part 22

[Virtual Presenter] We will discuss the significance of structured family care and the service standards that provider agencies must adhere to. We will outline the specific needs identified by the participant's person-centered planning process, as well as the supports provided within the home, which are managed and completed by the principal caregiver based on the participant's daily needs. We will also discuss the training and medication oversight provided to principal caregivers and providers..

[Audio] We will now discuss the attendant care services, medication oversight, escorting for necessary appointments, and other appropriate supports provided under the Health and Wellness (H&W) and Traumatic Brain Injury (T-B-I--) Waivers. We will also outline the service standards for structured family caregiving, which includes delivering services to older adults and adults with disabilities for three years. Provider agencies must conduct two home visits per quarter, provide access to a qualified substitute caregiver, and establish backup plans for emergencies. To ensure the success of structured family caregiving, documentation standards must be followed. The waiver care manager must document the identified need for Structured Family Caregiving in the service plan, services outlined in the service plan performed by the principal caregiver, and caregiver assessment findings. The provider agency is responsible for documenting training provided to the principal caregiver, electronic caregiver notes, medication management records, and regular review of caregiver notes. It is important to note that separate payment will not be made for any of the following waiver services: Adult Family Care, Assisted Living, Attendant Care, and Home and Community Assistance. In summary, structured family caregiving can greatly improve the quality of life for individuals with disabilities and older adults by following the documentation and service standards outlined in Section 12 of the Health and Wellness (H&W) and Traumatic Brain Injury (T-B-I--) Waivers..

[Audio] We are here to discuss the information presented in the Health and Wellness (H&W) and Traumatic Brain Injury (T-B-I--) Waivers DDRS HCBS Waivers. Our topic will be the service standards for structured family caregiving and the requirements for becoming an approved provider. Provider agencies must conduct two home visits per quarter, provide access to a qualified substitute caregiver, and establish backup plans for emergencies. Principal caregivers receive annual training and medication oversight providers must receive instruction from a doctor, nurse or pharmacist. The Provider Qualifications for Structured Family Caregiving are presented in Table 30 and the General requirements for direct care staff, procedures for protecting individuals, unusual occurrence; reporting, transfer of individual’s record upon change of provider, notice of termination of services, provider organizational chart, collaboration and quality control, data collection and reporting standards, quality assurance and quality improvement system, financial information, liability insurance, transportation of an individual, documentation of qualifications, maintenance of personnel records, adoption of personnel policies, operations manual, and maintenance of records of services provided are also noted. Next, we will move on to the Supported Employment for T-B-I Waiver. Supported Employment services consist of paid employment for persons for whom competitive employment at or above the minimum wage is unlikely, and who, because of their disabilities, need intensive ongoing support to perform in a work setting. Supported Employment is conducted in a variety of settings, particularly worksites where persons without disabilities are employed. Supported Employment includes activities needed to sustain paid work by individuals receiving waiver services, including supervision and training..

[Audio] We will discuss the information provided in Section 12 of the Health and Wellness (H&W) and Traumatic Brain Injury (T-B-I--) Waivers regarding attendant care services, medication oversight, escorting for necessary appointments, appointments and community activities that are therapeutic in nature, and other appropriate supports. We will also outline the service standards for structured family caregiving, which includes three years of delivering services to older adults and adults with disabilities, personalized service plans, ongoing management and support, and the ability to modify one's living area. Provider agencies must conduct two home visits per quarter, provide access to a qualified substitute caregiver, and establish backup plans for emergencies. Principal caregivers receive annual training and medication oversight providers must receive instruction from a doctor, nurse or pharmacist. Supported Employment services must follow a written service plan addressing specific needs determined by the individual's assessment. When Supported Employment services are provided at a worksite where persons without disabilities are employed, payment will be made only for the adaptation, supervision, and training required by individuals receiving waiver services as a result of their disabilities and will not include payment for supervisory activities rendered as a normal part of the business setting. Supported Employment services furnished under the waiver must be services that are not available under a program funded by either the Rehabilitation Act of 1973 or Public Law PL 94-142. Documentation standards for Supported Employment services include identified need in the service plan, services outlined in the service plan, data record of services provided, at least one entry on each day of service made by each staff member providing direct care or supervision of care to the individual, and documentation must be maintained in the file of each individual receiving this service, showing that the service is not otherwise available under a program funded under the Rehabilitation Act of 1973 or PL 94-142..

[Audio] We are discussing attendant care services, medication oversight, escorting for necessary appointments, community activities that are therapeutic in nature, and other appropriate supports. Additionally, we are outlining the service standards for structured family caregiving. These standards include three years of delivering services to older adults and adults with disabilities, personalized service plans, ongoing management and support, and the ability to modify one's living area. Provider agencies must conduct two home visits per quarter, provide access to a qualified substitute caregiver, and establish backup plans for emergencies. Principal caregivers receive annual training and medication oversight providers must receive instruction from a doctor, nurse or pharmacist..

[Audio] We are currently discussing the information provided in Section 12 of the Health and Wellness (H&W) and Traumatic Brain Injury (T-B-I--) Waivers. We are on slide 6 of 12, and the topic is attendant care services, medication oversight, escorting for necessary appointments, appointments and community activities that are therapeutic in nature, and other appropriate supports. These services are offered as part of the waiver, and participants must have a written service plan that addresses their specific needs. The plan is determined by their Personal Care Assistant (P-C-A--). These services are in addition to medical transportation, which is required under 42 CFR 431.53 and Transportation services under the Indiana Medicaid State Plan, defined at 42 CFR 440.170(a). They do not replace these services. Transportation services are reimbursed as three types of service: Level 1 Nonassisted Transportation, Level 2 Assisted Transportation, and Adult Day Service Transportation. It is important to follow documentation standards for Transportation waiver services. This includes identifying the need in the service plan, outlining the services in the plan, maintaining documentation by the provider or its agent to ensure they meet the requirements for providing services under 455 I-A-C 2, and specifying applicable limits on the amount, frequency, or duration of this service. Personal records must be kept in a prominent place in the participant's file and transferred with them for medical care or when they move from their residence, as required by state law. It is important to note that services provided under Transportation services will not duplicate those provided under the Indiana Medicaid State Plan or any other waiver service..

[Audio] During our meeting, we will cover various topics such as attendant care services, medication oversight, escorting to essential appointments, engaging in community activities, and identifying suitable support options. Additionally, we will outline the service standards for structured family caregiving, which includes a minimum of three years of providing services to older adults and adults with disabilities, personalized service plans, ongoing management and support, and the ability to make modifications to one's living area. As per regulations, provider agencies are required to conduct two home visits per quarter, provide a qualified substitute caregiver when needed, and have backup plans in place for emergencies. It is also mandatory for principal caregivers to receive annual training, and for medication oversight providers to receive instruction from a doctor, nurse, or pharmacist..

[Audio] We will discuss the information provided in Section 12 of the Health and Wellness (H&W) and Traumatic Brain Injury (T-B-I--) Waivers. This section covers attendant care services, medication oversight, escorting for necessary appointments, community activities with therapeutic benefits, and other appropriate supports. We will also outline the service standards for structured family caregiving, which includes three years of providing services to older adults and adults with disabilities, personalized service plans, ongoing management and support, and the ability to modify one's living area. Provider agencies are required to conduct two home visits per quarter, provide access to a qualified substitute caregiver, and establish backup plans for emergencies. Principal caregivers receive annual training and medication oversight providers must receive instruction from a doctor, nurse, or pharmacist. Next, we will focus on the Vehicle Modifications for H&W and T-B-I Waivers, which include the following subsections: Service Definition, Allowable Activities, and Maintenance. The Service Definition for Vehicle Modifications is the addition of adaptive equipment or structural changes to a motor vehicle that will enable a participant to have safe transportation. In order for a modification to be approved, justification and documentation must be provided to demonstrate its necessity for meeting the participant's identified needs. The following are allowable activities under the Vehicle Modifications service: wheelchair lifts, wheelchair tie-downs (if not included with lift), wheelchair/scooter hoist, wheelchair/scooter carrier for roof or back of vehicle, raised roof and raised door openings, and power transfer seat base. Additionally, there is a maintenance limit of $1000 annually for repair and service of items funded through the H-C-B-S waiver. Requests for service must clearly differentiate between parts and labor costs. If maintenance costs exceed $1000, the care manager will work with other available funding sources and community agencies to fulfill the need. If service costs exceed the annual limit, the parts and labor funded through the waiver must be itemized separately from those provided through a non-waiver funding source. It's important to note that any items requested that are not listed in this section must be requested and approved through a different process..

[Audio] During our discussion, we went over the information found in Section 12 of the Health and Wellness and Traumatic Brain Injury Waivers DDRS HCBS Waivers. This included topics such as attendant care services, medication oversight, escorted appointments, therapeutic community activities, and other appropriate supports. In addition, we reviewed the service standards for structured family caregiving, which involves three years of experience working with older adults and adults with disabilities, personalized service plans, ongoing management and support, and the ability to modify one's living area. It was noted that provider agencies are required to conduct two home visits per quarter and provide access to a qualified substitute caregiver. In case of emergencies, backup plans must also be established. Principal caregivers will receive annual training, while medication oversight providers must receive instruction from a doctor, nurse, or pharmacist. We also discussed the rebate program for participants who purchase a new vehicle that requires modifications for accessibility. Many automobile manufacturers offer a rebate of up to $1000 for these modifications. To receive the rebate, participants must submit documented proof of their expenditures for the modifications. We emphasized the standards for documenting vehicle modifications and how the care manager is responsible for determining the medical need for these modifications. This involves describing the specific modification requested, collecting two bids if the cost is over $1000, and submitting warranty information from the provider to the FSSA. A picture of the modification is also necessary. It was also mentioned that the provider is responsible for keeping receipts for all expenses related to the modifications, itemizing bids, and following F-S-S-A and FSSA-specific guidelines and policies. We discussed the limitations of this service, which include a lifetime cap of $15000 for one vehicle per every 10-year period for a participant's household and an annual allowable amount of $1000 for repairs, replacements, or adjustments to existing modifications funded by an H-C-B-S waiver. Lastly, we clarified that certain activities are not covered under this service, such as repairing or replacing modified equipment that has been damaged or destroyed in an accident..

[Audio] "We are pleased to provide details about our attendant care services, medication oversight, transportation for necessary appointments, therapeutic appointments and community activities, as well as other appropriate supports for individuals with Health and Wellness (H&W) and Traumatic Brain Injury (T-B-I--) waivers. Our service standards for structured family caregiving include three years of experience in serving older adults and individuals with disabilities, personalized service plans, ongoing management and support, and the ability to modify living spaces. Table 33 outlines the qualifications for providers of Vehicle Modifications. We encourage providers to visit the following websites for more information: F-S-S-A home page Medicaid H-C-B-S webpage Incident and Follow-Up Reporting (I-F-U-R-) Tool I-H-C-P Providers website For further inquiries, providers can contact F-S-S-A at 888-673-0002. Please refer to Figure 1 for information on local Area Agency on Aging (A-A-A--) offices. We hope this information is helpful in ensuring that individuals receive the necessary services to live their best lives..

[Audio] Attendant Care Services To ensure that individuals with disabilities receive the care they need, attendant care services are available. These services include assistance with activities of daily living (ADLs), such as bathing, grooming, dressing, and toileting. They also include assistance with instrumental activities of daily living (IADLs), such as managing medication, preparing meals, and managing finances. Medication Oversight Individuals with disabilities often require medication to manage their health conditions. To ensure that individuals receive the right medication at the right time, medication oversight is available. This includes monitoring medication adherence, ensuring that medications are stored safely, and administering medications as prescribed. Escorting for Necessary Appointments Individuals with disabilities may require assistance with attending appointments, such as doctor’s appointments or therapy sessions. Escorting for necessary appointments is available to ensure that individuals can attend their appointments safely and effectively. Community Activities that are Therapeutic in Nature Participating in community activities that are therapeutic in nature, such as exercise or music therapy, can have many benefits for individuals with disabilities. To ensure that individuals have access to these activities, community activities that are therapeutic in nature are available. Service Standards for Structured Family Caregiving Structured family caregiving is a program that provides individuals with disabilities with personalized care plans and ongoing support from a principal caregiver. To ensure that individuals receive the best possible care, service standards for structured family caregiving are in place. These standards include three years of delivering services to older adults and adults with disabilities, personalized service plans, ongoing management and support, and the ability to modify one’s living area. Provider Agencies Provider agencies are responsible for delivering attendant care services, medication oversight, escorting for necessary appointments, and community activities that are therapeutic in nature. To ensure that individuals receive the best possible care, provider agencies must conduct two home visits per quarter, provide access to a qualified substitute caregiver, and establish backup plans for emergencies. Principal caregivers receive annual training, and medication oversight providers must receive instruction from a doctor, nurse, or pharmacist..

[Audio] In conclusion, we have discussed essential information from Section 12 of the Health and Wellness (H&W) and Traumatic Brain Injury (T-B-I--) Waivers DDRS HCBS Waivers. This section addresses important topics such as attendant care services, medication oversight, escorting for necessary appointments, community activities, and other necessary supports. We have also highlighted the service standards for structured family caregiving, including the three-year requirement for delivering services to older adults and adults with disabilities, personalized service plans, ongoing management and support, and the ability to modify one's living area. As a provider agency, it is critical to stay informed about communications from the I-H-C-P-. The I-H-C-P publishes bulletins and provider reference modules that can be accessed through the Bulletins, Banner Pages and Reference Modules page at in.gov/medicaid/providers. We strongly recommend subscribing to the Email Notification Service, which sends emails to subscribers when new communications are posted on the I-H-C-P website. This will ensure that you are up-to-date with the latest policies and procedures. Thank you for your attention today as we discussed these important topics. The information provided in this presentation is current as of July 1, 2024, and version 11.1. We hope it has been informative and useful for your understanding of the DDRS HCBS Waivers..