[Virtual Presenter] Hello everyone, today is the day that we are here to discuss a crucial topic concerning the Division of Disability and Rehabilitative Services. Recently, the Division has announced the offering of home and community-based services waivers. As a professional in the field, I fully understand the importance of home and community-based services for individuals with disabilities. These services offer them the opportunity to lead independent lives and access the support and resources they need to thrive. The Division of Disability and Rehabilitative Services has recognized the need for these services and is now offering waivers. This means that individuals with disabilities can now access these services without having to go through the traditional waiver process. However, it is important to note that these waivers are subject to certain conditions and limitations. To help individuals navigate this process, the Division of Disability and Rehabilitative Services has published a detailed reference guide. This guide can be found on PubMed, and it is recommended that individuals review it carefully before applying for waivers. As of this presentation, the most up-to-date version is version 1.1.1. It is important to ensure that you are using the most current version. Finally, I would like to emphasize that this is a copyrighted product of Gainwell Technologies, and all rights are reserved. Thank you for your attention, and I hope that this information has been helpful to you.. 

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Division of Disability and 
Rehabilitative Services 
Home- and 
Community-Based 
Services Waivers 
L I B R A R Y  R E F E R E N C E  N U M B E R :  P R P R 1 0 0 1 4  
P U B L I S H E D :  S E P T .  9 ,  2 0 2 4  
P O L I C I E S  A N D  P R O C E D U R E S  A S  O F  J U L Y  1 ,  2 0 2 4  
V E R S I O N :  1 1 . 1  
© Copyright 2024 Gainwell Technologies, All Right Reserved

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[Audio] We are pleased to announce that the Division of Disability and Rehabilitative Services is offering home and community-based services waivers. This waiver provides more flexibility for states to design and implement programs that best meet the needs of individuals with disabilities. We are committed to working with states to ensure that these waivers are implemented in a way that is both effective and efficient. We believe that this waiver will be a valuable tool for states looking to improve the quality of services for individuals with disabilities. The Revision History for this document provides a detailed overview of the changes that have been made to the policies and procedures over time. From the initial release in 2012 to the most recent update in 2024, we have worked tirelessly to ensure that this document remains up-to-date and relevant. We are proud of the work that has been done and look forward to continuing to work with states to improve the lives of individuals with disabilities. Thank you for your interest in this important topic. If you have any questions, please do not hesitate to reach out to us. We are here to help.. 

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Library Reference Number: PRPR10014 
iii 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
Revision History 
Version 
Date 
Reason for Revisions 
Completed By 
1.0 
Policies and procedures as of 
Nov. 1, 2012 
Published: June 10, 2013 
Initial release 
FSSA 
1.1 
Policies and procedures as of 
Dec. 1, 2013 
Published: April 23, 2014 
Scheduled review 
FSSA and HP 
2.0 
Policies and procedures as of 
June 1, 2014 
Published: Nov. 6, 2014 
Scheduled review 
FSSA and HP 
2.1 
Policies and procedures as of 
Dec. 1, 2014 
Published: Feb. 24, 2015 
Scheduled review 
FSSA and HP 
2.2 
Policies and procedures as of 
Dec. 1, 2014 
Published: May 12, 2015 
Updates to Section 6, including updated 
tables 
FSSA and HP 
3.0 
Policies and procedures as of 
June 1, 2015 
Published: Sept. 8, 2015 
Scheduled review 
FSSA and HP 
3.1 
Policies and procedures as of 
Oct. 1, 2015 
Published: Feb. 25, 2016 
Conversion to modular format, scheduled 
review 
FSSA and HPE 
4.0 
Policies and procedures as of 
April 1, 2016 
Published: June 21, 2016 
Scheduled review 
FSSA and HPE 
4.1 
Policies and procedures as of 
April 1, 2016 
CoreMMIS updates as of: 
Feb. 13, 2017 
Published: April 13, 2017 
CoreMMIS updates 
FSSA and HPE 
5.0 
Policies and procedures as of 
April 1, 2017 
CoreMMIS updates as of 
Feb. 13, 2017 
Published: Aug. 24, 2017 
Scheduled review 
FSSA and DXC 
6.0 
Policies and procedures as of 
Aug. 1, 2018 
Published: Jan. 3, 2019 
Scheduled review 
FSSA and DXC 
6.0 
Policies and Procedures as of 
Aug. 1, 2018 
Published: Aug. 22, 2019 
Correction 
FSSA and DXC 
7.0 
Policies and procedures as of 
July 1, 2019 
Published: Dec. 19, 2019 
Scheduled review 
FSSA and DXC

[Audio] We are here to discuss the home and community-based services (H-C-B-S-) waivers offered by the Division of Disability and Rehabilitative Services (D-D-R-S-). D-D-R-S offers waivers for Family Supports Waiver (F-S-W--) and Community Integration and Habilitation Waiver (C-I-H--) services. These waivers are designed to provide individuals with disabilities with more flexibility and control over their services. With these waivers, individuals can choose the services they need and where they want to receive them. D-D-R-S has revised the policies and procedures for the H-C-B-S waivers several times, with the most recent version being published on July 1, 2024. This version includes information about legally responsible individuals (LRIs) and whether they are allowed or not allowed to provide certain services. The H-C-B-S waivers have also been updated to include information about Health and Wellness (H&W) and Traumatic Brain Injury (T-B-I--) services. D-D-R-S has updated the provider application process for F-S-W and C-I-H waivers. The application process now includes a review of the applicant's qualifications and a determination of their ability to provide the services required by the waiver. D-D-R-S has also updated the billing and reimbursement process for waiver services. Providers must now meet certain requirements in order to bill for their services.. 

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DDRS HCBS Waivers 
 
iv 
Library Reference Number: PRPR10014 
 
Published: Sept. 9, 2024 
 
Policies and procedures as of July 1, 2024 
 
Version: 11.1 
Version 
Date 
Reason for Revisions 
Completed By 
8.0 
Policies and procedures as of 
July 16, 2020  
Published: Dec. 8, 2020 
Scheduled review 
FSSA and 
Gainwell 
9.0 
Policies and procedures as of 
Jan. 1, 2022 
Published: June 24, 2022 
Scheduled review 
FSSA and 
Gainwell 
9.1 
Policies and procedures as of 
Jan. 1, 2022 
Published: Sept. 21, 2022 
Updated formatting 
FSSA and 
Gainwell 
10.0 
Policies and procedures as of 
June 1, 2023 
Published: June 29, 2023 
Scheduled review 
FSSA and 
Gainwell 
11.0 
Policies and procedures as of 
July 3, 2024 
Published: July 1, 2024 
Scheduled review: 
• Edited text as needed for clarity 
• Changed Bureau of Developmental 
Disabilities Services (BDDS) 
references to Bureau of Disabilities 
Services (BDS) 
• Added Health and Wellness (H&W) 
and Traumatic Brain Injury (TBI) 
waiver information 
• Added information about legally 
responsible individuals (LRIs) and 
whether they are allowed or not allowed 
to provide certain services 
• Updated Section 2.1: Provider 
Application Process for FSW and CIH 
Waiver 
• Updated Section 2.3: Billing and 
Reimbursement for Waiver Services 
• Updated Section 4: Disabilities Services 
Waivers 
• Added two more criteria to Section 5.5: 
Targeting Process for the Family 
Supports Waiver (FSW) 
• Added information about the NCI 
survey in Section 9.5: National Core 
Indicator (NCI) Project 
• Updated Table 3 – Medicaid Waiver 
Services, Codes and Rates for FSW and 
CIH Waiver 
• Updated Section 10.4: Behavioral 
Support Services for FSW and CIH 
Waiver 
• Added Section 10.5: Career 
Exploration and Planning for FSW and 
CIH Waiver 
• Added Section 10.12: Home 
Modification Assessment for the FSW 
and CIH Waiver 
FSSA and 
Gainwell

[Audio] Good morning everyone. We are here to discuss the Home and Community-based Services waivers offered by the Division of Disability and Rehabilitative Services. These waivers were introduced to provide individuals with disabilities access to a variety of services that were previously inaccessible. We have made several updates to the Home and Community-based Services waivers. We have updated the Limitations section of the Music Therapy service for F-S-W and C-I-H Waiver. We have also updated Section 10.13: Home Modifications for F-S-W and C-I-H Waiver. Additionally, we have made changes to the Service Definition section of the Residential Habilitation and Support (hourly) service for the C-I-H Waiver, as well as the Service Definition section of the Residential Habilitation and Support (daily) service for the C-I-H Waiver. We have also updated the rates in the Service Standards and Limitations sections of the Specialized Medical Equipment and Supplies service for the F-S-W and C-I-H Waiver. We have also updated the Reimbursable Activities and Activities Not Allowed sections of the Structured Family Caregiving service for the F-S-W and C-I-H Waiver. Additionally, we have made updates to the Transportation service for the F-S-W and C-I-H Waiver. We are committed to providing individuals with disabilities access to the services they need to live a fulfilling life. We believe that the Home and Community-based Services waivers are an important step towards achieving this goal. Thank you for your attention to this matter.. 

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Library Reference Number: PRPR10014 
v 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
Version 
Date 
Reason for Revisions 
Completed By 
• Updated Section 10.13: Home 
Modifications for FSW and CIH Waiver 
• Updated the Limitations section of the 
Music Therapy service for FSW and 
CIH Waiver 
• Updated Section 10.17: Participant 
Assistance and Care for the FSW 
• Updated Section 10.20: Prevocational 
Services for FSW and CIH Waiver 
• Updated the Limitations and 
Reimbursement Parameters section of 
the Remote Supports service for the 
FSW and CIH Waiver 
• Updated the Service Definition section 
of the Residential Habilitation and 
Support (hourly) service for the CIH 
Waiver 
• Updated the Service Definition section 
of the Residential Habilitation and 
Support (daily) service for the CIH 
Waiver 
• Updated the rates in the Service 
Standards and Limitations sections of 
the Specialized Medical Equipment and 
Supplies service for the FSW and CIH 
Waiver 
• Updated the Reimbursable Activities 
and Activities Not Allowed sections of 
the Structured Family Caregiving 
service for the FSW and CIH Waiver 
• Updated the rates in the Limitations 
section of the Transportation service for 
the FSW and CIH Waiver 
• Updated Section 11.1: Home 
Modification Policy  
• Updated the annual and lifetime limits 
in Section 11.2: Specialized Medical 
Equipment and Supplies 
• Added Section 12: Health and Wellness 
(H&W) and Traumatic Brain Injury 
(TBI) Waivers 
11.1 
Policies and procedures as of 
July 1, 2024 
Published: Sept. 9, 2024 
Correction: 
• Updated the Activities Not Allowed 
section for the Attendant Care services 
FSSA and 
Gainwell

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[Audio] We will provide information on the application process for F-S-W and C-I-H Waiver, the reversion process for F-S-W and C-I-H Waiver, details on billing and reimbursement for waiver services, and information on financial oversight and waiver audits.. 

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Library Reference Number: PRPR10014 
vii 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
Table of Contents 
Section 1: Roles and Responsibilities ............................................................................................. 1 
Section 1.1: The Centers for Medicare & Medicaid Services (CMS) ........................................ 1 
Section 1.2: FSSA Division of Disability and Rehabilitative Services (DDRS) ........................ 1 
Section 1.3: The Bureau of Disabilities Services (BDS) ............................................................ 2 
Section 1.4: BDS Quality Assurance Services ........................................................................... 2 
Section 1.5: FSSA Office of Medicaid Policy and Planning (OMPP) ....................................... 3 
Section 1.6: FSSA Division of Family Resources ..................................................................... 3 
Section 1.7: Waiver Service Providers, Including Selected Contracting Case Management 
Organizations ............................................................................................................... 4 
Section 1.8: Office of Administrative Law Proceedings (OALP) .............................................. 5 
Section 1.9: Participating Individuals and Guardians ................................................................ 5 
Section 1.10: FSSA BDS Documentation Requests ................................................................ 10 
Section 2: Provider Information .................................................................................................. 13 
Section 2.1: Provider Application Process for FSW and CIH Waiver ..................................... 13 
Section 2.2: Provider Reverification for FSW and CIH Waiver .............................................. 14 
Section 2.3: Billing and Reimbursement for Waiver Services ................................................. 16 
Section 2.4: Financial Oversight – Waiver Audits ................................................................... 21 
Section 3: Additional Medicaid Information .............................................................................. 23 
Section 3.1: Other Program Information .................................................................................. 23 
Section 3.2: Medicaid Prior Authorization and Funding Streams ............................................ 23 
Section 4: Disabilities Services Waivers ...................................................................................... 25 
Section 4.1: Medicaid Waiver Overview ................................................................................. 25 
Section 4.2: State Definition of Intellectual/Developmental Disability ................................... 26 
Section 4.3: Cost Neutrality ..................................................................................................... 26 
Section 4.4: Coordination With Indiana Medicaid State Plan Services ................................... 26 
Section 4.5: Community Integration and Habilitation (CIH) Waiver ...................................... 27 
Section 4.6: Family Supports Waiver (FSW) ........................................................................... 28 
Section 4.7: Health and Wellness (H&W) Waiver ................................................................... 30 
Section 4.8: Traumatic Brain Injury (TBI) Waiver .................................................................. 30 
Section 4.9: Indiana Money Follows the Person (MFP) .......................................................... 30 
Section 5: Application for and Start of FSW and CIH Waiver Services .................................. 33 
Section 5.1: Request for Application ....................................................................................... 33 
Section 5.2: Medicaid Eligibility ............................................................................................. 33 
Section 5.3: Initial Level of Care Evaluation for FSW and CIH Waiver ................................. 34 
Section 5.4: Waiting List for the Family Supports Waiver (FSW) .......................................... 35 
Section 5.5: Targeting Process for the Family Supports Waiver (FSW) .................................. 36 
Section 5.6: Entrance into the Community Integration and Habilitation Waiver Program ...... 38 
Section 5.7: Initial Plan of Care (POC)/Service Plan Development for FSW and CIH Waiver
 ................................................................................................................................... 40 
Section 5.8: State Authorization of the Initial POC/Service Plan ............................................ 41 
Section 5.9: Initial Service Plan Implementation for FSW and CIH Waiver ........................... 43 
Section 6: Objective-Based Allocation for the CIH Waiver ...................................................... 45 
Section 6.1: OBA Development for CIH Waiver ..................................................................... 45 
Section 6.2: ICAP Assessment and Algo Level Development for CIH Waiver....................... 45 
Section 6.3: Algo Level Descriptors for CIH Waiver .............................................................. 46 
Section 6.4: Translating Algo Level Into a Budget Allocation for CIH Waiver ...................... 47 
Section 6.5: Long-Term Budget Request and Short-Term Budget Request for CIH Waiver .. 50 
Section 6.6: Implementation of Objective-Based Allocations for CIH Waiver ....................... 53 
Section 6.7: Personal Allocation Review (PAR) and the Appeal Process for CIH Waiver ..... 54

[Audio] The home and community-based services waiver program includes important sections that are essential to understand. These include the monitoring and continuation of services, such as level of care reevaluation, Medicaid eligibility redetermination, annual person-centered individualized support plan (P-C-I-S-P) development, person-centered individualized support plan/service authorization updates and revisions, state authorization of the service authorization, service plan implementation and monitoring, interruption/termination of waiver services, waiver slot retention after termination and reentry, parents, guardians and relatives providing home and community-based services, appeal process, and more. It is important to note that specific actions must be taken in order to appeal a decision related to these waivers. This includes requesting an appeal, group appeals, time limits for requesting appeals, the hearing notice, request for continuance from the appellant, review of action, disposal of appeal without a fair hearing, the fair hearing, preparation for hearing by appellant, preparation for hearing by the B-D-S Service Coordinator or District Representative, B-D-S Waiver Unit, D-D-R-S Central Office, or Other State Designee, conduct of the hearing, continuance of hearing, the hearing record, the fair hearing decision, actions of the administrative law judge’s decision, agency review, judicial review, lawsuit, and more. In addition to these key sections, there are also important quality assurance measures in place for the home and community-based services waiver program. This includes incident reports, complaints, mortality reviews, national core indicator (N-C-I--) project, case record reviews, quality on-site provider review for home and community-based services, statewide waiver ombudsman for waiver participants with intellectual/developmental disabilities, and more. It is also important to understand the service definitions and requirements for the home and community-based services waivers. This includes information on service definition overview, home and community-based services, codes and rates, adult day services for home and community-based services, behavioral support services for home and community-based services, career exploration and planning for home and community-based services, case management for home and community-based services, community transition for home and community-based services, day habilitation for home and community-based services, extended services for home and community-based services, facility-based support for home and community-based services, family and caregiver training for home and community-based services, home modification assessment for home and community-based services, and more.. 

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DDRS HCBS Waivers 
 
viii 
Library Reference Number: PRPR10014 
 
Published: Sept. 9, 2024 
 
Policies and procedures as of July 1, 2024 
 
Version: 11.1 
Section 7: Monitoring and Continuation of FSW and CIH Waiver Services .......................... 55 
Section 7.1: Level of Care Reevaluation for FSW and CIH Waiver ........................................ 55 
Section 7.2: Medicaid Eligibility Redetermination .................................................................. 55 
Section 7.3: Annual Person-Centered Individualized Support Plan (PCISP) Development .... 55 
Section 7.4: Person-Centered Individualized Support Plan/Service Authorization Updates and 
Revisions ................................................................................................................... 57 
Section 7.5: State Authorization of the Service Authorization ................................................ 57 
Section 7.6: Service Plan Implementation and Monitoring ...................................................... 58 
Section 7.7: Interruption/Termination of Waiver Services ...................................................... 59 
Section 7.8: Waiver Slot Retention After Termination and Reentry ........................................ 60 
Section 7.9: Parents, Guardians and Relatives Providing FSW and CIH Waiver Services...... 61 
Section 8: Appeal Process ............................................................................................................. 63 
Section 8.1: Appeal Request .................................................................................................... 63 
Section 8.2: Group Appeals ..................................................................................................... 64 
Section 8.3: Time Limits for Requesting Appeals ................................................................... 65 
Section 8.4: The Hearing Notice .............................................................................................. 65 
Section 8.5: Request for Continuance from the Appellant ....................................................... 66 
Section 8.6: Review of Action ................................................................................................. 66 
Section 8.7: Disposal of Appeal Without a Fair Hearing ......................................................... 67 
Section 8.8: The Fair Hearing .................................................................................................. 67 
Section 8.9: Preparation for Hearing by Appellant .................................................................. 67 
Section 8.10: Preparation for Hearing by the BDS Service Coordinator or District 
Representative, BDS Waiver Unit, DDRS Central Office, or Other State Designee . 68 
Section 8.11: Conduct of the Hearing ...................................................................................... 69 
Section 8.12: Continuance of Hearing ..................................................................................... 70 
Section 8.13: The Hearing Record ........................................................................................... 70 
Section 8.14: The Fair Hearing Decision ................................................................................. 70 
Section 8.15: Actions of the Administrative Law Judge’s Decision ........................................ 70 
Section 8.16: Agency Review .................................................................................................. 70 
Section 8.17: Judicial Review .................................................................................................. 71 
Section 8.18: Lawsuit ............................................................................................................... 71 
Section 9: BDS Quality Assurance for HCBS Waiver Program Services ................................ 73 
Section 9.1: Overview .............................................................................................................. 73 
Section 9.2: Incident Reports ................................................................................................... 73 
Section 9.3: Complaints ........................................................................................................... 74 
Section 9.4: Mortality Reviews ................................................................................................ 75 
Section 9.5: National Core Indicator (NCI) Project ................................................................. 76 
Section 9.6: Case Record Reviews ........................................................................................... 76 
Section 9.7: Quality On-Site Provider Review for FSW and CIH Waiver .............................. 76 
Section 9.8: Statewide Waiver Ombudsman for Waiver Participants With 
Intellectual/Developmental Disabilities ..................................................................... 77 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers ...................... 79 
Section 10.1: Service Definition Overview .............................................................................. 79 
Section 10.2: FSW and CIH Waiver Services, Codes and Rates ............................................. 79 
Section 10.3: Adult Day Services for FSW and CIH Waiver .................................................. 84 
Section 10.4: Behavioral Support Services for FSW and CIH Waiver .................................... 86 
Section 10.5: Career Exploration and Planning for FSW and CIH Waiver ............................. 90 
Section 10.6: Case Management for FSW and CIH Waiver .................................................... 93 
Section 10.7: Community Transition for CIH Waiver ............................................................. 99 
Section 10.8: Day Habilitation for FSW and CIH Waiver ..................................................... 101 
Section 10.9: Extended Services for FSW and CIH Waiver .................................................. 104 
Section 10.10: Facility-Based Support for FSW and CIH Waiver ......................................... 108 
Section 10.11: Family and Caregiver Training for FSW and CIH Waiver ............................ 110 
Section 10.12: Home Modification Assessment for the FSW and CIH Waiver .................... 112

[Audio] We are thrilled to announce that we are now offering home and community-based services waivers. Our clients will finally have the opportunity to receive the care they need in the comfort of their own homes or communities. We are proud to provide a wide range of services that meet the unique needs of our clients. These services include home modifications, intensive behavioral intervention, music therapy, occupational therapy, participant assistance and care, personal emergency response system, physical therapy, prevocational services, psychological therapy, recreational therapy, remote supports, rent and food for unrelated live-in caregiver for the C-I-H waiver, residential habilitation and support – daily (RHS daily), respite, specialized medical equipment and supplies, speech/language therapy, structured family caregiving, transportation, vehicle modifications, wellness coordination, workplace assistance, home modification policy for F-S-W and C-I-H waiver, specialized medical equipment and supplies for the F-S-W and C-I-H waiver, vehicle modifications for F-S-W and C-I-H waiver, eligibility for H&W and T-B-I waiver services, H&W and T-B-I waiver provider certification, enrollment, and responsibility, quality assurance/quality improvement, program integrity and financial oversight, care coordination for T-B-I and H&W waivers, H&W and T-B-I waiver services, codes and rates, adult day services for H&W and T-B-I waivers, adult family care for H&W and T-B-I waivers, assisted living for H&W and T-B-I waivers, attendant care for H&W and T-B-I waivers, behavior management/behavior program and counseling for T-B-I waiver, care management for H&W and T-B-I waivers, caregiver coaching for H&W waiver, community transition for H&W and T-B-I waivers, home and community assistance for H&W and T-B-I waivers, home-delivered meals for H&W and T-B-I waivers, home modification assessment for H&W and T-B-I waivers, home modifications for H&W and T-B-I waivers, integrated health care coordination for H&W and T-B-I waiver, nutritional supplements for H&W and T-B-I waivers, participant-directed home care service for H&W waiver, personal emergency response system for H&W and T-B-I waivers, pest control for H&W and T-B-I waivers, residential-based habilitation for T-B-I waiver, skilled respite services for H&W and T-B-I waivers, specialized medical equipment and supplies for H&W and T-B-I waivers, library reference number: PRPR10014, published: Sept. 9, 2024, policies and procedures as of July 1, 2024, version: 11.1.. 

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DDRS HCBS Waivers 
Library Reference Number: PRPR10014 
ix 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
Section 10.13: Home Modifications for FSW and CIH Waiver............................................. 115 
Section 10.14: Intensive Behavioral Intervention for FSW and CIH Waiver ........................ 118 
Section 10.15: Music Therapy for FSW and CIH Waiver ..................................................... 121 
Section 10.16: Occupational Therapy for FSW and CIH Waiver .......................................... 123 
Section 10.17: Participant Assistance and Care for the FSW ................................................ 125 
Section 10.18: Personal Emergency Response System for FSW and CIH Waiver ................ 129 
Section 10.19: Physical Therapy for FSW and CIH Waivers ................................................ 131 
Section 10.20: Prevocational Services for FSW and CIH Waiver ......................................... 133 
Section 10.21: Psychological Therapy for FSW and CIH Waiver ......................................... 136 
Section 10.22: Recreational Therapy for FSW and CIH Waiver ........................................... 139 
Section 10.23: Remote Supports for FSW and CIH Waiver .................................................. 140 
Section 10.24: Rent and Food for Unrelated Live-in Caregiver for the CIH Waiver ............. 147 
Section 10.25: Residential Habilitation and Support – (Hourly) for the CIH Waiver ............ 149 
Section 10.26: Residential Habilitation and Support – Daily (RHS Daily) for the CIH Waiver
 ................................................................................................................................. 155 
Section 10.27: Respite for FSW and CIH Waiver .................................................................. 160 
Section 10.28: Specialized Medical Equipment and Supplies for the FSW and CIH Waiver 162 
Section 10.29: Speech/Language Therapy for FSW and CIH Waiver ................................... 165 
Section 10.30: Structured Family Caregiving for the CIH Waiver ........................................ 167 
Section 10.31: Transportation for FSW and CIH Waiver ...................................................... 171 
Section 10.32: Vehicle Modifications for FSW and CIH Waiver .......................................... 173 
Section 10.33: Wellness Coordination for the CIH Waiver ................................................... 177 
Section 10.34: Workplace Assistance for FSW and CIH Waiver .......................................... 179 
Section 11: RFA Policies ............................................................................................................. 183 
Section 11.1: Home Modification Policy for FSW and CIH Waiver ..................................... 183 
Section 11.2: Specialized Medical Equipment and Supplies for the FSW and CIH Waiver.. 189 
Section 11.3: Vehicle Modifications for FSW and CIH Waiver ............................................ 194 
Section 12: Health and Wellness (H&W) and Traumatic Brain Injury (TBI) Waivers ....... 199 
Section 12.1: Eligibility for H&W and TBI Waiver Services ................................................ 199 
Section 12.2: H&W and TBI Waiver Provider Certification, Enrollment and Responsibilities
 ................................................................................................................................. 204 
Section 12.3: Quality Assurance/Quality Improvement ......................................................... 211 
Section 12.4: Program Integrity and Financial Oversight ...................................................... 216 
Section 12.5: Care Coordination for TBI and H&W Waivers ............................................... 216 
Section 12.6: H&W and TBI Waiver Services, Codes and Rates .......................................... 220 
Section 12.7: Adult Day Services for H&W and TBI Waivers .............................................. 223 
Section 12.8: Adult Family Care for H&W and TBI Waivers ............................................... 225 
Section 12.9: Assisted Living for H&W and TBI Waivers .................................................... 230 
Section 12.10: Attendant Care for H&W and TBI Waivers ................................................... 233 
Section 12.11: Behavior Management/Behavior Program and Counseling for TBI Waiver . 237 
Section 12.12: Care Management for H&W and TBI Waivers .............................................. 239 
Section 12.13: Caregiver Coaching for H&W Waiver ........................................................... 244 
Section 12.14: Community Transition for H&W and TBI Waivers ....................................... 248 
Section 12.15: Home and Community Assistance for H&W and TBI Waivers .................... 250 
Section 12.16: Home-Delivered Meals for H&W and TBI Waivers ..................................... 253 
Section 12.17: Home Modification Assessment for H&W and TBI Waivers ........................ 255 
Section 12.18: Home Modifications for H&W and TBI Waivers .......................................... 258 
Section 12.19: Integrated Health Care Coordination for H&W and TBI Waiver .................. 263 
Section 12.20: Nutritional Supplements for H&W and TBI Waivers .................................... 265 
Section 12.21: Participant-Directed Home Care Service for H&W Waiver .......................... 267 
Section 12.22: Personal Emergency Response System for H&W and TBI Waivers ............. 270 
Section 12.23: Pest Control for H&W and TBI Waivers ....................................................... 272 
Section 12.24: Residential-Based Habilitation for TBI Waiver ............................................. 273 
Section 12.25: Skilled Respite Services for H&W and TBI Waivers .................................... 275 
Section 12.26: Specialized Medical Equipment and Supplies for H&W and TBI Waivers ... 278

[Audio] We are delighted to inform you that the Division of Disability and Rehabilitative Services is now offering home and community-based services waivers. The purpose of these waivers is to offer additional support and resources to individuals with disabilities and their families. We are pleased to share the following waivers: Structured Day Program for T-B-I Structured Family Caregiving for H&W and T-B-I Supported Employment for T-B-I Transportation for H&W and T-B-I Vehicle Modifications for H&W and T-B-I As of July 1, 2024, we have updated the policies and procedures for these waivers, and we are committed to providing ongoing support and resources to individuals and their families. We are thrilled to offer these waivers and are confident that they will have a positive impact on the lives of individuals with disabilities and their families. We hope you will consider these waivers and please reach out if you have any questions or need additional information.. 

Scene 10

DDRS HCBS Waivers 
 
x 
Library Reference Number: PRPR10014 
 
Published: Sept. 9, 2024 
 
Policies and procedures as of July 1, 2024 
 
Version: 11.1 
Section 12.27: Structured Day Program for TBI Waiver ....................................................... 281 
Section 12.28: Structured Family Caregiving for H&W and TBI Waivers ........................... 282 
Section 12.29: Supported Employment for TBI Waiver ........................................................ 287 
Section 12.30: Transportation for H&W and TBI Waivers ................................................... 289 
Section 12.31: Vehicle Modifications for H&W and TBI Waivers ....................................... 292 
Section 12.32: Provider Help ................................................................................................. 294

[Audio] The Division of Disability and Rehabilitative Services (D-D-R-S-) is pleased to announce that they will be offering home and community-based services waivers. This presentation will provide an in-depth analysis of the roles and responsibilities of the various stakeholders involved in providing these services, including the Centers for Medicare & Medicaid Services (C-M-S--), the Bureau of Disabilities Services (B-D-S--), and individuals and guardians.. 

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Library Reference Number: PRPR10014 
1 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
Section 1: Roles and Responsibilities 
This section presents the entities involved in the Division of Disability and Rehabilitative Services (DDRS) 
Home- and Community-Based Services (HCBS) waivers and their roles and responsibilities for providing 
these services. The roles and responsibilities of the individuals and guardians are included as well. 
Providers can give helpful hints to individuals or guardians to help them in selecting a waiver provider.  
Section 1.1: The Centers for Medicare & Medicaid 
Services (CMS) 
The Centers for Medicare & Medicaid Services (CMS), under the U.S. Department of Health and Human 
Services (HHS), is the federal agency that administers the Medicare and Medicaid programs that provide 
healthcare to the aged and indigent populations. In Indiana, the Medicaid program provides services to 
indigent families, children, pregnant women, senior citizens, persons with disabilities and persons who are 
blind.  
To provide home- and community-based Medicaid services as an alternative to institutional care, 1915(c) 
of the Social Security Act allows states to submit a request to the CMS to “waive” certain provisions in the 
Social Security Act that apply to state Medicaid programs:  
• A waiver of comparability of services allows states to offer individuals in target groups services that 
are different from those the general Medicaid population receives. 
• A waiver of statewideness gives states the option of limiting availability of services to specified 
geographic areas of the state. 
• A waiver of income and resource requirements for the medically needy permits states to apply 
different eligibility rules for medically needy persons in the community. 
The CMS must review and approve all waiver proposals and amendments submitted by each state. The 
CMS reviews all waiver requests, applications, renewals, amendments and financial reports. Additionally, 
the CMS performs management reviews of all Home- and Community-Based Services (HCBS) waivers to 
ascertain their effectiveness, safety and cost-effectiveness. The CMS requires states to assure that federal 
requirements for waiver service programs are met and verifies that the states’ assurances in their waiver 
programs are upheld in the day-to-day operation. 
Additional information about the CMS is available on the CMS website at cms.gov. 
Section 1.2: FSSA Division of Disability and 
Rehabilitative Services (DDRS) 
As a division of the Indiana Family and Social Services Administration (FSSA), the DDRS has two 
overarching responsibilities for children and adults with physical and cognitive disabilities: 
• Facilitate partnerships that enhance the quality of life. 
• Provide continuous, life-long support. 
The Bureau of Disabilities Services (BDS) is under the DDRS.  
For more information, see the DDRS homepage at in.gov/fssa.

[Audio] We are here to provide an update on the home and community-based services waivers that we are offering. We are responsible for providing individualized, integrated community-based services for individuals with disabilities and their families. The Bureau of Disabilities Services (B-D-S--) is a part of us that administers four H-C-B-S waiver programs for individuals who meet the level-of-care (L-O-C--) requirements for admission to an intermediate care facility for individuals with intellectual disabilities (ICF/IID) or to a nursing facility (N-F---): Community Integration and Habilitation (C-I-H--) Waiver – Must meet L-O-C for an ICF/IID, Family Supports Waiver (F-S-W--) – Must meet L-O-C for an ICF/IID, Health and Wellness (H&W) Waiver – Must meet L-O-C for an NF, and Traumatic Brain Injury (T-B-I--) Waiver – Must meet L-O-C for either an ICF/IID or an NF. B-D-S administers the H&W and T-B-I waivers and minor differences exist between waiver programs. With the transition of the H&W and T-B-I waivers from the Division of Aging to us, and differences in the applicable administrative code requirements, statewide provision of services and supports is ensured through the establishment of eight B-D-S district offices serving specific regions in Indiana. B-D-S service coordinators determine initial eligibility for intellectual/developmental disability services, determining L-O-C for ICF/IID services. B-D-S service coordinators also determine a new “initial” L-O-C for individuals who have been terminated from the H-C-B-S waiver program, but desire to return to waiver services within the same waiver year. We have statutory authority over the state’s home and community-based services for individuals of all ages with intellectual/developmental disabilities, and for individuals age 59 and under with physical disabilities. We are also the placement authority for persons with intellectual/developmental disabilities and help develop policies and procedures for Indiana Medicaid waivers that serve persons with intellectual/developmental disabilities. To ensure the health and welfare of individuals receiving Medicaid H-C-B-S waiver services, we have developed and implemented quality improvement and quality assurance systems. Oversight activities include the development of policy, case record reviews, investigation of complaints, and reviewing mortality. Thank you for listening.. 

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Section 1: Roles and Responsibilities  
DDRS HCBS Waivers 
2 
Library Reference Number: PRPR10014 
 
Published: Sept. 9, 2024 
 
Policies and procedures as of July 1, 2024 
 
Version: 11.1 
Section 1.3: The Bureau of Disabilities Services (BDS) 
Within the DDRS, the BDS administers individualized, integrated community-based services for 
individuals with disabilities and their families, including four HCBS waiver programs for persons who 
meet the level-of-care (LOC) requirements for admission to an intermediate care facility for individuals 
with intellectual disabilities (ICF/IID) or to a nursing facility (NF): 
• Community Integration and Habilitation (CIH) Waiver – Must meet LOC for an ICF/IID 
• Family Supports Waiver (FSW) – Must meet LOC for an ICF/IID  
• Health and Wellness (H&W) Waiver – Must meet LOC for an NF 
• Traumatic Brain Injury (TBI) Waiver – Must meet LOC for either an ICF/IID or an NF 
Note: As of July 1, 2024, the DDRS BDS administers the H&W Waiver and the TBI Waiver. 
With the transition of the H&W and TBI waivers from the Division of Aging to the 
DDRS, and differences in the applicable administrative code requirements, minor 
differences exist between waiver programs. Indiana Administrative Code (IAC) 
governing the FSW and CIH Waiver is found in 460 IAC 6 while the TBI and H&W 
waivers are still governed by 455 IAC 2. 
 
Guidance unique to the H&W and TBI programs is found in Section 12 of this 
module. 
The HCBS waiver programs provide services to individuals in a range of community settings, as an 
alternative to care in an ICF/IID or NF. 
To ensure provision of services and supports statewide, the BDS has established eight BDS district offices 
serving specific regions in Indiana. The BDS service coordinators determine initial eligibility for 
intellectual/developmental disability services, determining LOC for ICF/IID services. BDS service 
coordinators also determine a new “initial” LOC for individuals who have been terminated from the HCBS 
waiver program, but desire to return to waiver services within the same waiver year. Information specific to 
the determination of LOC for individuals choosing the TBI or H&W waivers is found in Section 12.2: 
Eligibility for H&W and TBI Waiver Services of this module. 
The BDS has statutory authority over the state’s home and community-based services for individuals of all 
ages with intellectual/developmental disabilities, and for individuals age 59 and under with physical 
disabilities . The BDS is also the placement authority for persons with intellectual/developmental 
disabilities and helps develop policies and procedures for Indiana Medicaid waivers that serve persons with 
intellectual/developmental disabilities. 
Additional information about the BDS is available on the Disabilities Services page at in.gov/fssa/ddrs. 
Section 1.4: BDS Quality Assurance Services 
Previously, the responsibility of the quality assurance belonged to the Bureau of Quality Improvement 
Services (BQIS), which has been integrated into BDS. BDS is now responsible for developing and 
implementing quality improvement and quality assurance systems to assure the health and welfare of 
individuals receiving Medicaid HCBS waiver services, including the CIH, FSW, H&W and TBI waivers.. 
The oversight activities include the following: 
• Developing policy 
• Conducting case record reviews 
• Investigating complaints 
• Reviewing mortality

[Audio] We are presenting an overview of the Division of Disability and Rehabilitative Services (D-D-R-S-) H-C-B-S Waivers. This presentation will provide an in-depth look at the roles and responsibilities of the D-D-R-S in managing the state’s automated system for reporting incidents of abuse, neglect, and exploitation, assuring compliance with Indiana waiver regulations, researching best practices, analyzing quality data, managing provider reverification, and monitoring provider accreditation. We will also discuss the responsibilities of the F-S-S-A Office of Medicaid Policy and Planning (O-M-P-P-) in monitoring the D-D-R-S operation of the H-C-B-S programs for compliance with C-M-S requirements, developing Medicaid policy for the state of Indiana, and collaborating with the D-D-R-S to revise and develop the application of the H-C-B-S program to reflect current F-S-S-A goals and policy programs.. 

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DDRS HCBS Waivers 
Section 1: Roles and Responsibilities 
Library Reference Number: PRPR10014 
3 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
• Managing the state’s automated system for reporting incidents of abuse, neglect and exploitation  
• Assuring compliance with Indiana waiver regulations 
• Researching best practices 
• Analyzing quality data 
• Managing provider reverification 
• Monitoring provider accreditation 
Additional information about the BDS quality assurance services is available on the BDS Quality 
Assurance page at in.gov/fssa/ddrs. 
Section 1.5: FSSA Office of Medicaid Policy and 
Planning (OMPP) 
The FSSA is the single state Medicaid agency for Indiana. A division of the FSSA, the Office of Medicaid 
Policy and Planning (OMPP), has been appointed by the Secretary to serve as the administrative authority 
for Medicaid HCBS programs and is responsible for monitoring the DDRS operation of the HCBS 
programs for compliance with CMS requirements. The OMPP is responsible for oversight of all HCBS 
program activities, including the following: 
• LOC determinations 
• Plan of care reviews 
• Identification of trends and outcomes 
• Initiating action to achieve desired outcomes 
• Retaining final authority for approval of LOC and plans of care 
The OMPP develops Medicaid policy for the state of Indiana and, on an ongoing and as-needed basis, 
works collaboratively with the DDRS to formulate policies specific to the HCBS program or that have a 
substantial impact on HCBS program individuals. The OMPP seeks and reviews comments from the DDRS 
before the adoption of rules or standards that may affect the services, programs or providers of medical 
assistance services for individuals with intellectual disabilities who receive Medicaid services. The OMPP 
and DDRS collaborate to revise and develop the application of the HCBS program to reflect current FSSA 
goals and policy programs. The OMPP reviews and approves all HCBS program documents, bulletins, 
communications regarding HCBS program policy and quality assurance/improvement plans prior to 
implementation or release to providers, individuals, families or any other entity. 
Additional information about the OMPP is available on the Office of Medicaid Policy & Planning page 
at in.gov/fssa. For Medicaid eligibility requirements, see the Eligibility Guide on the member website at 
in.gov/medicaid/members. 
Section 1.6: FSSA Division of Family Resources 
As a division of the FSSA, the Division of Family Resources (DFR) is responsible for establishing 
eligibility and managing the timely and accurate delivery of benefits, including: 
• Medicaid – health coverage plans 
• Supplemental Nutrition Assistance Program (SNAP) – food assistance 
• Temporary Assistance for Needy Families (TANF) – cash assistance 
• Refugee assistance

[Audio] We thank you for joining us on our presentation on the Division of Disability and Rehabilitative Services offering home and community-based services waivers. We hope you have a better understanding of the roles and responsibilities involved in the DDRS HCBS waivers program. If you have any more questions, please don't hesitate to reach out to the D-D-R-S-. Thank you for your time and attention.. 

Scene 14

Section 1: Roles and Responsibilities  
DDRS HCBS Waivers 
4 
Library Reference Number: PRPR10014 
 
Published: Sept. 9, 2024 
 
Policies and procedures as of July 1, 2024 
 
Version: 11.1 
The DFR Indiana Manpower and Comprehensive Training (IMPACT) program helps SNAP and TANF 
recipients to achieve economic self-sufficiency through education, training, job search and job placement 
activities. 
The division’s overarching focus is the support and preservation of families by emphasizing self- 
sufficiency and personal responsibility. Information about the DFR and DFR programs is available online 
on the DFR section of the FSSA website at in.gov/fssa or by telephone at 800-403-0864. 
Section 1.7: Waiver Service Providers, Including 
Selected Contracting Case Management Organizations 
HCBS waiver provider applicants are agencies, companies and individuals that have applied to provide 
waiver services and have been found to have the qualifications and business structures in place to seek 
enrollment as a Medicaid provider. After approval from the DDRS (for FSW and CIH waiver providers) or 
OMPP (for H&W and TBI waiver providers), the providers must then enroll in Medicaid as Indiana Health 
Coverage Programs (IHCP) providers.  
For IHCP enrollment, the provider type for HCBS waiver providers is Type 32 – Waiver Provider. There 
are specialties under this waiver provider type including: 
• 350 – Health and Wellness Waiver  
• 356 – Traumatic Brain Injury Waiver  
• 359 – Community Integration and Habilitation Waiver 
• 360 – Family Supports Waiver 
• 363 – Money Follows the Person (MFP) Demonstration Grant 
For more information on how to enroll in Medicaid, see the Provider Enrollment provider reference 
module. After enrolling in Medicaid, the providers are paid by the IHCP to provide direct services to 
Medicaid HCBS waiver program individuals.  
Selected Contracting Case Management Organizations 
(For FSW and CIH Waivers) 
The DDRS-approved selected contracting case management organizations are FSW and CIH waiver 
service providers that provide only case management services to waiver individuals. These services include 
the following: 
• Implementing the recently enhanced person-centered planning process  
• Helping the individual identify members of the Individualized Support Team (IST)  
• Developing and submitting to the state the service plan known as the plan of care/service plan 
• Developing a person-centered individualized support plan (PCISP)  
Case management providers often refer to themselves as case management organizations, using the 
acronym CMOs. Specific responsibilities of the case management provider, including monitoring activities, 
are described in Section 10.6: Case Management for FSW and CIH Waiver.

 part 1

We are pleased to announce that the Division of Disability and Rehabilitative Services is offering home and community-based services waivers. This waiver provides more flexibility for states to design and implement programs that best meet the needs of individuals with disabilities. We are committed to working with states to ensure that these waivers are implemented in a way that is both effective and efficient. We believe that this waiver will be a valuable tool for states looking to improve the quality of services for individuals with disabilities.
                                    
                                    The Revision History for this document provides a detailed overview of the changes that have been made to the policies and procedures over time. From the initial release in 2012 to the most recent update in 2024, we have worked tirelessly to ensure that this document remains up-to-date and relevant. We are proud of the work that has been done and look forward to continuing to work with states to improve the lives of individuals with disabilities.
                                    
                                    Thank you for your interest in this important topic. If you have any questions, please do not hesitate to reach out to us. We are here to help.

avatar

We are here to discuss the home and community-based services (H-C-B-S-) waivers offered by the Division of Disability and Rehabilitative Services (D-D-R-S-). D-D-R-S offers waivers for Family Supports Waiver (F-S-W--) and Community Integration and Habilitation Waiver (C-I-H--) services.
                                    
                                    These waivers are designed to provide individuals with disabilities with more flexibility and control over their services. With these waivers, individuals can choose the services they need and where they want to receive them.
                                    
                                    D-D-R-S has revised the policies and procedures for the H-C-B-S waivers several times, with the most recent version being published on July 1, 2024. This version includes information about legally responsible individuals (LRIs) and whether they are allowed or not allowed to provide certain services.
                                    
                                    The H-C-B-S waivers have also been updated to include information about Health and Wellness (H&W) and Traumatic Brain Injury (T-B-I--) services.
                                    
                                    D-D-R-S has updated the provider application process for F-S-W and C-I-H waivers. The application process now includes a review of the applicant's qualifications and a determination of their ability to provide the services required by the waiver.
                                    
                                    D-D-R-S has also updated the billing and reimbursement process for waiver services. Providers must now meet certain requirements in order to bill for their services.

Good morning everyone. We are here to discuss the Home and Community-based Services waivers offered by the Division of Disability and Rehabilitative Services. These waivers were introduced to provide individuals with disabilities access to a variety of services that were previously inaccessible.
                                     We have made several updates to the Home and Community-based Services waivers. We have updated the Limitations section of the Music Therapy service for F-S-W and C-I-H Waiver. We have also updated Section 10.13: Home Modifications for F-S-W and C-I-H Waiver. Additionally, we have made changes to the Service Definition section of the Residential Habilitation and Support (hourly) service for the C-I-H Waiver, as well as the Service Definition section of the Residential Habilitation and Support (daily) service for the C-I-H Waiver. We have also updated the rates in the Service Standards and Limitations sections of the Specialized Medical Equipment and Supplies service for the F-S-W and C-I-H Waiver. We have also updated the Reimbursable Activities and Activities Not Allowed sections of the Structured Family Caregiving service for the F-S-W and C-I-H Waiver. Additionally, we have made updates to the Transportation service for the F-S-W and C-I-H Waiver. We are committed to providing individuals with disabilities access to the services they need to live a fulfilling life. We believe that the Home and Community-based Services waivers are an important step towards achieving this goal. Thank you for your attention to this matter.

We will provide information on the application process for F-S-W and C-I-H Waiver, the reversion process for F-S-W and C-I-H Waiver, details on billing and reimbursement for waiver services, and information on financial oversight and waiver audits.

The home and community-based services waiver program includes important sections that are essential to understand. These include the monitoring and continuation of services, such as level of care reevaluation, Medicaid eligibility redetermination, annual person-centered individualized support plan (P-C-I-S-P) development, person-centered individualized support plan/service authorization updates and revisions, state authorization of the service authorization, service plan implementation and monitoring, interruption/termination of waiver services, waiver slot retention after termination and reentry, parents, guardians and relatives providing home and community-based services, appeal process, and more. It is important to note that specific actions must be taken in order to appeal a decision related to these waivers. This includes requesting an appeal, group appeals, time limits for requesting appeals, the hearing notice, request for continuance from the appellant, review of action, disposal of appeal without a fair hearing, the fair hearing, preparation for hearing by appellant, preparation for hearing by the B-D-S Service Coordinator or District Representative, B-D-S Waiver Unit, D-D-R-S Central Office, or Other State Designee, conduct of the hearing, continuance of hearing, the hearing record, the fair hearing decision, actions of the administrative law judge’s decision, agency review, judicial review, lawsuit, and more. In addition to these key sections, there are also important quality assurance measures in place for the home and community-based services waiver program. This includes incident reports, complaints, mortality reviews, national core indicator (N-C-I--) project, case record reviews, quality on-site provider review for home and community-based services, statewide waiver ombudsman for waiver participants with intellectual/developmental disabilities, and more. It is also important to understand the service definitions and requirements for the home and community-based services waivers. This includes information on service definition overview, home and community-based services, codes and rates, adult day services for home and community-based services, behavioral support services for home and community-based services, career exploration and planning for home and community-based services, case management for home and community-based services, community transition for home and community-based services, day habilitation for home and community-based services, extended services for home and community-based services, facility-based support for home and community-based services, family and caregiver training for home and community-based services, home modification assessment for home and community-based services, and more.

We are thrilled to announce that we are now offering home and community-based services waivers. Our clients will finally have the opportunity to receive the care they need in the comfort of their own homes or communities. We are proud to provide a wide range of services that meet the unique needs of our clients. These services include home modifications, intensive behavioral intervention, music therapy, occupational therapy, participant assistance and care, personal emergency response system, physical therapy, prevocational services, psychological therapy, recreational therapy, remote supports, rent and food for unrelated live-in caregiver for the C-I-H waiver, residential habilitation and support – daily (RHS daily), respite, specialized medical equipment and supplies, speech/language therapy, structured family caregiving, transportation, vehicle modifications, wellness coordination, workplace assistance, home modification policy for F-S-W and C-I-H waiver, specialized medical equipment and supplies for the F-S-W and C-I-H waiver, vehicle modifications for F-S-W and C-I-H waiver, eligibility for H&W and T-B-I waiver services, H&W and T-B-I waiver provider certification, enrollment, and responsibility, quality assurance/quality improvement, program integrity and financial oversight, care coordination for T-B-I and H&W waivers, H&W and T-B-I waiver services, codes and rates, adult day services for H&W and T-B-I waivers, adult family care for H&W and T-B-I waivers, assisted living for H&W and T-B-I waivers, attendant care for H&W and T-B-I waivers, behavior management/behavior program and counseling for T-B-I waiver, care management for H&W and T-B-I waivers, caregiver coaching for H&W waiver, community transition for H&W and T-B-I waivers, home and community assistance for H&W and T-B-I waivers, home-delivered meals for H&W and T-B-I waivers, home modification assessment for H&W and T-B-I waivers, home modifications for H&W and T-B-I waivers, integrated health care coordination for H&W and T-B-I waiver, nutritional supplements for H&W and T-B-I waivers, participant-directed home care service for H&W waiver, personal emergency response system for H&W and T-B-I waivers, pest control for H&W and T-B-I waivers, residential-based habilitation for T-B-I waiver, skilled respite services for H&W and T-B-I waivers, specialized medical equipment and supplies for H&W and T-B-I waivers, library reference number: PRPR10014, published: Sept. 9, 2024, policies and procedures as of July 1, 2024, version: 11.1.

We are delighted to inform you that the Division of Disability and Rehabilitative Services is now offering home and community-based services waivers. The purpose of these waivers is to offer additional support and resources to individuals with disabilities and their families. We are pleased to share the following waivers:
                            Structured Day Program for T-B-I
                            Structured Family Caregiving for H&W and T-B-I
                            Supported Employment for T-B-I
                            Transportation for H&W and T-B-I
                            Vehicle Modifications for H&W and T-B-I
                          As of July 1, 2024, we have updated the policies and procedures for these waivers, and we are committed to providing ongoing support and resources to individuals and their families. We are thrilled to offer these waivers and are confident that they will have a positive impact on the lives of individuals with disabilities and their families. We hope you will consider these waivers and please reach out if you have any questions or need additional information.

The Division of Disability and Rehabilitative Services (D-D-R-S-) is pleased to announce that they will be offering home and community-based services waivers. This presentation will provide an in-depth analysis of the roles and responsibilities of the various stakeholders involved in providing these services, including the Centers for Medicare & Medicaid Services (C-M-S--), the Bureau of Disabilities Services (B-D-S--), and individuals and guardians.

We are here to provide an update on the home and community-based services waivers that we are offering. We are responsible for providing individualized, integrated community-based services for individuals with disabilities and their families. The Bureau of Disabilities Services (B-D-S--) is a part of us that administers four H-C-B-S waiver programs for individuals who meet the level-of-care (L-O-C--) requirements for admission to an intermediate care facility for individuals with intellectual disabilities (ICF/IID) or to a nursing facility (N-F---): Community Integration and Habilitation (C-I-H--) Waiver – Must meet L-O-C for an ICF/IID, Family Supports Waiver (F-S-W--) – Must meet L-O-C for an ICF/IID, Health and Wellness (H&W) Waiver – Must meet L-O-C for an NF, and Traumatic Brain Injury (T-B-I--) Waiver – Must meet L-O-C for either an ICF/IID or an NF. B-D-S administers the H&W and T-B-I waivers and minor differences exist between waiver programs. With the transition of the H&W and T-B-I waivers from the Division of Aging to us, and differences in the applicable administrative code requirements, statewide provision of services and supports is ensured through the establishment of eight B-D-S district offices serving specific regions in Indiana. B-D-S service coordinators determine initial eligibility for intellectual/developmental disability services, determining L-O-C for ICF/IID services. B-D-S service coordinators also determine a new “initial” L-O-C for individuals who have been terminated from the H-C-B-S waiver program, but desire to return to waiver services within the same waiver year. We have statutory authority over the state’s home and community-based services for individuals of all ages with intellectual/developmental disabilities, and for individuals age 59 and under with physical disabilities. We are also the placement authority for persons with intellectual/developmental disabilities and help develop policies and procedures for Indiana Medicaid waivers that serve persons with intellectual/developmental disabilities. To ensure the health and welfare of individuals receiving Medicaid H-C-B-S waiver services, we have developed and implemented quality improvement and quality assurance systems. Oversight activities include the development of policy, case record reviews, investigation of complaints, and reviewing mortality. Thank you for listening.

We are presenting an overview of the Division of Disability and Rehabilitative Services (D-D-R-S-) H-C-B-S Waivers. This presentation will provide an in-depth look at the roles and responsibilities of the D-D-R-S in managing the state’s automated system for reporting incidents of abuse, neglect, and exploitation, assuring compliance with Indiana waiver regulations, researching best practices, analyzing quality data, managing provider reverification, and monitoring provider accreditation. We will also discuss the responsibilities of the F-S-S-A Office of Medicaid Policy and Planning (O-M-P-P-) in monitoring the D-D-R-S operation of the H-C-B-S programs for compliance with C-M-S requirements, developing Medicaid policy for the state of Indiana, and collaborating with the D-D-R-S to revise and develop the application of the H-C-B-S program to reflect current F-S-S-A goals and policy programs.

We thank you for joining us on our presentation on the Division of Disability and Rehabilitative Services offering home and community-based services waivers. We hope you have a better understanding of the roles and responsibilities involved in the DDRS HCBS waivers program. If you have any more questions, please don't hesitate to reach out to the D-D-R-S-. Thank you for your time and attention.