part 10

[Virtual Presenter] This presentation will cover the definitions and requirements for the DDRS HCBS FSW and C-I-H waivers. It is essential to have a thorough understanding of this information in order to properly and effectively complete home modifications. We will discuss the specific criteria and limitations for home modifications, including disallowed activities, provider qualifications, and necessary licenses and certifications. Firstly, we will review the activities that are not permitted under home modifications. These include general utility adaptations such as carpeting, roof repair, and central air conditioning. These adaptations must directly benefit the individual's medical or remedial needs in order to be considered acceptable. Additionally, modifications that increase the home's total square footage or are not part of the person's P-C-I-S-P are not allowed. It is important to note that any adaptations must be approved using the Request for Approval to Authorize Services form. Furthermore, adaptations to housing owned by the service provider are not allowed, unless the individual receives residential habilitation and support services in their own home. This ensures that there is no conflict of interest and that services are provided ethically. The use of waiver funds for life safety code modifications or accessibility modifications to housing owned by providers is also not allowed. Finally, waivers cannot be used for living arrangements owned or leased by waiver service providers, or provided by the parent of a minor child participant or the spouse of a participant. These are known as L-R-Is and are not considered appropriate providers for home modifications. Moving on to provider qualifications, in order to be eligible to provide home modifications under these waivers, providers must be an active Medicaid provider and have approval from FSSA DDRS. They must also comply with the rules and regulations outlined in the Indiana Administrative Code, 460 I-A-C 6. This includes documentation of criminal histories, insurance, financial status, and environmental modification supports. Providers must also adhere to any applicable B-D-S service standards, guidelines, policies, and/or manuals, as well as FSSA DDRS policies and this module. This concludes our overview of home modifications under the DDRS HCBS FSW and C-I-H waivers..

[Audio] On this slide, we will discuss the specific criteria and limitations for Home Modifications under the DDRS HCBS Waivers, specifically focusing on Intensive Behavioral Intervention (I-B-I--) services. Section 10 of the waivers outlines the service definitions and requirements for F-S-W and C-I-H Waivers, with a focus on I-B-I services. These services are intended for individuals with challenging behavioral issues that may put them at risk of being placed in a more restrictive residential setting. The goal of I-B-I services is to develop effective behavior management strategies and teach individuals, families, and caregivers how to respond to and manage intense and challenging behaviors. The need for I-B-I services is determined through a functional and behavioral needs assessment, and they are specified in the Personal Care and Integrated Supports Plan (P-C-I-S-P). When it comes to I-B-I services, there are certain requirements that must be met, including a detailed functional and behavioral assessment, reinforcement, specific and ongoing objective measurement of progress, and family training and involvement for skill generalization and communication promotion. Additionally, there is a focus on acquiring, generalizing, and maintaining new behaviors across various environments and individuals. Caregivers, I-B-I direct care staff, and other waiver service providers must also receive training. To ensure success, I-B-I also includes breaking down targeted skills into small and attainable steps for behavior change, utilizing systematic instruction and consistent structure, and providing one-on-one structured therapy. The treatment approach is tailored to the specific needs of the individual. Skills training must include measurable goals and objectives, with specific targets that may include acquiring, generalizing, and maintaining new behaviors across various environments and individuals..

[Audio] This presentation will discuss the definitions and requirements for F-S-W and C-I-H waivers under the DDRS HCBS program. These waivers allow individuals with intellectual and developmental disabilities to receive customized home modifications. We will examine the criteria and limitations for these modifications, including disallowed activities, provider qualifications, and necessary licenses and certifications. A crucial factor to consider when implementing these modifications is the individual's behavior and response to them. Therapists must understand the individual's behavior in order to provide effective modifications. Additionally, we must also consider the consequences of these modifications, including the therapist's reaction and the impact on the individual's progress and well-being. To support the individual's learning and progress, we use a natural environment training approach, which focuses on learner-directed, motivating, and reinforcing training. This is in contrast to the more controlled reinforcement used in intensive trial training. Our interventions are based on behavior analysis research and have been proven effective for individuals with intellectual and developmental disabilities. These interventions may include precision teaching, direct instruction, and pivotal response training. We also use errorless teaching and other prompting procedures to support learning and progress. By understanding these methods and techniques, we can ensure successful home modifications for individuals with intellectual and developmental disabilities..

[Audio] This is slide number 4 out of 14 in our presentation on DDRS HCBS Waivers. This section will discuss the service definitions and requirements for F-S-W and C-I-H Waivers. These waivers outline specific criteria and limitations for Home Modifications, including prohibited activities, necessary provider qualifications, and required licenses/certifications. One important aspect of these waivers is the need for regular reporting to relevant parties. The I-B-I case supervisor will provide a written and visual report to pertinent parties at least once a month. These parties include the individual, I-B-I director, guardian, B-D-S service coordinator, waiver case manager, and all service providers and other involved entities. The I-B-I director will also provide a written and visual report to pertinent parties at least quarterly. These parties include the individual, I-B-I case supervisor, guardian, B-D-S service coordinator, waiver case manager, and all service providers and other entities. It should be noted that the services offered under the I-B-I waiver are limited to additional services not covered under the Indiana Medicaid State Plan, such as EPSDT, but align with the waiver objectives of preventing institutionalization. In terms of documentation standards, there are specific requirements for Intensive Behavioral Intervention services. This includes following the services outlined in the P-C-I-S-P and documenting in accordance with 460 I-A-C 6. Similar to regular reporting, the I-B-I case supervisor and director are responsible for providing these reports to relevant parties on a monthly and quarterly basis, respectively. Additionally, these reports must be uploaded to the document library of the state's case management system by the selected service provider on or before the 15th day of the following month. Lastly, there are limitations to be aware of. If an individual under the age of 21 chooses to receive services under these waivers, they must adhere to the aforementioned reporting and documentation requirements. Please proceed to the next slide for further information..

[Audio] Slide number five out of fourteen in our presentation on DDRS HCBS Waivers discusses the service definitions and requirements for F-S-W and C-I-H Waivers. Specifically, we will be focusing on the qualifications and necessary licenses and certifications for providers. Providers offering waiver-funded services must meet certain criteria, including being an active Medicaid provider and being approved by FSSA DDRS. They must also adhere to Indiana Administrative Code 460 I-A-C 6, which outlines regulations regarding criminal histories, insurance, financial status, and staff training. Additionally, providers must follow all applicable B-D-S service standards, guidelines, policies, and manuals, including those provided by FSSA DDRS and this module. These can be accessed on the I-H-C-P Provider Reference Modules page at in.gov/medicaid/providers. If a provider offers services requiring licensure or certification, they must obtain and maintain Indiana-specific licensure or certification. For instance, an I-B-I director must be a licensed psychologist or psychiatrist, while an I-B-I case supervisor must be a Board Certified Behavior Analyst or Board-Certified Assistant Behavior Analyst. Moving on to section 10.15, we will now discuss Music Therapy for F-S-W and C-I-H Waivers. This therapy utilizes music in the treatment of a person's disability, targeting both physiological and psychosocial aspects. The goal is to improve nonmusical skills and behaviors through therapeutic methods. It is important to note that the ultimate focus of Music Therapy must be on therapeutic benefits, rather than the acquisition of musical skills. Thank you for taking the time to listen to this information on provider qualifications and music therapy services for F-S-W and C-I-H Waivers. For more detailed information on these topics, please refer to the provided resources..

[Audio] Section 6 of this presentation focuses on the DDRS HCBS Waivers and the service definitions and requirements for F-S-W and C-I-H Waivers. These waivers were created to support individuals with disabilities and promote their independence and self-direction. One key aspect of these waivers is the need for individuals to actively participate in therapy sessions and demonstrate attending behavior. The waivers also cover therapy to prevent or reduce disruptive behaviors and to improve emotional expression and creativity. Music therapy is a service provided by a music therapist or through demonstration techniques to other service personnel or family members. It can be offered individually or in a group, with a maximum group size of four individuals per music therapist. The unit rate for this service is divided by the number of individuals in the group. Service standards must be followed when providing music therapy under these waivers, including reflecting it in the individual's PCISP, maintaining appropriate documentation, and complying with state requirements. All attendance records, therapist logs, and charts must be kept and any required reports must be uploaded to the state's case management system..

[Audio] Hello, this is slide seven of our presentation on DDRS HCBS waivers. This section will focus on the service definitions and requirements for F-S-W and C-I-H waivers. We will outline specific criteria and limitations for services, including disallowed activities, provider qualifications, and necessary licenses and certifications. Let's begin with the activities that are not allowed under Music Therapy. These include any services that are reimbursable through the Indiana Medicaid State Plan, therapy services provided within an educational or school setting, and specialized equipment which should be purchased under the Specialized Medical Equipment and Supplies service. Additionally, music therapy services are not allowed in nursing facilities, and group sizes must not exceed four individuals per music therapist or the maximum allowable size determined by the I-S-T for each individual group. Moving on to provider qualifications, all providers must meet certain criteria. This includes being enrolled as an active Medicaid provider and being FSSA DDRS-approved. Furthermore, providers must comply with Indiana Administrative Code, including documentation of criminal histories, insurance, and financial status. Specifically for music therapy services, providers must also comply with B-D-S service standards and be certified by a Certification Board for Music Therapists, accredited by a National Commission for Certifying Agencies. It is important for providers to also be aware of any applicable policies and guidelines, including those from FSSA DDRS and the I-H-C-P-, which can be accessed from the I-H-C-P Provider Reference Modules page at in.gov/medicaid/providers. Thank you for your attention to this section on service definitions and requirements for F-S-W and C-I-H waivers. We hope this has provided a clear understanding of the criteria and limitations for Home Modifications, including disallowed activities and necessary qualifications for providers. Please continue to follow along as we dive further into the details of these waivers in the rest of our presentation..

[Audio] This is slide number 8 out of 14 in our presentation on 'Def. and Req. for F-S-W and C-I-H Waivers outlining the specific criteria and limitations for Home Modifications, including disallowed activities, provider qualifications, and necessary licenses/certifications.' In this slide, we will discuss the service definitions and requirements for DDRS HCBS Waivers, specifically related to Occupational Therapy. Section 10 of the DDRS HCBS Waivers covers the services that can be reimbursed under these waivers. These services include evaluation, training, and direct therapeutic intervention for gross and fine motor function, self-care, sensory and perceptual motor function, as well as screening and assessments. Design, fabrication, training, and assistance with adaptive aids and devices are also covered. Consultation and demonstration of techniques with other service providers and family members are also included. It is important to note that at least 45 minutes of every hour billed for therapy must consist of direct patient care, while the remaining 15 minutes may be spent in related patient services. Moving on, let's discuss the service standards for Occupational Therapy. It is required that individual Occupational Therapy services be documented in the Person-Centered Individualized Support Plan (P-C-I-S-P), regardless of the funding source. The need for these services must also be supported by an appropriate assessment and authorized in the PCISP. Additionally, documentation of this service being requested on Indiana Medicaid State Plan must be included in the PCISP. When it comes to documentation standards, a qualified therapist must conduct the appropriate assessment. Services provided under both the Indiana Medicaid State Plan and the waiver must be outlined in the PCISP, and the service provider must have the necessary credentials for providing Occupational Therapy. Adequate documentation, including attendance records, therapist logs, and charts with dates and times of services provided, must be kept in compliance with 460 IAC 6 Supported Living Services and Supports requirements. Monthly/quarterly reports must also be submitted, as applicable. Thank you for your attention during this slide of our presentation..

[Audio] Section 10 of the DDRS HCBS Waivers discusses the specific guidelines and limitations for Home Modifications under the F-S-W and C-I-H waivers. These waivers offer crucial services to individuals with disabilities to improve their independence and overall quality of life. Now, we will examine the activities that are not allowed under Occupational Therapy, a service covered by these waivers. It is important to note that therapy services cannot be given in educational or school settings, or as part of a school day, in order to avoid duplicating services and ensure the individual receives the best care possible. Additionally, activities cannot be provided in a nursing facility, as this is not an appropriate setting for occupational therapy services. Furthermore, it is important to note that services covered under the Indiana Medicaid State Plan cannot be duplicated under the F-S-W and C-I-H waivers. This means that a Medicaid State Plan Prior Authorization denial must be obtained before reimbursement is available for this service under the waivers. Lastly, therapy services cannot be provided by the parent of a minor child or by the spouse of a participant. This is to prevent Living-Related Incidents and ensure that therapy services under this service do not duplicate those provided by any other service. Moving on to provider qualifications, it is essential that providers meet specific criteria in order to deliver services under the F-S-W and C-I-H waivers. This includes being enrolled as an active Medicaid provider and approved by the FSSA DDRS. Providers must also comply with the Indiana Administrative Code, specifically 460 I-A-C 6, which includes requirements such as documentation of criminal histories, insurance, and financial status. Additionally, providers must comply with B-D-S service standards, guidelines, policies, and manuals, including those set by FSSA DDRS and this module. These resources can be accessed on the I-H-C-P Provider Reference Modules page at in.gov/medicaid/providers. It is also important to note that in cases where licensure or certification is necessary, providers of waiver-funded services must obtain and maintain Indiana-specific licensure or certification to ensure the appropriate delivery of services..

[Audio] We will discuss the Service Definitions and Requirements for F-S-W and C-I-H Waivers in this section of our presentation on DDRS HCBS Waivers. During an acute care hospitalization, H-C-B-S provides assists to help individuals maintain their current level of functioning and support new or additional needs identified by the person-centered planning team. The H-C-B-S provided must not duplicate services available in the hospital setting, ensuring effective and efficient care. We understand the importance of family involvement in the care of individuals with intellectual/developmental disabilities and may choose a relative as the provider of Personal Assistance Care (P-A-C--) during the person-centered planning process. An annual review is conducted to ensure the relative is still the best choice for providing these services. Under the Indiana Medicaid State Plan, individuals have access to any appropriate services available. P-A-C services are only available under the F-S-W and not available under the CIH, H&W, or T-B-I waivers. P-A-C services include reimbursable activities such as assistance with personal care, meals, shopping, errands, and scheduling appointments. We strive to ensure individuals with intellectual/developmental disabilities receive the necessary support to lead fulfilling lives and maintain their independence. Thank you for your attention..

[Audio] We understand that P-A-C services are a part of the DDRS HCBS Waivers program and therefore must comply with specific standards to ensure a smooth transition between acute care settings and home and community-based settings while preserving the individual's functional abilities. The following service standards apply to P-A-C-: * P-A-C services must have a written PCISP/service authorization that addresses the specific needs determined by the individual's assessment and identified in the PCISP. * Ability to consult with a nurse as needed (on staff or on call for the provider). * The following documentation standards must be adhered to: plus P-A-C services documentation must include: Recorded completion of tasks on an individual-specific task list (created by the I-S-T--) that includes identification of paid staff members as well as the date and start/stop time of each waiver-funded shift. Documentation in compliance with 460 I-A-C 6. As applicable, monthly/quarterly reports must be uploaded to the document library of the state's case management system by the chosen service provider on or before the 15th day of the following month. * There are limitations to P-A-C services:.

[Audio] We will discuss the service definitions and requirements for F-S-W and C-I-H Waivers under the DDRS HCBS program. Firstly, it is important to note that these services are only available for individuals who are eligible under the Rehabilitation Act of 1973 or Sections 602 (16) and (17) of the Individuals with Disabilities Education Act. Furthermore, these services are not to be used for homeschooling, special education, or related activities. Additionally, F-S-W and C-I-H Waivers can be utilized for homemaker or maid services, as well as a substitute for care provided by a registered nurse, licensed practical nurse, licensed physician, behaviorist, licensed therapist, or other health professional. Transportation costs can also be covered under these waivers. However, it is important to note that group sizes are limited to four individuals per one paid staff member from the provider of P-A-C services. Any group exceeding this limit must be approved by the Interdisciplinary Support Team (I-S-T--). Moreover, individuals who are using different support options, such as P-A-C or Day Habilitation, cannot receive group supports together. This type of activity is not allowed. Lastly, regarding hospitalizations, providers may only bill for P-A-C reimbursement during the time when an individual is admitted to an acute care hospital setting for inpatient medical care or other related services. All conditions specified in guidance under Section 2.3: Billing and Reimbursement for Waiver Services must be met for reimbursement to be approved. However, providers may not bill for P-A-C reimbursement during extended hospital stays or when individuals require long-term care in a facility-based setting, such as nursing homes, rehabilitation centers, or treatment facilities. It is crucial to follow these guidelines and requirements to ensure that individuals receive the appropriate care and support they need under the F-S-W and C-I-H Waivers. Thank you for your attention to this information..

[Audio] It is clear that there are specific standards and restrictions for home modifications, including activities that are not permitted, the qualifications of providers, and the licenses and certifications that are required. If you require additional information on any of these areas, please do not hesitate to contact us. We appreciate your time and focus..

[Audio] We have discussed that Personal Emergency Response System (P-E-R-S-) is a reimbursable activity under Section 10: Service Definitions and Requirements for F-S-W and C-I-H Waivers. However, there are certain limitations and restrictions that must be followed when providing pers services. First and foremost, pers is only available to individuals who live alone, or who are alone for significant parts of the day, and have no regular caregiver for extended periods of time, and who would otherwise require extensive supervision. Additionally, reimbursement is not available for pers when the individual requires constant support to maintain health and safety, or when provided by the parent of a minor child participant or the spouse of a participant (also known as LRIs). Furthermore, providers must meet certain criteria to be eligible for reimbursement. They must be enrolled as an active Medicaid provider, be FSSA DDRS-approved, and comply with Indiana Administrative Code, 460 I-A-C 6, including but not limited to documenting criminal histories, having insurance, and maintaining a personal emergency response system. Providers must also comply with any applicable B-D-S service standards, guidelines, policies, and manuals, including FSSA DDRS policies and this module, accessible from the I-H-C-P Provider Reference Modules page at in.gov/medicaid/providers. In conclusion, providing pers services requires adherence to specific criteria and limitations..