[Virtual Presenter] Good morning/afternoon/evening ladies and gentlemen, and welcome to today's presentation on DDRS HCBS Waivers. We are delighted to have the opportunity to discuss with you the important requirements for remote support devices, emergency response drills, and incident reporting, as well as the many benefits of this non-invasive and flexible option for individuals and families to build life skills and independence.. 

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DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
Library Reference Number: PRPR10014 
145 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
➢ Proof of utilization of the remote support device outlined in the PCISPs, and budgets of each 
individual in a setting, including typical hours of remote supports utilization 
– Each remote site where remote supports are used in place of in-person direct support service 
delivery will have a written policy and procedure approved by the DDRS (and available to the 
OMPP for all providers serving waiver individuals) that defines emergency situations and details 
how remote and backup staff will respond to each. Examples include: 
➢ Fire, medical crises, stranger in the home, violence between individuals and any other 
situation that appears to threaten the health or welfare of the individual. 
➢ Emergency response drills must be carried out once per quarter per shift in each home 
equipped with and capable of utilizing the remote supports monitoring service. 
Documentation of the drills must be available for review upon request. 
➢ When used to replace in-person direct support service delivery, the remote monitoring base 
staff shall generate a written report on each individual served in each individual’s residential 
living site on a daily basis. This report will follow documentation standards of the RHS or 
PAC service. This report must be transmitted to the primary RHS or PAC provider daily. 
➢ Each time an emergency response is generated, an incident report must be submitted to the 
state per the BDS and quality assurance procedures. 
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. 
Limitations and Reimbursement Parameters 
Remote Supports can be provided one-on-one or as a group service. 
RemoteSupports provides a realistic, non-invasive way for many individuals and families to find the 
supports they need to build life skills and familiarity in their level of independence with a sense of security. 
Individuals and families who are utilizing the FSW may want to try the service to see if it works for them. 
The first $500 of Remote Supports added to their annual service plan year will be outside of the $26,482 
budget cap. 
The budget will be completed for each individual based upon the total number of individuals residing 
within the residence. However, lower tiers may also appear on the service plans to reflect reimbursement 
rates for situations where one or more individual is away from the home during service utilization. 
Reimbursement will then be the hourly rate of $24.26 divided by and among the number of individuals who 
are at home during the hours of utilization (see Table 4). If only one individual from a four-individual 
setting is at home during service utilization, the solitary individual pays the full hourly rate of $24.26. If 
only two of the four individuals are home, each pays $12.13 per hour of utilization, and if three of the four 
are home, each pay $8.09 per hour of utilization.  
Table 4 – Reimbursement Rates by Tier 
Tier 
Number of Individuals 
Reimbursement 
Tier 1 
One individual in a home 
$24.26 
Tier 2 
Two individuals in a home 
$12.13 
Tier 3 
Three individuals in a home 
$8.09 
Tier 4 
Four individuals in a home 
$6.06 
Billing clarification: When all service standards are met, the service provider shall be reimbursed at the full 
unit rate for each hour that the Remote Supports service is rendered. The unit rate for each hour of Remote 
Supports service utilization shall be divided by and among the number of waiver individuals present in the 
home during any portion of the hour for which reimbursement is requested.

[Audio] Remote support devices have become increasingly popular, providing individuals and families with flexibility and non-invasive options to build life skills and independence. However, it is important for providers to understand the limitations of these devices. Certain activities are not allowed under remote supports, including concurrent use with structured family caregiving services, monitoring direct care staff, and camera usage in bathrooms or bedrooms. Providers must meet specific criteria to be approved and enrolled as an active Medicaid provider and FSSA DDRS-approved, and comply with Indiana Administrative Code, 460 I-A-C 6. Remote support devices may serve as a potential replacement for P-A-C or R-H-S services under the F-S-W or C-I-H waiver, but they are not billable during the same time period. Providers must also comply with policies and procedures as of July 1, 2024. It is essential for providers to understand these requirements to effectively utilize remote support devices under DDRS HCBS waivers.. 

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DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
146 
Library Reference Number: PRPR10014 
 
Published: Sept. 9, 2024 
 
Policies and procedures as of July 1, 2024 
 
Version: 11.1 
Reimbursement for paid on-site backup responders would be billed as RHS (hourly) for CIH Waiver or as 
PAC for FSW. Therefore, it may be necessary for the remote supports provider to contract with an RHS or 
PAC provider.  
Activities Not Allowed 
The following activities are not allowed under Remote Supports: 
• Remote supports used concurrently with Structured Family Caregiving services in the structured 
family caregiving home 
Note:  Structured Family Caregiving is available under the CIH Waiver; it is not available 
under the FSW. For unique information related to Structured Family Caregiving 
under the H&W and TBI Waiver, see Section 12.28: Structured Family Caregiving for 
H&W and TBI Waivers.  
• Remote supports systems intended to monitor direct care staff 
• Remote Supports service in intermediate care facilities for individuals with intellectual disabilities 
(ICFs/IID) licensed under IC 16-28 and 410 IAC 16.2 
• Remote supports systems used in place of in-home staff when in-person staff has been deemed 
necessary by IST 
• Cameras in bathrooms or bedrooms 
• Installation costs related to video and/or audio equipment for any purpose other than the provision 
of remote support services in place of on-site staffing 
• Services furnished to a minor by parents, stepparents or legal guardian 
• Services furnished to an individual by the individual’s spouse 
Remote support services may serve as a potential replacement for PAC services under the FSW, or as a 
replacement for RHS services Level 1 and Level 2; therefore, Remote Supports and PAC, or Remote 
Supports and RHS services are not billable during the same time period. However, Remote Supports are an 
allowable component of the RHS daily service but may not be billed in addition to the daily rate of the 
RHS daily service.  
Note:  RHS is available only under the CIH Waiver; it is not available under the FSW. For 
unique information about the similarly named Residential-Based Habilitation service, 
available under the TBI Waiver, see Section 12.24: Residential-Based Habilitation for 
TBI Waiver. 
Provider Qualifications 
Providers must meet the following criteria: 
• Be enrolled as an active Medicaid provider 
• Be FSSA DDRS-approved 
• Must comply with Indiana Administrative Code, 460 IAC 6, including but not limited to: 
– 460 IAC 6-10-5 Documentation of Criminal Histories 
– 460 IAC 6-12-1 and 460 IAC 6-12-2 Insurance 
– 460 IAC 6-11-1 to 460 IAC 6-11-3 Financial Status of Providers

[Audio] We present the requirements for the use of remote support devices, emergency response drills, and incident reporting. These requirements offer a non-invasive and flexible option for individuals and families to develop life skills and independence.. 

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DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
Library Reference Number: PRPR10014 
147 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
• Must comply with any applicable BDS service standards, guidelines, policies and/or manuals, 
including FSSA DDRS policies and this module, accessible from the IHCP Provider Reference 
Modules page at in.gov/medicaid/providers 
• To be approved to provide Remote Supports services, a provider shall: 
• Be an entity approved by FSSA DDRS or BDS to provide Remote Supports services  
• Assure that the system must be monitored by a staff person trained and oriented to the specific needs 
of each individual served as outlined in their PCISP 
• Assure that the paid support staff meet the qualifications for direct support professionals as set out 
in DDRS’ BDS policy on requirements and training for direct support professional staff 
• If the backup support is unpaid, natural supports such as family, a guardian or a person the 
individual chooses 
– The need for backup support to meet qualifications for direct support professionals would not be 
applicable. 
• Assure that the individual, family, guardian, team and backup provider, if applicable, are trained on 
the use of remote supports equipment 
Section 10.24: Rent and Food for Unrelated Live-in 
Caregiver for the CIH Waiver 
The following subsections provide information and requirements for Rent and Food for Unrelated Live-in 
Caregiver services for the CIH Waiver. 
Service Definition 
Rent and Food for Unrelated Live-in Caregiver services are payment for the additional costs of rent and 
food that can be reasonably attributed to an unrelated live-in caregiver who resides in the same household 
as the waiver individual. Payment will not be made when the individual lives in the caregiver’s home or in 
a residence that is owned or leased by the provider of Medicaid services. 
Additional Information: 
• 
Rent and Food for Unrelated Live-in Caregiver services are available only under the 
CIH Waiver. These services are not available under the FSW, H&W or TBI waivers. 
• 
Paid caregivers are not eligible for the Rent and Food for Unrelated Live-in Caregiver 
service. 
Reimbursable Activities 
Reimbursable activities under Rent and Food for Unrelated Live-in Caregiver include the following: 
• The individual receiving these services lives in their own home. 
• For payment to not be considered income for the individual receiving services, payment for the 
portion of the costs of rent and food attributable to an unrelated live-in caregiver (who has no legal 
responsibility to support the individual) must be made directly to the live-in caregiver. 
• Room and board for the unrelated live-in caregiver (who is not receiving any other financial 
reimbursement for the provision of this service).

[Audio] We are pleased to present to you on DDRS HCBS waivers. Our presentation today will focus on the requirements for utilizing remote support devices, emergency response drills, and incident reporting. First, we will discuss remote support devices. These devices are designed to assist individuals in performing daily tasks and activities. They can include a variety of devices, such as speech recognition software, hearing aids, and mobility devices. Next, we will discuss emergency response drills. These drills are designed to prepare individuals for emergency situations, such as natural disasters or other unexpected events. Finally, we will discuss incident reporting. This process involves the reporting of any incidents or accidents that occur while an individual is receiving DDRS HCBS waivers. In summary, DDRS HCBS waivers include essential requirements for the utilization of remote support devices, emergency response drills, and incident reporting. These requirements are designed to ensure the safety and well-being of individuals receiving DDRS HCBS waivers.. 

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DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
148 
Library Reference Number: PRPR10014 
 
Published: Sept. 9, 2024 
 
Policies and procedures as of July 1, 2024 
 
Version: 11.1 
• Room: Shelter-type expenses including all property-related costs such as rental or purchase of real 
estate and furnishings, maintenance, utilities, and related administrative services. 
• Board: Three meals a day or other full nutritional regimen. 
• Caregiver is unrelated: Unrelated by blood or marriage to any degree. 
• Caregiver: An individual providing a covered service as defined by BDS service definitions or in a 
Medicaid HCBS waiver, to meet the physical, social or emotional needs of the individual receiving 
services. 
Service Standards 
The following service standards apply to Rent and Food for Unrelated Live-in Caregiver: 
• Rent and Food for Unrelated Live-in Caregiver should be reflected in the PCISP. 
• Services must address needs identified in the person-centered planning process and be outlined in 
the PCISP. 
• Services must complement other services the individual receives and enhance increasing 
independence for the individual. 
• The person-centered planning team will decide and assure that the individual who will serve as a 
live-in caregiver has the experience, skills, training and knowledge appropriate to the individual and 
the type of support needed. 
Documentation Standards 
Rent and Food for Unrelated Live-in Caregiver services documentation must include the following: 
• Identified in the PCISP 
• Documentation of how amount of rent and food was determined 
• Receipt that funds were paid to the live-in caregiver 
• Documentation in compliance with 460 IAC 6 Supported Living Services and Supports 
requirements 
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.  
Limitations 
See Activities Not Allowed. 
Activities Not Allowed 
The following situations are not allowed under Rent and Food for Unrelated Live-in Caregiver: 
• The individual is not permitted to live in the home of the caregiver or in a residence that is owned or 
leased by the provider of other services, including Medicaid waiver services. 
• The live-in caregiver cannot be related by blood or marriage (to any degree) to the individual and/or 
has any legal responsibility to support the individual. 
• The individual cannot receive live-in caregiver services and structured family caregiving services 
concurrently.

[Audio] We welcome you to our presentation on DDRS HCBS Waivers. These waivers have specific requirements for the use of remote support devices, emergency response drills, and incident reporting. They also provide a non-invasive and flexible option for individuals and families to develop life skills and independence.. 

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DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
Library Reference Number: PRPR10014 
149 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
• This service will not be reimbursed when provided by the parent of a minor child participant or the 
spouse of a participant (also known as LRIs) 
Provider Qualifications 
Providers must meet the following criteria: 
• Enrolled as an active Medicaid provider 
• Be FSSA DDRS-approved 
• Comply with Indiana Administrative Code, 460 IAC 6, including but not limited to:  
– 460 IAC 6-5-24 Residential Habilitation and Support Services Provider Qualifications 
– 460 IAC 6-14-5 Requirements for Direct Care Staff 
– 460 IAC 6-14-4 Training 
• Comply with any applicable BDS service standards, guidelines, policies and/or manuals, including 
FSSA DDRS policies and this module, accessible from the IHCP Provider Reference Modules page 
at in.gov/medicaid/providers 
Section 10.25: Residential Habilitation and Support – 
(Hourly) for the CIH Waiver 
The following subsections provide information and requirements for hourly Residential Habilitation and 
Support services for the FSW and CIH Waiver. 
Service Definition 
Residential Habilitation and Support hourly (RHS hourly) services mean individually tailored supports that 
are specified in the PCISP that assist with the acquisition, retention or improvement in skills related to 
living in the community. These supports include adaptive skill development, assistance with activities of 
daily living, community inclusion, transportation, adult educational supports, and social and leisure skill 
development that support the individual to live successfully in their own home. 
HCBS provided during an acute care hospitalization assists the individual to maintain current levels of 
functioning and support, provides ongoing coordination of care, and provides assurance that new or 
additional needs are identified and addressed by the person-centered planning team as the individual 
prepares to return to the community. 
The HCBS provided in an acute care hospital must not be duplicative of services available in the acute care 
hospital setting. 
A relative of the individual may be a provider of RHS services. The decision that a relative is the best 
choice of persons to provide these services is a part of the person-centered planning process and is 
documented in the PCISP. When the provider is a relative, there is an annual review by the IST to 
determine whether the individual’s relative should continue to be the provider of RHS services. 
RHS Level 1 and Level 2 services provide up to a full day (24-hour basis) of services and/or supports for 
individuals assigned an Algo score of 0, 1 or 2, or individuals assigned any Algo level not meeting criterion 
for RHS Daily Rate. 
The service is billable as either of the following: 
• RH1O − Level 1 - for intermittent use of RHS Level 1 at 35 or fewer hours per week 
• RH2O − Level 2 - for greater than 35 hours per week of RHS

[Audio] Individuals with developmental disabilities may require different levels of support based on their individual needs. The following Algo score/descriptors/ICAP/OBA are used to determine the necessary level of support for individuals with developmental disabilities: Level 0: Individuals with an Algo score of zero (0) are highly independent and require minimal support. They have no significant behavioral issues and only require minimal residential habilitation services. Level 1: Individuals with an Algo score of one (1) are moderately independent and may require some support. They may have behavioral needs that can be managed with medication or informal guidance from caregivers through the Medicaid State Plan services. They may also require day programming and light residential habilitation services for certain tasks, but can be left unsupervised for most of the day and night. Level 2: Individuals with an Algo score of two (2) are moderately independent but require frequent support. They may have behavioral needs that can be managed with medication or light therapy every one (1) to two (2) weeks. They do not need 24-hour support, but may require structure and routine throughout the day. They can sleep unsupervised but need support during the day. Level 3: Individuals with an Algo score of three (3) require full-time support for medical and/or behavioral needs that are not very intense. This support can be provided in a shared staff setting. Level 4: Individuals with an Algo score of four (4) require full-time support for medical and/or behavioral needs that are moderately intense. This support includes 24/7 staff interaction and requires line of sight supervision. This level can generally be managed in a shared staff setting. Level 5: Individuals with an Algo score of five (5) require full-time support with absolute line of sight supervision 24/7. Their needs are intense and they require the full attention of a caregiver at all times, with a one-to-one staff to individual ratio. This level is typically only necessary for individuals with very intense needs.. 

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DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
150 
Library Reference Number: PRPR10014 
 
Published: Sept. 9, 2024 
 
Policies and procedures as of July 1, 2024 
 
Version: 11.1 
Algo Score/Descriptors/ICAP/OBA  
The following descriptors appear in Indiana Administrative Code 460 IAC 13-5-1 Algo levels:  
Level: 0 (Low) 
Descriptor: Individuals with Algo score of zero (0): 
(A) High level of independence with few supports needed; 
(B) No significant behavioral issues; and 
(C) Requires minimal residential habilitation services. 
Level: 1 (Basic) 
Descriptor: Individuals with Algo score of one (1): 
(A) Moderately high level of independence with few supports needed; 
(B) Behavioral needs, if any, can be met with medication or informal direction by caregivers 
through the Medicaid State Plan services; and 
(C) Likely a need for day programming and light residential habilitation services to assist with 
certain tasks, but the individual/participant can be unsupervised for much of the day and night. 
Level: 2 (Regular) 
Descriptor: Individuals with Algo score of two (2): 
(A) Moderate level of independence with frequent supports needed; 
(B) Behavioral needs, if any, can be met with medication or light therapy, or both, every one (1) to 
two (2) weeks; 
(C) Does not require twenty-four (24) hours a day support; and 
(D) Generally able to sleep unsupervised but needs structure and routine throughout the day. 
Level: 3 (Moderate) 
Descriptor: Individuals with Algo score of three (3): 
(A) Requires access to full-time support for medical or behavioral, or both, needs; 
(B) Twenty-four (24) hours a day, seven (7) days a week staff availability; 
(C) Behavioral and medical supports are not generally intense; and 
(D) Behavioral and medical supports can be provided in a shared staff setting. 
Level: 4 (High) 
Descriptor: Individuals with Algo score of four (4): 
(A) Requires access to full-time support for medical or behavioral, or both, needs: 
(i) Twenty-four (24) hours a day, seven (7) days a week frequent staff interaction; and 
(ii) Requires line of sight support; and 
(B) Has moderately intense needs that can generally be provided in a shared staff setting. 
Level: 5 (Intensive) 
Descriptor: Individuals with Algo score of five (5): 
(A) Requires access to full-time support with twenty-four (24) hours a day, seven (7) days a week 
absolute line of sight support; 
(B) Needs are intense; 
(C) Needs require the full attention of a caregiver with a one-to-one staff to individual ratio; and 
(D) Typically, only needed by those with intense behavioral needs, not medical needs alone.

[Audio] At our presentation, we are discussing the requirements for utilizing remote support devices, emergency response drills, and incident reporting under DDRS HCBS waivers. We want to make it clear that these waivers offer a non-invasive and flexible option for individuals and families to build life skills and independence. We understand that some individuals may have exceptional needs that require more than one caregiver exclusively devoted to them for at least part of each day. We also recognize that there is a risk of harm to the individual and others without vigilant support. To ensure that individuals receive the appropriate level of care, we have selected the Inventory for Client and Agency Planning (I-C-A-P-) as the primary tool for individual assessment. The I-C-A-P assessment determines an individual's level of functioning for broad independence and general maladaptive factors. The I-C-A-P addendum, commonly referred to as the behavior and health factors, determines an individual's level of functioning on behavior and health factors. These two assessments determine an individual's overall Algo score, which can range from 0-6. We recognize that individuals with Algo scores between 0 and 6 are considered outliers representing those who are the lowest and the highest on both ends of the functioning spectrum. We understand that individuals who receive an Algo score of 5 may continue to receive the Algo 5 budget but may require additional oversight to ensure their safety and well-being. To build the allocations, we have designed a grid with the following tenets playing key roles: Focus on daytime programming, employment, community integration, and housemates. We have determined the objective-based allocation (O-B-A--) by combining the overall Algo score (determined by the I-C-A-P and I-C-A-P addendum), age, employment, and living arrangement. We want to make it clear that individuals designated as Algo 3, 4, or 5 and meeting criteria for R-H-S Daily services may choose to use R-H-S Daily. We also want to note that RHS-hourly services are available only under the C-I-H Waiver and are not available under the F-S-W--. We recommend that individuals and families review the policies and procedures for RHS-hourly services as of July 1, 2024, version 11.1, which can be found under Library Reference Number PRPR10014151. In conclusion, DDRS HCBS waivers include requirements for utilization of remote support devices, emergency response drills, and incident reporting, while also offering a non-invasive and flexible option for individuals and families to build life skills and independence. We believe that by focusing on daytime programming, employment, community integration, and housemates, we can build the allocations that are best suited for each individual's needs.. 

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DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
Library Reference Number: PRPR10014 
151 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
Level: 6 (High Intensive) 
Descriptor: Individuals with Algo score of six (6): 
(A) Requires access to full-time support: 
(i) Twenty-four (24) hours a day, seven (7) days a week; and 
(ii) More than a one-to-one staff to individual ratio; 
(B) Needs are exceptional; 
(C) Needs require more than one (1) caregiver exclusively devoted to the individual for at least part 
of each day; and 
(D) Imminent risk of individual harming self or others, or both, without vigilant support. 
The nationally recognized Inventory for Client and Agency Planning (ICAP) was selected to be the primary 
tool for individual assessment.  
The ICAP assessment determines an individual’s level of functioning for broad independence and general 
maladaptive factors. The ICAP addendum, commonly referred to as the behavior and health factors, 
determines an individual’s level of functioning on behavior and health factors.  
These two assessments determine an individual’s overall Algo score, which can range from 0-6. Individuals 
with Algo scores between 0 and 6 are considered outliers representing those who are the lowest and the 
highest on both ends of the functioning spectrum. On review, the state may manually adjust the designation 
of an individual from an Algo score of 5 to an Algo score of 6. Although this individual continues receiving 
the Algo 5 budget, their Algo score of 6 indicates a need for additional oversight of the individual.  
The stakeholder group designed a grid to build the allocations. The grid was developed with the following 
tenets playing key roles:  
• Focus on daytime programming  
• Employment  
• Community integration  
• Housemates  
The objective-based allocation (OBA) is then determined by combining the overall Algo score (determined 
by the ICAP and ICAP addendum), age, employment and living arrangement. 
Note:  Individuals designated as Algo 3, 4 or 5 and meeting criteria for RHS Daily services 
may choose to use RHS Daily. 
Additional Information:  
• 
RHS-hourly services are available only under the CIH Waiver; they are not available 
under the FSW.  
• 
For information related to the similarly named but unique Residential-Based 
Habilitation service, available only under the TBI Waiver, see Section 12.24: 
Residential-Based Habilitation for TBI Waiver.

[Audio] We are pleased to present DDRS HCBS waivers, which provide individuals and families with a flexible and non-invasive option for building life skills and independence. These waivers require specific utilization of remote support devices, emergency response drills, and incident reporting. The Direct Support, Monitoring and Training (R-H-S--) program offers reimbursable activities, such as assistance with personal care, meals, shopping, errands, chore and leisure activities, and transportation (excluding transportation that is covered under the Indiana Medicaid State Plan). Direct service staff must be aware and active individuals in the development and implementation of PCISP, behavior support plans, and risk plans. Coordination and facilitation of medical and non-medical services to meet healthcare needs, such as physician consults, medications, development and oversight of a health plan, utilization of available supports in a cost-effective manner, and maintenance of each individual’s health record when the individual receiving R-H-S does not also use wellness coordination services, are also reimbursable activities. When wellness coordination services are used in addition to RHS-hourly services, the wellness coordinator is responsible for the development, oversight, and maintenance of a wellness coordination plan and the health-related risk plan. However, a comprehensive medical risk plan may substitute for the wellness coordination plan or individual risk plans. The registered nurse/licensed practical nurse (RN/LPN) determines the appropriate mode of training to be used for the direct support professional to ensure implementation of risk plans. Additionally, the RN/LPN ensures completion of training of the direct support professional to ensure implementation of risk plans. Group services/shared staffing is reimbursable at the unit rate divided by the number of individuals sharing R-H-S staffing. However, group services/shared staffing is not billable at a 1:1 ratio. All RHS-hourly documentation must include the following: services must be outlined in the PCISP, a data record of staff-to-individual service must document the complete date and time entry (including a.m. or p.m.), and all staff members who provide uninterrupted, continuous service in direct supervision or care of the individual must make one entry. If a staff member provides interrupted service (one hour in the morning and one hour in the evening), an entry for each unique encounter must be made. All entries should describe an issue or circumstance concerning the individual. We are committed to ensuring that individuals and families have access to the services they need to build life skills and independence. DDRS HCBS waivers provide individuals and families with a flexible and non-invasive option for achieving these goals while also meeting regulatory requirements.. 

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DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
152 
Library Reference Number: PRPR10014 
 
Published: Sept. 9, 2024 
 
Policies and procedures as of July 1, 2024 
 
Version: 11.1 
Reimbursable Activities 
RHS includes the following reimbursable activities: 
• Direct support, monitoring and training to implement the PCISP outcomes for the individual 
through the following: 
– Assistance with personal care, meals, shopping, errands, chore and leisure activities, and 
transportation (excluding transportation that is covered under the Indiana Medicaid State Plan) 
– Assurance that direct service staff are aware and active individuals in the development and 
implementation of PCISP, behavior support plans and risk plans 
– Coordination and facilitation of medical and nonmedical services to meet healthcare needs, 
including physician consults, medications, development and oversight of a health plan, 
utilization of available supports in a cost-effective manner, and maintenance of each individual’s 
health record when the individual receiving RHS does not also use wellness coordination 
Services. Collaboration and coordination with the wellness coordinator when the individual 
receiving RHS also uses wellness coordination services. 
When wellness coordination services are used in addition to RHS-hourly services, the wellness coordinator 
is responsible for the development, oversight and maintenance of a wellness coordination plan and the 
health-related risk plan, noting that a comprehensive medical risk plan may substitute for the wellness 
coordination plan or individual risk plans. 
The registered nurse/licensed practical nurse (RN/LPN) determines the appropriate mode of training to be 
used for the direct support professional to ensure implementation of risk plans, noting that training may be 
by staff trained by the RN/LPN with the exception of nursing delegated tasks or other items the nurse feels 
that only a licensed nurse should train.  
Additionally, the RN/LPN ensures completion of training of the direct support professional to ensure 
implementation of risk plans. 
Group services/shared staffing is reimbursable at the unit rate divided by the number of individuals sharing 
RHS staffing. Group services/shared staffing is not billable at a 1:1 ratio. 
Service Standards 
The following service standards apply to RHS hourly: 
• Services must address needs identified in the person-centered planning process and be outlined in 
the PCISP. 
• RHS-hourly services should complement but not duplicate habilitation services being provided in 
other settings. 
• Services provided must be consistent with the individual’s service plan. 
Documentation Standards 
RHS-hourly documentation must include the following: 
• Services must be outlined in the PCISP. 
• Data record of staff-to-individual service must document the complete date and time entry 
(including a.m. or p.m.). All staff members who provide uninterrupted, continuous service in direct 
supervision or care of the individual must make one entry. If a staff member provides interrupted 
service (one hour in the morning and one hour in the evening), an entry for each unique encounter 
must be made. All entries should describe an issue or circumstance concerning the individual. The

[Audio] Providers are required to follow DDRS HCBS waivers in order to ensure the safety and well-being of individuals receiving H-C-B-S waiver services. These waivers entail the use of remote support devices, conducting emergency response drills, and reporting any incidents. They also provide a non-invasive and flexible option for individuals and families to develop life skills and gain independence. It is imperative for all providers to comprehend and adhere to the specific requirements outlined in Section 10 of the waivers, including staffing, documentation, and reporting. Furthermore, providers must ensure appropriate use of RHS-hourly services without any limitations. As professionals, it is crucial to meet all requirements for DDRS HCBS waivers in order to deliver safe and effective services to individuals and families. By complying with these requirements, we can collaborate towards creating a better future for those who require support and services.. 

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DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
Library Reference Number: PRPR10014 
153 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
entry should include complete time and date of entry and at least the last name, first initial of the 
staff person making the entry. 
• If the person providing the service is required to be professionally licensed, the title of that 
individual must also be included. For example, if a nurse is required, the nurse’s title should be 
documented. 
• Any significant issues involving the individual requiring intervention by a healthcare professional, 
case manager or BDS staff member that involved the individual are also to be documented. 
• Quarterly reporting summaries are required. 
• Documentation must be in compliance with 460 IAC 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. 
Limitations 
The following are limitations on RHS-hourly services: 
• Reimbursable waiver funded services furnished to an adult waiver individual by a paid relative 
and/or legal guardian may not exceed a total of 40 hours per week per paid relative and/or legal 
guardian caregiver. (Definition of relative follows the Activities Not Allowed section below.) 
Additionally: 
• Providers may not bill for RHS (hourly) reimbursement for time when staff/paid caregiver is asleep. 
Only awake, engaged staff can be counted in reimbursement. (A team may decide that a staff or 
contractor may sleep while with an individual, but this activity is not billable.)  
• Providers may only bill for RHS reimbursement during the time when an individual receiving 
HCBS waiver services is admitted to an acute care hospital setting for inpatient medical care or 
other related services for surgery, acute medical condition or injuries if all conditions specified in 
guidance under Section 2.3: Billing and Reimbursement for Waiver Services in this module are met. 
• Providers may not bill for RHS reimbursement during the time when an individual is admitted for 
an extended stay hospitalization, or when individuals require long-term care in a facility-based 
setting including but not limited to nursing homes, rehabilitation centers and/or treatment facilities. 
(As specified under guidance in Section 2.3: Billing and Reimbursement for Waiver Services in this 
module, the care and support of an individual who is admitted to a hospital or facility for long-term 
is a non-billable RHS activity.) 
• RHS Level 1 and RHS Level 2 and remote support services are not billable concurrently/during the 
same time period.  
• Intermittent use of RHS Level 1 may not exceed 35 hours of service per week.  
Note:  Per Indiana Code [IC 12-11-1.1], supported living service arrangements providing 
residential services may not serve more than four unrelated individuals in any one 
setting. However, a program that was in existence on Jan. 1, 2013, as a supervised 
group living program described within IC 12-11-1.1 and having more than four 
individuals residing as part of that program, was allowed to convert to a supported 
living service arrangement and continue to provide services to up to the same number 
of individuals in the supported living setting.

[Audio] Our organization provides information on the DDRS HCBS waivers, which include the use of remote support devices, emergency response drills, and incident reporting. These waivers also offer a non-invasive and flexible option for individuals and families to develop life skills and gain independence. According to Section 10 of the DDRS HCBS waivers, F-S-W and C-I-H waivers specify the definitions and requirements for these services. It is not permitted to provide services to a minor by their parents, stepparents, or legal guardian, or to an individual by their spouse. Additionally, services are not allowed for individuals receiving structured family caregiving or children's foster care services, or for services available under the Indiana Medicaid State Plan. Providers must meet certain criteria to become DDRS-approved. This includes being an active Medicaid provider, complying with 460 I-A-C 6, and meeting qualifications for Residential Habilitation and Support Services, Criminal History Documentation, Insurance, Financial Status, Health Care Coordination Services, Staff Training and Training, Transportation Services, and Transportation Supports. Additionally, providers must follow any applicable B-D-S service standards, guidelines, policies, and/or manuals, as well as FSSA DDRS policies and this module, which can be accessed from the I-H-C-P Provider Reference Modules page at in.gov/medicaid/providers. It is crucial to understand these waivers and their requirements in order to ensure that individuals receive the necessary support and services to build life skills and gain independence.. 

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DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
154 
Library Reference Number: PRPR10014 
 
Published: Sept. 9, 2024 
 
Policies and procedures as of July 1, 2024 
 
Version: 11.1 
Activities Not Allowed 
Reimbursement is not available through RHS-hourly in the following circumstances: 
• Services furnished to a minor by the parents, stepparents or legal guardian 
• Services furnished to an individual by the individual’s spouse 
• Services to individuals in structured family caregiving services or children’s foster care services 
• Services that are available under the Indiana Medicaid State Plan 
Related/relative implies any of the following natural, adoptive and/or step relationships, whether by blood 
or by marriage, inclusive of half and/or in-law status: 
• Aunt (natural, step, adopted) 
• Brother (natural, step, half, adopted, in-law) 
• Child (natural, step, adopted) 
• First cousin (natural, step, adopted) 
• Grandchild (natural, step, adopted) 
• Grandparent (natural, step, adopted) 
• Nephew (natural, step, adopted) 
• Niece (natural, step, adopted) 
• Parent (natural, step, adopted, in-law) 
• Sister (natural, step, half, adopted, in-law) 
• Spouse (husband or wife) 
• Uncle (natural, step, adopted) 
Provider Qualifications 
Providers must meet the following criteria: 
• Enrolled as an active Medicaid provider 
• Be DDRS-approved 
• Comply with 460 IAC 6, including but not limited to: 
– 460 IAC 6-5-24 Residential Habilitation and Support Services Provider Qualifications 
– 460 IAC 6-10-5 Documentation of Criminal Histories 
– 460 IAC 6-12-1 and 460 IAC 6-12-2 Insurance 
– 460 IAC 6-11-1 to 460 IAC 6-11-3 Financial Status of Providers 
– 460 IAC 6-5-14 Health Care Coordination Services Provider Qualifications 
– 460 IAC 6-14-4 Staff Training and 460 IAC 6-14-4 Training 
– 460 IAC 6-5-30 Transportation Services Provider Qualifications 
– 460 IAC 6-5-31 Transportation Supports Provider Qualifications 
• Comply with any applicable BDS service standards, guidelines, policies and/or manuals, including 
FSSA DDRS policies and this module, accessible from the IHCP Provider Reference Modules page 
at in.gov/medicaid/providers

[Audio] We are pleased to announce that the DDRS HCBS waivers have been updated to include new requirements for the use of remote support devices, emergency response drills, and incident reporting. These updates provide a non-invasive and flexible option for individuals and families to build life skills and independence. We believe that these changes will greatly benefit individuals and families who may require additional support in navigating the community. In order to maintain the highest quality of care, our R-H-S providers are required to obtain accreditation by at least one of the following organizations: CARF, CQL, JCAHO, NCQA, ISO-9001, Council on Accreditation, or an independent national accreditation organization approved by the F-S-S-A Secretary. We recognize the importance of accessing high-quality services and are committed to ensuring that our providers meet these standards. Our daily Residential Habilitation and Support (RHS daily) services are available under the C-I-H Waiver and are tailored to assist with the acquisition, retention, or improvement of skills related to living in the community. These services help maintain current levels of functioning and support, provide ongoing coordination of care, and ensure that new or additional needs are identified and addressed by the person-centered planning team. We want to note that RHS-daily services are only available under the C-I-H Waiver and not under the F-S-W--. Additionally, there are policies and procedures in place to ensure the safety and well-being of individuals who receive R-H-S services. We are proud to be at the forefront of these advancements and are committed to providing the highest quality of care to our clients.. 

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DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
Library Reference Number: PRPR10014 
155 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
In accordance with Indiana Code 12-11-1.1-1, RHS providers must obtain/maintain accreditation (specific 
to Indiana programs) by at least one of the following organizations: 
• The Commission on Accreditation of Rehabilitation Facilities (CARF), or its successor 
• The Council on Quality and Leadership In Supports for People with Disabilities, or its successor 
• The Joint Commission on Accreditation of Healthcare Organizations (JCAHO), or its successor 
• The National Committee for Quality Assurance, or its successor 
• The ISO-9001 human services quality assurance (QA) system 
• The Council on Accreditation, or its successor 
• An independent national accreditation organization approved by the FSSA Secretary. 
Section 10.26: Residential Habilitation and Support – 
Daily (RHS Daily) for the CIH Waiver 
The following subsections provide information and requirements for daily Residential Habilitation and 
Support services for the CIH Waiver. 
Service Definition  
Residential Habilitation and Support – daily (RHS daily) services provides individually tailored supports 
that are specified in the PCISP that assist with the acquisition, retention or improvement in skills related to 
living in the community. These supports include adaptive skill development, assistance with activities of 
daily living, community inclusion, transportation, adult educational supports, and social and leisure skill 
development that support the individual to live successfully in their own home.  
HCBS provided during an acute care hospitalization assists the individual to maintain current levels of 
functioning and support, provides ongoing coordination of care, and provides assurance that new or 
additional needs are identified and addressed by the person-centered planning team as the individual 
prepares to return to the community. 
The HCBS provided in an acute care hospital must not be duplicative of services available in the acute care 
hospital setting. 
A relative of the individual may be a provider of Residential Habilitation and Support (RHS) services. The 
decision that a relative is the best choice of persons to provide these services is a part of the person-
centered planning process and is documented in the PCISP. When the provider is a relative, there is an 
annual review by the IST to determine whether the individual’s relative should continue to be the provider 
of RHS services. 
Additional Information:  
• 
RHS-daily services are available only under the CIH Waiver; they are not available 
under the FSW.  
• 
For information related to the similarly named but unique service Residential-Based 
Habilitation, available only under the TBI Waiver, see Section 12.24: Residential-
Based Habilitation for TBI Waiver.

[Audio] We are an author and voiceover script writer of this presentation on DDRS HCBS Waivers. Our focus is on ensuring that individuals have access to the support and resources they need to lead fulfilling lives. We believe that DDRS HCBS Waivers are a crucial non-invasive and flexible option for individuals and families to build life skills and independence. To be eligible for R-H-S daily services, individuals must have an Algo score of 3, 4, or 5 on their objective-based allocation (O-B-A--), live with housemates and use a shared staffing model, or live outside their family home. We have designed a grid to build our allocations based on the following tenets: focus on daytime programming, employment, community integration, and housemates. Our reimbursable activities include assistance with acquiring, enhancing and building natural supports, working with the individual to meet the goals they have set for themselves on their PCISP, and training the individual to enhance their homemaking skills, meal preparation, household chores, money management, shopping, communication skills, social skills, and positive behavior.. 

Scene 12

DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
156 
Library Reference Number: PRPR10014 
 
Published: Sept. 9, 2024 
 
Policies and procedures as of July 1, 2024 
 
Version: 11.1 
Individuals Eligible for RHS Daily Services 
Individuals who choose RHS and meet all the following criteria are eligible for and may choose to use RHS 
daily services:  
• Individuals who have an Algo score of 3, 4 or 5 on their objective-based allocation (OBA) 
• Individuals who are living with housemates and are using a shared staffing model 
• Individuals who are living outside their family home 
Algo Score Descriptors 
Table 1 presents the Algo level descriptors as found in Indiana Administrative Code 460 IAC 13. 
Refer to Table 3 – Medicaid Waiver Services, Codes and Rates for FSW and CIH Waiver for applicable 
billing information. 
The nationally recognized Inventory for Client and Agency Planning (ICAP) was selected to be the primary 
tool for individual assessment. 
The ICAP assessment determines an individual’s level of functioning for broad independence and general 
maladaptive factors. The ICAP addendum, commonly referred to as the behavior and health factors, 
determines an individual’s level of functioning on behavior and health factors.  
These two assessments determine an individual’s overall Algo level, which can range from 0-6. Algos 0 
and 6 are considered outliers representing those who are the lowest and the highest on both ends of the 
functioning spectrum. On review, the state may manually adjust the budget of an individual from an Algo 5 
to an Algo 6. Although this individual continues receiving the Algo 5 budget, the Algo 6 indicates a need 
for additional oversight of the individual. 
The stakeholder group designed a grid to build the allocations. The grid was developed with the following 
tenets playing key roles:  
• Focus on daytime programming 
• Employment 
• Community integration 
• Housemates 
The OBA is then determined by combining the overall Algo (determined by the ICAP and ICAP 
addendum), age, employment and living arrangement. 
See Section 6: Objective-Based Allocation in this module for further details. 
Reimbursable Activities 
Reimbursable activities include the following: 
• Assistance with acquiring, enhancing and building natural supports 
– For example, a measurable outcome would be increased hours of natural supports and a decrease 
in the number of hours needed for paid staff. Another measurable outcome would be the number 
of activities an individual participates in with nonpaid (natural support) supports versus paid 
staff. 
• Working with the individual to meet the goals they have set for themselves on their PCISP 
• Training the individual to enhance their homemaking skills, meal preparation, household chores, 
money management, shopping, communication skills, social skills and positive behavior

[Audio] We are discussing the provisions of the DDRS HCBS waivers. These provisions require the use of remote support devices, emergency response drills, and incident reporting. They offer a flexible option for individuals and families to build life skills and independence. The waivers have specific provisions for transportation, wellness services, and maintenance of health records. Remote support services are only allowable when billed as a component of R-H-S daily. When wellness coordination services are used in addition to RHS-daily services, the wellness coordinator is responsible for the development, oversight, and maintenance of a wellness coordination plan and the health-related risk plan. The RN/LPN is responsible for determining the appropriate mode of training for direct support professionals to ensure implementation of risk plans. The RN/LPN also ensures completion of training of the direct support professional to ensure implementation of risk plans. Additionally, the waivers include service standards, such as addressing needs identified in the person-centered planning process and complementing but not duplicating habilitation services provided in other settings. Additionally, the individual must be present and receive R-H-S daily services for at least a portion of any day the provider bills as a day of R-H-S daily service. Finally, the waivers have documentation standards, such as requiring a minimum of one daily note for each day the individual is present and receiving R-H-S daily services, with appropriate elements, documenting one or more distinct actions or behaviors as outlined in the Reimbursable Activities section. The R-H-S daily service provider must be able to demonstrate through relevant time keeping records or other similar documentation which staff members were working during the R-H-S daily service provided upon audit, or upon request by the state or its contracted agents.. 

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DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
Library Reference Number: PRPR10014 
157 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
• Provision of transportation to fully participate in social and recreational activities in the community 
(such as transportation to church, the park, the library, the YMCA and classes) 
• Provision of transportation to community employment and/or volunteer activities 
• Coordination and facilitation of medical and wellness services to meet the healthcare and wellness 
needs, including physician consults, medications, implementation of risk plans, dining plans and 
wellness plans 
• Maintenance of each individual’s health record 
• Remote support services are allowable only when billed as a component of RHS daily (Remote 
support services may not be billed concurrently with RHS daily.) 
• When wellness coordination services are used in addition to RHS-daily services, the wellness 
coordinator is responsible for the development, oversight and maintenance of a wellness 
coordination plan and the health-related risk plan, noting that a comprehensive medical risk plan 
may substitute for the wellness coordination plan or individual risk plans. 
• The RN/LPN determines the appropriate mode of training to be used for the direct support 
professional to ensure implementation of risk plans, noting that training may be by staff trained by 
the RN/LPN with the exception of nursing delegated tasks or other items the nurse feels that only a 
licensed nurse should train.  
• Additionally, the RN/LPN ensures completion of training of the direct support professional to 
ensure implementation of risk plans. 
Service Standards 
The following service standards apply to RHS daily: 
• Services must address needs identified in the person-centered planning process and be outlined in 
the PCISP. 
• RHS daily should complement but not duplicate habilitation services provided in other settings. 
• The individual must be present and receive RHS daily services for at least a portion of any day the 
provider bills as a day of RHS daily service. 
Documentation Standards 
A minimum of one daily note for each day the individual is present and receiving RHS daily services, with 
appropriate elements, documenting one or more distinct actions or behaviors as outlined in the 
Reimbursable Activities section, per individual served is required to support the billing of RHS daily 
services. The RHS daily service provider must be able to demonstrate through relevant time keeping 
records or other similar documentation which staff members were working during the RHS daily service 
provided upon audit, or upon request by the state or its contracted agents.  
RHS daily documentation standards are as follows:  
• Documentation of services rendered as outlined in the PCISP 
• Data record of service delivered documenting the complete date and time entry (including a.m. or 
p.m.) 
– If the person providing the service is required to be professionally licensed, the title of that 
individual must also be included. For example, if a nurse provides RHS daily services, the 
nurse’s title should be included.  
• Any significant issues involving the individual requiring intervention by a healthcare professional, 
case manager or BDS staff member

[Audio] We will discuss the specific guidelines and limitations for DDRS HCBS waivers. These waivers allow individuals and families to develop life skills and gain independence through non-invasive and flexible options. We will focus on service definitions and requirements for the F-S-W and C-I-H waivers. Providers must comply with 460 IAC 6 and provide quarterly summaries as specified by B-D-S--. Additionally, we will discuss the requirements for monthly, quarterly, and/or annual outcome data that must be reported as specified by B-D-S and uploaded to the state's case management system's library. Reimbursable waiver-funded residential habilitation services provided by a paid relative and/or legal guardian have limitations. These services cannot exceed a total of 40 hours per week per paid caregiver, and the individual receiving services must be present and receive daily R-H-S services for at least a portion of the day that the provider is billing for. Remote support services are included in the daily rate of R-H-S services, and providers must adhere to all remote support service standards as defined within the definition. Providers cannot bill for R-H-S daily reimbursement during times when staff or paid caregivers are asleep. Only awake and engaged staff can be counted for reimbursement. Providers may only bill for R-H-S daily reimbursement when an individual is admitted to an acute care hospital for inpatient medical care or surgery, or for acute medical conditions or injuries, adhering to all conditions specified in Section 2.3 for claims. Thank you for your attention and participation in this presentation. We hope you now have a better understanding of the requirements and limitations for the DDRS HCBS waivers. Please feel free to reach out if you have any further questions or concerns.. 

Scene 14

DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
158 
Library Reference Number: PRPR10014 
 
Published: Sept. 9, 2024 
 
Policies and procedures as of July 1, 2024 
 
Version: 11.1 
• Documentation in compliance with 460 IAC 6 
• Quarterly summaries as specified by BDS and monthly, quarterly and/or annual outcome data as 
specified by BDS 
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. 
Limitations 
Reimbursable waiver funded residential habilitation services furnished to an adult waiver individual by a 
paid relative and/or legal guardian may not exceed a total of 40 hours a week per paid relative and/or legal 
guardian caregiver. (Definition of a relative follows the below Activities Not Allowed.)  
The individual must be present and receive RHS daily services for at least a portion of any day the provider 
bills as a day of RHS daily service. 
Additionally, the following limitations apply: 
• Providers will not be reimbursed separately for remote support services for individuals receiving 
RHS daily services. Remote support is built into the daily rate of RHS daily services. Providers 
must adhere to all remote support service standards as defined within the remote support service 
definition. 
• Providers may not bill for RHS daily reimbursement for time when staff/paid caregiver is asleep. 
Only awake, engaged staff can be counted in reimbursement. 
• Providers may only bill for RHS daily reimbursement during the time when an individual receiving 
HCBS waiver services is admitted to an acute care hospital setting for inpatient medical care or 
other related services for surgery, acute medical condition, or injuries if all conditions specified in 
guidance under Section 2.3: Claims and Billing of this module are met. 
• Providers may not bill for RHS daily reimbursement during the time when an individual is admitted 
for an extended stay hospitalization, or when individuals require long term care in a facility-based 
setting including but not limited to nursing homes, rehabilitation centers and/or treatment facilities. 
(As specified under guidance in Section 2.3: Billing and Reimbursement for Waiver Services in this 
module, the care and support of an individual who is admitted to a hospital or facility for long-term 
is a non-billable RHS activity.) 
Per IC 12-11-1.1, supported living service arrangements providing residential services may not serve more 
than four unrelated individuals in anyone setting. However, a program that was in existence on Jan. 1, 
2013, as a supervised group living program described within IC 12-11-1.1 and having more than four 
individuals residing as part of that program, was allowed to convert to a supported living service 
arrangement and continue to provide services to up to the same number of individuals in the supported 
living setting. 
Activities Not Allowed 
Reimbursement is not available through RHS daily in the following circumstances: 
• Services furnished to a minor by the parents, stepparents or legal guardian 
• Services furnished to an individual by the individual’s spouse 
• Services to individuals in structured family caregiving services 
• Services that are available under the Indiana Medicaid State Plan

 part 12

Remote support devices have become increasingly popular, providing individuals and families with flexibility and non-invasive options to build life skills and independence. However, it is important for providers to understand the limitations of these devices. Certain activities are not allowed under remote supports, including concurrent use with structured family caregiving services, monitoring direct care staff, and camera usage in bathrooms or bedrooms. Providers must meet specific criteria to be approved and enrolled as an active Medicaid provider and FSSA DDRS-approved, and comply with Indiana Administrative Code, 460 I-A-C 6. Remote support devices may serve as a potential replacement for P-A-C or R-H-S services under the F-S-W or C-I-H waiver, but they are not billable during the same time period. Providers must also comply with policies and procedures as of July 1, 2024. It is essential for providers to understand these requirements to effectively utilize remote support devices under DDRS HCBS waivers.

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We present the requirements for the use of remote support devices, emergency response drills, and incident reporting. These requirements offer a non-invasive and flexible option for individuals and families to develop life skills and independence.

We are pleased to present to you on DDRS HCBS waivers. Our presentation today will focus on the requirements for utilizing remote support devices, emergency response drills, and incident reporting. 

                                    First, we will discuss remote support devices. These devices are designed to assist individuals in performing daily tasks and activities. They can include a variety of devices, such as speech recognition software, hearing aids, and mobility devices.

                                    Next, we will discuss emergency response drills. These drills are designed to prepare individuals for emergency situations, such as natural disasters or other unexpected events.

                                    Finally, we will discuss incident reporting. This process involves the reporting of any incidents or accidents that occur while an individual is receiving DDRS HCBS waivers.

                                    In summary, DDRS HCBS waivers include essential requirements for the utilization of remote support devices, emergency response drills, and incident reporting. These requirements are designed to ensure the safety and well-being of individuals receiving DDRS HCBS waivers.

We welcome you to our presentation on DDRS HCBS Waivers. These waivers have specific requirements for the use of remote support devices, emergency response drills, and incident reporting. They also provide a non-invasive and flexible option for individuals and families to develop life skills and independence.

Individuals with developmental disabilities may require different levels of support based on their individual needs. The following Algo score/descriptors/ICAP/OBA are used to determine the necessary level of support for individuals with developmental disabilities: 

Level 0: Individuals with an Algo score of zero (0) are highly independent and require minimal support. They have no significant behavioral issues and only require minimal residential habilitation services. 

Level 1: Individuals with an Algo score of one (1) are moderately independent and may require some support. They may have behavioral needs that can be managed with medication or informal guidance from caregivers through the Medicaid State Plan services. They may also require day programming and light residential habilitation services for certain tasks, but can be left unsupervised for most of the day and night. 

Level 2: Individuals with an Algo score of two (2) are moderately independent but require frequent support. They may have behavioral needs that can be managed with medication or light therapy every one (1) to two (2) weeks. They do not need 24-hour support, but may require structure and routine throughout the day. They can sleep unsupervised but need support during the day. 

Level 3: Individuals with an Algo score of three (3) require full-time support for medical and/or behavioral needs that are not very intense. This support can be provided in a shared staff setting. 

Level 4: Individuals with an Algo score of four (4) require full-time support for medical and/or behavioral needs that are moderately intense. This support includes 24/7 staff interaction and requires line of sight supervision. This level can generally be managed in a shared staff setting. 

Level 5: Individuals with an Algo score of five (5) require full-time support with absolute line of sight supervision 24/7. Their needs are intense and they require the full attention of a caregiver at all times, with a one-to-one staff to individual ratio. This level is typically only necessary for individuals with very intense needs.

At our presentation, we are discussing the requirements for utilizing remote support devices, emergency response drills, and incident reporting under DDRS HCBS waivers. We want to make it clear that these waivers offer a non-invasive and flexible option for individuals and families to build life skills and independence. We understand that some individuals may have exceptional needs that require more than one caregiver exclusively devoted to them for at least part of each day. We also recognize that there is a risk of harm to the individual and others without vigilant support.  To ensure that individuals receive the appropriate level of care, we have selected the Inventory for Client and Agency Planning (I-C-A-P-) as the primary tool for individual assessment. The I-C-A-P assessment determines an individual's level of functioning for broad independence and general maladaptive factors. The I-C-A-P addendum, commonly referred to as the behavior and health factors, determines an individual's level of functioning on behavior and health factors. These two assessments determine an individual's overall Algo score, which can range from 0-6. We recognize that individuals with Algo scores between 0 and 6 are considered outliers representing those who are the lowest and the highest on both ends of the functioning spectrum. We understand that individuals who receive an Algo score of 5 may continue to receive the Algo 5 budget but may require additional oversight to ensure their safety and well-being.  To build the allocations, we have designed a grid with the following tenets playing key roles: Focus on daytime programming, employment, community integration, and housemates. We have determined the objective-based allocation (O-B-A--) by combining the overall Algo score (determined by the I-C-A-P and I-C-A-P addendum), age, employment, and living arrangement.  We want to make it clear that individuals designated as Algo 3, 4, or 5 and meeting criteria for R-H-S Daily services may choose to use R-H-S Daily. We also want to note that RHS-hourly services are available only under the C-I-H Waiver and are not available under the F-S-W--. We recommend that individuals and families review the policies and procedures for RHS-hourly services as of July 1, 2024, version 11.1, which can be found under Library Reference Number PRPR10014151.  In conclusion, DDRS HCBS waivers include requirements for utilization of remote support devices, emergency response drills, and incident reporting, while also offering a non-invasive and flexible option for individuals and families to build life skills and independence. We believe that by focusing on daytime programming, employment, community integration, and housemates, we can build the allocations that are best suited for each individual's needs.

We are pleased to present DDRS HCBS waivers, which provide individuals and families with a flexible and non-invasive option for building life skills and independence. These waivers require specific utilization of remote support devices, emergency response drills, and incident reporting. The Direct Support, Monitoring and Training (R-H-S--) program offers reimbursable activities, such as assistance with personal care, meals, shopping, errands, chore and leisure activities, and transportation (excluding transportation that is covered under the Indiana Medicaid State Plan). Direct service staff must be aware and active individuals in the development and implementation of PCISP, behavior support plans, and risk plans. Coordination and facilitation of medical and non-medical services to meet healthcare needs, such as physician consults, medications, development and oversight of a health plan, utilization of available supports in a cost-effective manner, and maintenance of each individual’s health record when the individual receiving R-H-S does not also use wellness coordination services, are also reimbursable activities. When wellness coordination services are used in addition to RHS-hourly services, the wellness coordinator is responsible for the development, oversight, and maintenance of a wellness coordination plan and the health-related risk plan. However, a comprehensive medical risk plan may substitute for the wellness coordination plan or individual risk plans. The registered nurse/licensed practical nurse (RN/LPN) determines the appropriate mode of training to be used for the direct support professional to ensure implementation of risk plans. Additionally, the RN/LPN ensures completion of training of the direct support professional to ensure implementation of risk plans. Group services/shared staffing is reimbursable at the unit rate divided by the number of individuals sharing R-H-S staffing. However, group services/shared staffing is not billable at a 1:1 ratio. All RHS-hourly documentation must include the following: services must be outlined in the PCISP, a data record of staff-to-individual service must document the complete date and time entry (including a.m. or p.m.), and all staff members who provide uninterrupted, continuous service in direct supervision or care of the individual must make one entry. If a staff member provides interrupted service (one hour in the morning and one hour in the evening), an entry for each unique encounter must be made. All entries should describe an issue or circumstance concerning the individual. We are committed to ensuring that individuals and families have access to the services they need to build life skills and independence. DDRS HCBS waivers provide individuals and families with a flexible and non-invasive option for achieving these goals while also meeting regulatory requirements.

Providers are required to follow DDRS HCBS waivers in order to ensure the safety and well-being of individuals receiving H-C-B-S waiver services. These waivers entail the use of remote support devices, conducting emergency response drills, and reporting any incidents. They also provide a non-invasive and flexible option for individuals and families to develop life skills and gain independence. It is imperative for all providers to comprehend and adhere to the specific requirements outlined in Section 10 of the waivers, including staffing, documentation, and reporting. Furthermore, providers must ensure appropriate use of RHS-hourly services without any limitations. As professionals, it is crucial to meet all requirements for DDRS HCBS waivers in order to deliver safe and effective services to individuals and families. By complying with these requirements, we can collaborate towards creating a better future for those who require support and services.

Our organization provides information on the DDRS HCBS waivers, which include the use of remote support devices, emergency response drills, and incident reporting. These waivers also offer a non-invasive and flexible option for individuals and families to develop life skills and gain independence. 
According to Section 10 of the DDRS HCBS waivers, F-S-W and C-I-H waivers specify the definitions and requirements for these services. It is not permitted to provide services to a minor by their parents, stepparents, or legal guardian, or to an individual by their spouse. Additionally, services are not allowed for individuals receiving structured family caregiving or children's foster care services, or for services available under the Indiana Medicaid State Plan. 
Providers must meet certain criteria to become DDRS-approved. This includes being an active Medicaid provider, complying with 460 I-A-C 6, and meeting qualifications for Residential Habilitation and Support Services, Criminal History Documentation, Insurance, Financial Status, Health Care Coordination Services, Staff Training and Training, Transportation Services, and Transportation Supports. Additionally, providers must follow any applicable B-D-S service standards, guidelines, policies, and/or manuals, as well as FSSA DDRS policies and this module, which can be accessed from the I-H-C-P Provider Reference Modules page at in.gov/medicaid/providers. 
It is crucial to understand these waivers and their requirements in order to ensure that individuals receive the necessary support and services to build life skills and gain independence.

We are pleased to announce that the DDRS HCBS waivers have been updated to include new requirements for the use of remote support devices, emergency response drills, and incident reporting. These updates provide a non-invasive and flexible option for individuals and families to build life skills and independence. We believe that these changes will greatly benefit individuals and families who may require additional support in navigating the community.
                                     In order to maintain the highest quality of care, our R-H-S providers are required to obtain accreditation by at least one of the following organizations: CARF, CQL, JCAHO, NCQA, ISO-9001, Council on Accreditation, or an independent national accreditation organization approved by the F-S-S-A Secretary. We recognize the importance of accessing high-quality services and are committed to ensuring that our providers meet these standards.
                                     Our daily Residential Habilitation and Support (RHS daily) services are available under the C-I-H Waiver and are tailored to assist with the acquisition, retention, or improvement of skills related to living in the community. These services help maintain current levels of functioning and support, provide ongoing coordination of care, and ensure that new or additional needs are identified and addressed by the person-centered planning team.
                                     We want to note that RHS-daily services are only available under the C-I-H Waiver and not under the F-S-W--. Additionally, there are policies and procedures in place to ensure the safety and well-being of individuals who receive R-H-S services. We are proud to be at the forefront of these advancements and are committed to providing the highest quality of care to our clients.

We are an author and voiceover script writer of this presentation on DDRS HCBS Waivers. Our focus is on ensuring that individuals have access to the support and resources they need to lead fulfilling lives. We believe that DDRS HCBS Waivers are a crucial non-invasive and flexible option for individuals and families to build life skills and independence. 

                                    To be eligible for R-H-S daily services, individuals must have an Algo score of 3, 4, or 5 on their objective-based allocation (O-B-A--), live with housemates and use a shared staffing model, or live outside their family home. We have designed a grid to build our allocations based on the following tenets: focus on daytime programming, employment, community integration, and housemates. Our reimbursable activities include assistance with acquiring, enhancing and building natural supports, working with the individual to meet the goals they have set for themselves on their PCISP, and training the individual to enhance their homemaking skills, meal preparation, household chores, money management, shopping, communication skills, social skills, and positive behavior.

We are discussing the provisions of the DDRS HCBS waivers. These provisions require the use of remote support devices, emergency response drills, and incident reporting. They offer a flexible option for individuals and families to build life skills and independence. The waivers have specific provisions for transportation, wellness services, and maintenance of health records. Remote support services are only allowable when billed as a component of R-H-S daily. When wellness coordination services are used in addition to RHS-daily services, the wellness coordinator is responsible for the development, oversight, and maintenance of a wellness coordination plan and the health-related risk plan. The RN/LPN is responsible for determining the appropriate mode of training for direct support professionals to ensure implementation of risk plans. The RN/LPN also ensures completion of training of the direct support professional to ensure implementation of risk plans. Additionally, the waivers include service standards, such as addressing needs identified in the person-centered planning process and complementing but not duplicating habilitation services provided in other settings. Additionally, the individual must be present and receive R-H-S daily services for at least a portion of any day the provider bills as a day of R-H-S daily service. Finally, the waivers have documentation standards, such as requiring a minimum of one daily note for each day the individual is present and receiving R-H-S daily services, with appropriate elements, documenting one or more distinct actions or behaviors as outlined in the Reimbursable Activities section. The R-H-S daily service provider must be able to demonstrate through relevant time keeping records or other similar documentation which staff members were working during the R-H-S daily service provided upon audit, or upon request by the state or its contracted agents.

We will discuss the specific guidelines and limitations for DDRS HCBS waivers. These waivers allow individuals and families to develop life skills and gain independence through non-invasive and flexible options. We will focus on service definitions and requirements for the F-S-W and C-I-H waivers. Providers must comply with 460 IAC 6 and provide quarterly summaries as specified by B-D-S--. Additionally, we will discuss the requirements for monthly, quarterly, and/or annual outcome data that must be reported as specified by B-D-S and uploaded to the state's case management system's library. 

Reimbursable waiver-funded residential habilitation services provided by a paid relative and/or legal guardian have limitations. These services cannot exceed a total of 40 hours per week per paid caregiver, and the individual receiving services must be present and receive daily R-H-S services for at least a portion of the day that the provider is billing for. Remote support services are included in the daily rate of R-H-S services, and providers must adhere to all remote support service standards as defined within the definition. Providers cannot bill for R-H-S daily reimbursement during times when staff or paid caregivers are asleep. Only awake and engaged staff can be counted for reimbursement. Providers may only bill for R-H-S daily reimbursement when an individual is admitted to an acute care hospital for inpatient medical care or surgery, or for acute medical conditions or injuries, adhering to all conditions specified in Section 2.3 for claims. 

Thank you for your attention and participation in this presentation. We hope you now have a better understanding of the requirements and limitations for the DDRS HCBS waivers. Please feel free to reach out if you have any further questions or concerns.