants..

[Audio] During the presentation, we will cover the rules and regulations that must be followed in order for care management services to be reimbursed for eligible participants. It is crucial to have a clear understanding of these guidelines in order to ensure that care management services are provided effectively and efficiently. Our focus will primarily be on the health and wellness (H&W) and traumatic brain injury (T-B-I--) waivers, as well as the DDRS HCBS waivers. We will also discuss the qualifications for being a provider of home and community assistance services, which include becoming an approved provider and maintaining approval, having liability insurance, meeting professional qualifications and requirements, and keeping accurate personnel records. We will also address compliance with IC 16-27-4, if applicable, and the requirements for being an F-S-S-A approved home health agency, as stated in IC 16-27-1, IC 16-27-4, and section 12.16: Home-Delivered Meals for H&W and T-B-I waivers. It is important to note that care management services will only be reimbursed for eligible participants who meet specific qualifications, such as completing the care management curriculum and having relevant education and work experience. Furthermore, reimbursement will not be provided if the provider is the parent of a minor child participant, spouse of a participant, attorney-in-fact (or P-O-A--) of a participant, H-C-R of a participant, or legal guardian of a participant. It is crucial to adhere to these qualifications and restrictions in order to receive proper reimbursement for care management services..

[Audio] Our Delivered Meal service is an essential component of Care Management services that provides a nutritionally adequate meal to eligible participants in a safe and cost-effective manner. The meals we provide must contain at least one-third of the current daily recommended dietary allowance as established by the Food and Nutrition Board of the National Academy of Sciences, National Research Council. Meals should also contain less than 10% daily calories from added sugars, saturated fats, and sodium, unless prior F-S-S-A or registered dietitian approval is received. Documentation standards must be followed, including the care manager documenting the need for Home-Delivered Meals and the amount being requested, and the provider documenting the date of delivery, how many meals are included, and the name of the care professional or care manager that involved the participant. Food allergies, food preferences, or gluten sensitivity for waiver participants must also be documented. It is important to note that more than two meals per day are not allowed, and services provided to participants receiving either of the following waiver services: Adult Family Care or Assisted Living, are not reimbursed when provided by the parent of a minor child participant or the spouse of a participant as outlined in C-2-d and C-2-3 of the H&W and T-B-I waivers. Proper documentation and adherence to the documentation standards and activities not allowed are crucial to ensure that the service is reimbursable and effective..

[Audio] We are pleased to announce the availability of Care Management services through the Health and Wellness (H&W) and Traumatic Brain Injury (T-B-I--) waivers. In order to be eligible for reimbursement, participants must complete the care management curriculum, have relevant education and work experience, and not be the parent of a minor child participant, spouse of a participant, attorney-in-fact (or P-O-A--) of a participant, H-C-R of a participant, or legal guardian of a participant. The Home-Delivered Meals (H-D-M--) services have specific provider qualifications which are outlined in Table 18. These qualifications include being an approved provider, maintaining approval, and adhering to all state and local health laws and ordinances related to food preparation, handling, and serving. For Home Modification Assessment (H-M-A--) services under the H&W and T-B-I waivers, participants must select a certified waiver provider before any home modifications are made and must undergo a home modification inspection upon completion of the work. Reimbursement for home modifications will only be granted after a final inspection has taken place. The assessor will be responsible for determining specifications, assessing feasibility, and conducting the post-project inspection. We hope that this information will help ensure the safety, suitability, and practicality of Care Management services for eligible participants..

[Audio] Home Modification Assessment Service Standards The Home Modification Assessment service is a critical component of DDRS HCBS Waivers. According to Section 12 of the DDRS HCBS Waivers, the Home Modification service will only be deducted from the participant's lifetime cap if completed by an eligible provider and if the participant meets specific qualifications. It is important to note that the provider cannot be a parent, spouse, attorney-in-fact, H-C-R--, or legal guardian of the participant. The allowable activities for the Home Modification Assessment service include evaluating the current environment and identifying any barriers that may prevent desired modifications, reimbursing for nonfeasible assessments, drafting specifications, and submitting them for approval. The modification must also undergo an inspection and approval process, and the county code enforcement must be contacted. Service standards require the participant's plan of care to indicate a need for home modification, and the proposed modifications must address the participant's level of service needs. The specifications must comply with the requirements and limitations outlined in the approved service definition for Home Modifications. The assessment itself must be conducted by an approved and qualified individual who is independent from the entity providing the modifications. Documentation standards require proper contact to be made regarding potential code violations. In conclusion, the Home Modification Assessment service is a critical component of DDRS HCBS Waivers, and it must adhere to specific standards to ensure the safety and well-being of participants..