[Virtual Presenter] Hello everyone and welcome to our presentation on DDRS HCBS Waivers. In this presentation, we will be discussing the requirements for providers of DDRS HCBS Waivers, including qualifications, compliance with various regulations, and the need for accreditation from approved organizations. Let's start with the qualifications required for providers. To be eligible for a DDRS HCBS Waiver, providers must be enrolled as an active Medicaid provider and be DDRS-approved. In addition, providers must comply with various regulations related to residential habitation and support services, documentation of criminal histories, insurance, financial status, health care coordination services, direct care staff, transportation services, and B-D-S service standards. In terms of accreditation, providers must obtain and maintain accreditation from at least one of the approved organizations, such as the Commission on Accreditation of Rehabilitation Facilities (C-A-R-F-), the Council on Quality and Leadership In Supports for People with Disabilities, the Joint Commission on Accreditation of Healthcare Organizations (J-C-A-H-O), the National Committee for Quality Assurance, the ISO-9001 human services quality assurance (Q-A---) system, the Council on Accreditation, or an independent national accreditation organization approved by the F-S-S-A Secretary. Thank you for your attention, and we look forward to discussing these requirements in more detail in the following slides.. 

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DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
Library Reference Number: PRPR10014 
159 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
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) 
• Niece (natural, step, adopted) 
• Nephew (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 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 6-10-5 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 Heath Care Coordination Services Provider Qualifications  
– 460 IAC 6-14-5 Requirements for Direct Care Staff  
– 460 IAC 6-14-4 Training 
– 460 IAC 6-34 Transportation Services Requirements 
• Comply with Indiana Administrative Code, 460 IAC 6, including but not limited 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. 
• 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

[Audio] Our presentation will focus on the specifications for Respite services under the F-S-W and C-I-H Waiver. Respite services are accessible to individuals who are unable to care for themselves and are provided on a short-term basis. These services can be provided in the individual’s home or place of residence, in the respite caregiver’s home, in a camp setting, in a DDRS-approved Day Habilitation facility, or in a nonprivate residential setting. Respite nursing care (R-N---) or Respite nursing care L-P-N--) services may only be delivered when skilled care is necessary, as documented in the PCISP. It is crucial to remember that Respite must be documented in the PCISP, and providers must adhere to the service standards outlined in our presentation. We hope that these requirements will help ensure the safe and effective delivery of Respite services to individuals in need.. 

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DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
160 
Library Reference Number: PRPR10014 
 
Published: Sept. 9, 2024 
 
Policies and procedures as of July 1, 2024 
 
Version: 11.1 
Section 10.27: Respite for FSW and CIH Waiver 
The following subsections provide information and requirements for Respite services for the FSW and CIH 
Waiver. 
Service Definition 
Respite services means services provided to individuals unable to care for themselves that are furnished on 
a short-term basis because of the absence or need for relief of those persons who normally provide care for 
the individual. Respite can be provided in the individual’s home or place of residence, in the respite 
caregiver’s home, in a camp setting, in a DDRS-approved Day Habilitation facility or in a nonprivate 
residential setting (such as a respite home). 
Additional Information: 
• 
Respite services are available under the FSW and CIH Waiver. 
• 
Respite may be used intermittently to cover those hours normally covered by an 
unpaid caregiver.  
• 
For the similarly named but unique Skilled Respite service available under the H&W 
and TBI Waivers, see Section 12.25: Skilled Respite Services for H&W and TBI 
Waivers. 
Reimbursable Activities 
Reimbursable activities under Respite include the following: 
• Assistance with toileting and feeding  
• Assistance with daily living skills, including assistance with accessing the community and 
community activities  
• Assistance with grooming and personal hygiene  
• Meal preparation, serving and cleanup  
• Administration of medications  
• Supervision/support  
• Individual services  
• Group services (unit rate divided by number of individuals served) 
Service Standards 
The following service standards apply to Respite: 
• Respite must be reflected in the PCISP.  
• Respite nursing care (RN) or Respite nursing care LPN) services may be delivered only when 
skilled care is required and documented in the PCISP.

[Audio] We will be discussing qualifications, compliance with regulations, and the need for accreditation from approved organizations for providers of DDRS HCBS Waivers. When it comes to service definitions and requirements for F-S-W and C-I-H Waivers, there are certain documentation standards that must be followed. A service note can include multiple discrete services, as long as discrete services are clearly identified. A service note must include the individual name, I-H-C-P Member ID of the individual, date of service, provider rendering service, and primary location of services rendered. Additionally, an activity summary for each block of time this service is rendered must exist and must include duration, service, a brief description of activities, significant medical or behavioral incidents requiring intervention, or any other situation that is uncommon for the individual. A staff signature must be present for each block of time claimed on a service note. A new entry is not required unless a different discrete service is provided. 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. For Group Services, the provider must be able to verify, in a concise format, that the ratio for each claimed time frame of service did not exceed the maximum allowable ratio, whether or not all group individuals use a waiver funding stream. Electronic signatures are acceptable if the provider has a log on file showing the staff member's electronic signature, actual signature, and printed name. It's important to note that waiver-funded Respite services may not be rendered in a nursing facility. The following activities are not allowed under Respite: reimbursement for room and board, services provided to an individual living in a licensed facility-based setting, the cost of registration fees or the cost of recreational activities, when the service of structured family caregiving is being furnished to the individual or when the individual is in children's foster care, other family members may not receive care or support from the provider while Respite is being provided/billed for the waiver individuals, Respite used as day/child care, Respite care is not intended to be provided on a continuous, long-term basis as part of daily services that would enable the unpaid caregiver to go to work or to attend school, and Respite care shall not be used to provide services to an individual while the individual is attending school. Thank you for listening, and we hope this information has been helpful. Please refer to PRPR10014 for more information on policies and procedures as of July 1, 2024, version 11.1.. 

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DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
Library Reference Number: PRPR10014 
161 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
Documentation Standards 
A service note can include multiple discrete services, as long as discrete services are clearly identified. A 
service note must include: 
• Individual name 
• IHCP Member ID of the individual 
• Date of service 
• Provider rendering service 
• Primary location of services rendered 
An activity summary for each block of time this service is rendered must exist and must include duration, 
service, a brief description of activities, significant medical or behavioral incidents requiring intervention, 
or any other situation that is uncommon for the individual. A staff signature must be present for each block 
of time claimed on a service note. A new entry is not required unless a different discrete service is provided 
(that is, one continuous note may exist even if the ratio changes). 
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. 
For Group Services 
On request, the provider must be able to verify, in a concise format, that the ratio for each claimed time 
frame of service did not exceed the maximum allowable ratio, whether or not all group individuals use a 
waiver funding stream. 
Electronic signatures are acceptable if the provider has a log on file showing the staff member’s electronic 
signature, actual signature, and printed name. 
Limitations 
Waiver-funded Respite services may not be rendered in a nursing facility. 
Activities Not Allowed 
The following activities are not allowed under Respite: 
• Reimbursement for room and board  
• Services provided to an individual living in a licensed facility-based setting  
• The cost of registration fees or the cost of recreational activities (for example, camp)  
• When the service of structured family caregiving is being furnished to the individual or when the 
individual is in children’s foster care 
• Other family members (such as siblings of the individual) may not receive care or support from the 
provider while Respite is being provided/billed for the waiver individuals 
• Respite used as day/child care 
• Respite care is not intended to be provided on a continuous, long-term basis as part of daily services 
that would enable the unpaid caregiver to go to work or to attend school  
• Respite care shall not be used to provide services to an individual while the individual is attending 
school

[Audio] We are currently discussing the requirements for providers of DDRS HCBS Waivers. In this section of the presentation, we will be focusing on Section 10: Service Definitions and Requirements for F-S-W and C-I-H Waivers. Firstly, it is essential to note that respite care should not be used to replace skilled nursing services that should be provided under the Indiana Medicaid State Plan. Additionally, respite care must not duplicate any other service being provided under the individual’s PCISP. Services furnished to a minor by a parent, stepparent, or legal guardian, and services furnished to an individual by the individual’s spouse are also prohibited. In terms of provider qualifications, providers must be enrolled as an active Medicaid provider and be FSSA DDRS-approved. They must also comply with Indiana Administrative Code, 460 I-A-C 6, which includes requirements for documentation of criminal histories, insurance, and financial status of providers. Providers must also comply with any applicable B-D-S service standards, guidelines, policies, and/or manuals. Where licensure/certification is required, providers rendering waiver-funded services must obtain/maintain Indiana-specific licensure/certification. For L-P-Ns and RNs, this means meeting requirements set forth in IC 25-23. For home health agencies, this means meeting requirements set forth in IC 16-27-1 for Home Health Agency, IC 25-23-1 for RN and LPN; IC 16-27-1.5 for Home Health Aide, Registered. Moving on to Section 10.28, we will discuss specialized medical equipment and supplies for the F-S-W and C-I-H waiver. These include devices, controls, or appliances specified in the P-C-I-S-P that enable individuals to increase their ability to perform activities of daily living or to perceive, control, or communicate with the environment in which they live. It is crucial for providers to understand these requirements and ensure that they are in compliance with them to provide the best possible care for their Medicaid clients. Thank you for your attention to this section of the presentation.. 

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DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
162 
Library Reference Number: PRPR10014 
 
Published: Sept. 9, 2024 
 
Policies and procedures as of July 1, 2024 
 
Version: 11.1 
• Respite care shall not be used to replace skilled nursing services that should be provided under the 
Indiana Medicaid State Plan 
• Respite care must not duplicate any other service being provided under the individual’s PCISP  
• Services furnished to a minor by a parents, stepparents or legal guardian 
• Services furnished to an individual by the individual’s spouse 
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 6-10-5 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 6-5-26 Respite Care Services Provider Qualifications 
– 460 IAC 6-5-14 Heath Care Coordination 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 
• Where licensure/certification is required, providers rendering waiver funded services must 
obtain/maintain Indiana-specific licensure/certification  
– For LPNs and RNs, meet requirements set forth in IC 25-23 
– For home health agencies, meet requirements set forth in IC 16-27-1 for Home Health Agency, 
IC 25-23-1 for RN and LPN; IC 16-27-1.5 for Home Health Aide, Registered  
Section 10.28: Specialized Medical Equipment and 
Supplies for the FSW and CIH Waiver 
The following subsections provide information and requirements for Specialized Medical Equipment and 
Supplies services for the FSW and CIH Waiver. 
Service Definition 
Specialized Medical Equipment and Supplies include: 
• Devices, controls or appliances, specified in the PCISP that enable individuals to increase their 
ability to perform activities of daily living, or to perceive, control or communicate with the 
environment in which they live.

[Audio] Hello everyone, I will be discussing the requirements for providers of Specialized Medical Equipment and Supplies under DDRS HCBS Waivers. These waivers are designed to provide additional services to individuals who require specialized medical equipment and supplies. To be a provider of Specialized Medical Equipment and Supplies, you must meet certain qualifications. Firstly, you must be licensed and certified to provide these services. You must also have a team of trained professionals who are knowledgeable about the equipment and supplies they are providing. In addition to qualifications, providers must also comply with various regulations. These regulations ensure that the services provided are safe, effective, and meet the needs of the individuals receiving them. Providers must follow all applicable laws and regulations, including those related to patient safety, privacy, and confidentiality. Another requirement for providers of Specialized Medical Equipment and Supplies is accreditation from approved organizations. Providers must be accredited by organizations that have been approved by the state of Indiana. These organizations set standards for the equipment and supplies provided and ensure that they are of high quality and meet the needs of the individuals receiving them. Now, let's move on to Section 10 of the DDRS HCBS Waivers: Service Definitions and Requirements for F-S-W and C-I-H Waivers. This section outlines the items necessary for life support or to address physical conditions, as well as ancillary supplies and equipment necessary to the proper functioning of such items. Additionally, it describes other durable and nondurable medical equipment not available under the Indiana Medicaid State Plan that is necessary to address individual functional limitations. When providing Specialized Medical Equipment and Supplies, providers must approve all items before they are rendered. This ensures that the equipment and supplies are of direct medical or remedial benefit to the individual and meet applicable standards of manufacture, design, and installation. It's important to note that Specialized Medical Equipment and Supplies services are available under the F-S-W and C-I-H Waivers. Sensory items, seizure detection devices, G-P-S tracking devices, and other electronic devices that are not currently specified as items covered or reimbursable in the waiver or current R-F-A policy may be electronically submitted for consideration. For information on Specialized Medical Equipment and Supplies services available under the H&W and T-B-I Waivers, please refer to Section 12.26. Reimbursable activities under Specialized Medical Equipment and Supplies services include items necessary for life support, adaptive equipment and supplies, ancillary supplies and equipment needed for the proper functioning of Specialized Medical Equipment and Supplies, durable medical equipment not available under Indiana Medicaid State Plan, and nondurable medical equipment not available under Indiana Medicaid State Plan. Providers are responsible for offering interpreter services if needed by the individual. Per the Introduction to the I-H-C-P provider reference module, providers make available free aids and services to people with disabilities to communicate effectively with the provider, including qualified interpreters, written information in other formats, and free language services to people whose primary language is not English. Finally, providers are responsible for following all applicable service standards. Equipment and supplies must be of direct medical or remedial benefit to the individual, and all items shall meet applicable standards of manufacture, design, and installation. In conclusion, providers of Specialized Medical Equipment and Supplies must be licensed and certified, comply with various regulations, and be accredited by approved organizations. They must also follow all applicable service standards when providing Specialized Medical Equipment and Supplies. By following these requirements, providers can ensure that they are providing high-quality services that meet the needs of the individuals receiving them. Thank you for your attention. If you have any questions, please feel free to ask.. 

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DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
Library Reference Number: PRPR10014 
163 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
• Items necessary for life support or to address physical conditions along with ancillary supplies and 
equipment necessary to the proper functioning of such items. 
• Other durable and nondurable medical equipment not available under the Indiana Medicaid State 
Plan that is necessary to address individual functional limitations. 
DDRS waiver services staff must approve all Specialized Medical Equipment and Supplies prior to service 
being rendered. 
Additional Information: 
• 
Specialized Medical Equipment and Supplies services described in this section are 
available under the FSW and CIH Waiver. 
• 
Sensory items, seizure detection devices, GPS tracking devices and other electronic 
devices not currently specified as items covered or reimbursable in the waiver or 
current Request for Approval to Authorize Services (RFA) policy may be 
electronically submitted for consideration under Specialized Medical Equipment and 
Supplies via the Request for Approval to Authorize Services form as outlined in 
Section 11: RFA Policies of this module.  
• 
For information on Specialized Medical Equipment and Supplies services available 
under the H&W and TBI Waivers, see Section 12.26: Specialized Medical Equipment 
and Supplies for H&W and TBI Waivers. 
Reimbursable Activities 
Reimbursable activities under Specialized Medical Equipment and Supplies services include the following: 
• Items necessary for life support 
• Adaptive equipment and supplies 
• Ancillary supplies and equipment needed for the proper functioning of Specialized Medical 
Equipment and Supplies 
• Durable medical equipment not available under Indiana Medicaid State Plan 
• Nondurable medical equipment not available under Indiana Medicaid State Plan 
• Communications devices 
• Interpreter services or equipment necessary to access and participate in the home and community 
that are not otherwise provided as a reasonable accommodation per state and federal law  
– It is the responsibility of the provider to offer interpreter services if needed by the individual. Per 
the Introduction to the IHCP provider reference module, the provider makes available free aids 
and services to people with disabilities to communicate effectively with the provider, including 
qualified interpreters, written information in other formats and free language services to people 
whose primary language is not English. 
Service Standards 
The following service standards apply to Specialized Medical Equipment and Supplies: 
• Equipment and supplies must be of direct medical or remedial benefit to the individual. 
• All items shall meet applicable standards of manufacture, design and installation.

[Audio] We would like to welcome everyone to the DDRS HCBS Waiver presentation. Today, we will discuss the requirements for providers of DDRS HCBS Waivers, including qualifications, compliance with regulations, and the need for accreditation from approved organizations. We request you to review the following: Service Definitions and Requirements: * Any individual item exceeding $500 requires an evaluation by a qualified professional such as a physician, nurse, occupational therapist, physical therapist, speech and language therapist, or rehabilitation engineer.
* Annual maintenance service is available and is limited to $1000 per year. If the need for maintenance exceeds $1000, the case manager will work with other available funding streams and community agencies to fulfill the need. Documentation Standards: * Specialized Medical Equipment and Supplies documentation must include the following: plus Identified need in P-C-I-S-P and the service authorization plus Identified direct medical benefit for the individual plus Documentation of the request for Indiana Medicaid State Plan PA plus Documentation of the reason of denial of Indiana Medicaid State Plan PA plus Signed and approved Request for Approval to Authorize Services (State Form 45750) Limitations: * Service and repair up to $1000 per year are permitted for maintenance and repair of previously obtained specialized medical equipment that was funded by a H-C-B-S waiver. If the need for maintenance exceeds $1000, the case manager will work with other available funding streams and community agencies to fulfill the need.
* Specialized Medical Equipment and Supplies has a lifetime cap of $15000 under the Family Supports Waiver (F-S-W--).
* Specialized Medical Equipment and Supplies has no lifetime cap under the Community Integration and Habilitation (C-I-H--) Waiver Activities Not Allowed: * Equipment and services that are available under the Indiana Medicaid State Plan * Equipment and services that are not of direct medical or remedial benefit to the individual * Equipment and services that are not reflected in the PCISP * Equipment and services that do not address needs identified in the person-centered planning process * Equipment and services that have not been approved on a Request for Approval to Authorize Services (R-F-A--) form * Service provided by the parent of a minor child participant or the spouse of a participant (also known as LRIs) In conclusion, providers of DDRS HCBS Waivers must comply with various regulations and requirements to ensure that their services are of direct medical or remedial benefit to the individual and are reflected in the person-centered planning process. It is important to follow the documentation standards and limitations to ensure that the services are provided in a timely and efficient manner. Thank you for your attention, and we hope that you have found this presentation informative.. 

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DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
164 
Library Reference Number: PRPR10014 
 
Published: Sept. 9, 2024 
 
Policies and procedures as of July 1, 2024 
 
Version: 11.1 
• Any individual item costing more than $500 requires an evaluation by a qualified professional such 
as a physician, nurse, occupational therapist, physical therapist, speech and language therapist, or 
rehabilitation engineer. 
• Annual maintenance service is available and is limited to $1,000 per year. If the need for 
maintenance exceeds $1,000, the case manager will work with other available funding streams and 
community agencies to fulfill the need. 
Documentation Standards 
Specialized Medical Equipment and Supplies services documentation must include the following: 
• Identified need in PCISP and the service authorization 
• Identified direct medical benefit for the individual 
• Documentation of the request for Indiana Medicaid State Plan PA 
• Documentation of the reason of denial of Indiana Medicaid State Plan PA 
• Signed and approved Request for Approval to Authorize Services (State Form 45750) 
• Receipts for purchases 
Limitations 
The following are limitations on Specialized Medical Equipment and Supplies services: 
• Service and repair up to $1,000 per year are permitted for maintenance and repair of previously 
obtained specialized medical equipment that was funded by a HCBS waiver. If the need for 
maintenance exceeds $1,000, the case manager will work with other available funding streams and 
community agencies to fulfill the need. 
• Specialized Medical Equipment and Supplies has a lifetime cap of $15,000 under the Family 
Supports Waiver (FSW).  
• Specialized Medical Equipment and Supplies has no lifetime cap under the Community Integration 
and Habilitation (CIH) Waiver 
The services under the CIH Waiver and FSW are limited to additional services not otherwise covered under 
the Indiana Medicaid State Plan, including Early and Periodic Screening, Diagnosis and Treatment 
(EPSDT), but consistent with waiver objectives of avoiding institutionalization.  
Activities Not Allowed 
The following activities are not allowed under Specialized Medical Equipment and Supplies: 
• Equipment and services that are available under the Indiana Medicaid State Plan 
• Equipment and services that are not of direct medical or remedial benefit to the individual 
• Equipment and services that are not reflected in the PCISP 
• Equipment and services that do not address needs identified in the person-centered planning process 
• Equipment and services that have not been approved on a Request for Approval to Authorize 
Services (RFA) form 
• Service provided by the parent of a minor child participant or the spouse of a participant (also 
known as LRIs)

[Audio] We are here today to discuss the qualifications for providers in Indiana. For provider qualifications, we require that providers be enrolled as an active Medicaid provider and be FSSA DDRS-approved. They must also comply with any applicable B-D-S service standards, guidelines, policies, and manuals, including FSSA DDRS policies and this module, accessible from the I-H-C-P Provider Reference Modules page at in.gov/medicaid/providers. We have specific requirements for the provision of Speech/Language Therapy services under the F-S-W and C-I-H Waivers. These services are only provided to individuals ages 21 and over by a licensed speech pathologist under 460 I-A-C 6. Reimbursable activities under Speech/Language Therapy services include screening, assessment, and direct therapeutic intervention and treatment for speech and hearing disabilities such as delayed speech, stuttering, spastic speech, aphasic disorders, injuries, lip reading or signing, or the use of hearing aids. Our goal is to ensure that providers of DDRS HCBS Waivers in Indiana meet the highest standards of quality and compliance. We hope that this presentation has provided a comprehensive understanding of the requirements for providers in Indiana. Thank you for your attention.. 

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DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
Library Reference Number: PRPR10014 
165 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
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 6-10-5 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 6-5-27 Specialized Medical Equipment and Supplies 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. 
• Where licensure/certification is required, providers rendering waiver funded services must 
obtain/maintain Indiana-specific licensure/certification. Examples include but are not limited to: 
– For licensed/certified occupational therapist, meet requirements set forth in IC 25-23.5 
– For licensed physical therapist, meet requirements set forth in IC 25-27-1 
– For DDRS-approved pharmacies (as applicable), meet requirement set forth in IC 25-26-13-18 
– For speech/language therapist, meet requirements set forth in IC 25-35.6 
– For home health agencies, meet requirements set forth in IC 16-27-1 
Section 10.29: Speech/Language Therapy for FSW and 
CIH Waiver 
The following subsections provide information and requirements for Speech/Language Therapy services 
for the FSW and CIH Waiver. 
Service Definition 
Speech/Language Therapy services are services provided by a licensed speech pathologist under 460 IAC 6 
Supported Living Services and Supports requirements. 
These services cannot be provided as a substitute for services offered under the Indiana Medicaid State 
Plan. 
This waiver service is only provided to individuals ages 21 and over. All medically necessary 
Speech/Language Therapy services for children under age 21 are covered in the state plan benefit pursuant 
to the EPSDT benefit. 
Reimbursable Activities 
Reimbursable activities under Speech/Language Therapy services include the following: 
• Screening 
• Assessment 
• Direct therapeutic intervention and treatment for speech and hearing disabilities such as delayed 
speech, stuttering, spastic speech, aphasic disorders, injuries, lip reading or signing, or the use of 
hearing aids

[Audio] Good afternoon everyone, and welcome to our presentation on DDRS HCBS Waivers. Today, we will be discussing the service definitions and requirements for F-S-W and C-I-H Waivers, as well as the service standards for Speech/Language Therapy. Speech/Language Therapy services are provided to individuals who have been examined by a certified audiologist or a certified speech therapist and have recommended a formal speech and language program. The need for such services must be documented by an appropriate assessment and authorized in the individual’s PCISP. To be eligible for Speech/Language Therapy services, individuals must have a certified audiologist or a certified speech therapist examine them and recommend a formal speech and language program. The need for such services must be documented by an appropriate assessment and authorized in the individual’s PCISP. Speech/Language Therapy services documentation must include the following: documentation of an appropriate assessment, services provided under both the Indiana Medicaid State Plan and the waiver outlined in the PCISP, BDS-approved provider, appropriate credentials for the service provider, attendance record, therapist logs and/or chart detailing services provided, dates and times, and 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. It's important to note that individuals under the age of 21 should access Speech/Language Therapy services through EPSDT. One hour of billed therapy service must include a minimum of 45 minutes of direct patient care/therapy, with the balance of the hour spent in related patient services. This waiver service is only provided to individuals ages 21 and over. All medically necessary Speech/Language Therapy services for children under the age of 21 are covered in the Indiana Medicaid State Plan benefit pursuant to the E-P-S-D-T benefit. In conclusion, providers of DDRS HCBS Waivers must meet certain qualifications, comply with various regulations, and be accredited from approved organizations. Speech/Language Therapy services must adhere to specific service standards, including documentation requirements and limitations for individuals under the age of 21. Thank you for your attention, and we look forward to continuing our presentation.. 

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DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
166 
Library Reference Number: PRPR10014 
 
Published: Sept. 9, 2024 
 
Policies and procedures as of July 1, 2024 
 
Version: 11.1 
• Evaluation and training services to improve the ability to use verbal or nonverbal communication 
• Language stimulation and correction of defects in voice, articulation, rate and rhythm 
• Design, fabrication, training and assistance with adaptive aids and devices 
• Consultation demonstration of techniques with other service providers and family members 
• Planning, reporting and write-up when in association with the actual one-on-one direct care/therapy 
service delivery with the waiver individual 
Service Standards 
The following service standards apply to Speech/Language Therapy: 
• Individual Speech/Language Therapy services must be reflected in the PCISP regardless of funding 
sources. 
• To be eligible for this service, the individual must have been examined by a certified audiologist 
and/or a certified speech therapist who has recommended a formal speech and audio logical 
program. 
• The need for such services must be documented by an appropriate assessment and authorized in the 
individual’s PCISP. 
Documentation Standards 
Speech/Language Therapy services documentation must include the following: 
• Documentation of an appropriate assessment 
• Services provided under both the Indiana Medicaid State Plan and the waiver outlined in the PCISP 
• BDS-approved provider 
• Appropriate credentials for service provider 
• Attendance record, therapist logs and/or chart detailing services provided, dates and times 
• Documentation in compliance with 460 IAC 6 Supported Living Services and Supports 
requirements 
• Service being requested on Indiana Medicaid State Plan included in the PCISP 
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 
If individuals under age 21 choose to use Speech/Language Therapy, they should access Speech/Language 
Therapy services through EPSDT. 
One hour of billed therapy service must include a minimum of 45 minutes of direct patient care/therapy, 
with the balance of the hour spent in related patient services. 
This waiver service is only provided to individuals ages 21 and over. All medically necessary 
Speech/Language Therapy services for children under age 21 are covered in the Indiana Medicaid State 
Plan benefit pursuant to the EPSDT benefit.

[Audio] Welcome to our presentation. Today, we will be discussing the requirements for providers of DDRS HCBS Waivers. These waivers are designed to provide additional funding for services and programs that are not covered by traditional Medicaid. To be eligible for a DDRS HCBS Waiver, providers must enroll as an active Medicaid provider, be DDRS-approved, and comply with various regulations, including Indiana Administrative Code, 460 I-A-C 6, Indiana licensure, and any applicable B-D-S service standards and policies. It is important to note that certain activities are not allowed under Speech/Language Therapy, including therapy services delivered in a nursing facility, and services provided by the parent of a minor child participant or the spouse of a participant. We also need to discuss structured family caregiving for the C-I-H Waiver. This means a living arrangement in which an individual lives in the private home of a principal caregiver who may be a nonfamily member (foster care) or a family member who is not the individual's spouse, the parent of the individual who is a minor, or the legal guardian of the minor. To be eligible for a DDRS HCBS Waiver, providers must meet all of these requirements. These waivers can provide important funding for programs and services that are not covered by traditional Medicaid, and can help to improve the overall quality of care for individuals in need.. 

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DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
Library Reference Number: PRPR10014 
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Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
Activities Not Allowed 
The following activities are not allowed under Speech/Language Therapy: 
• Services available through the Indiana Medicaid State Plan (a Medicaid State Plan PA denial is 
required before reimbursement is available through the Medicaid waiver for this service) 
• Therapy services furnished to the individual within the educational/school setting or as a component 
of the individual’s school day 
• Activities delivered in a nursing facility 
• Service provided by the parent of a minor child participant or the spouse of a participant (also 
known as LRIs) 
Note: Therapies provided through this service will not duplicate therapies provided under 
any other service. 
Provider Qualifications 
Providers must meet the following criteria: 
• Enrolled as an active Medicaid provider 
• Be DDRS-approved 
• 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 
– 460 IAC 6-5-28 Speech-Language Therapy Services 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 
• Speech/language therapists rendering waiver funded services must obtain/maintain Indiana 
licensure. 
• Where licensure/certification is required, providers rendering waiver funded services must 
obtain/maintain Indiana-specific licensure/certification  
– For speech/language therapist, meet requirements set forth in IC 25-35.6 
– For home health agencies, meet requirements set forth in IC 16-27-1 
Section 10.30: Structured Family Caregiving for the CIH 
Waiver 
The following subsections provide information and requirements for Structured Family Caregiving services 
for the CIH Waiver. 
Service Definition 
Structured Family Caregiving means a living arrangement in which an individual lives in the private home 
of a principal caregiver who may be a nonfamily member (foster care) or a family member who is not the 
individual’s spouse, the parent of the individual who is a minor, or the legal guardian of the minor

[Audio] We are here today to discuss the requirements for DDRS HCBS Waivers, specifically regarding service definitions and requirements for F-S-W and C-I-H Waivers. Individuals who are guardians of adult individuals are allowed to provide Structured Family Caregiving with the agreement of the Individualized Support Team (I-S-T--). Necessary support services are provided by the principal caregiver (family caregiver) as part of Structured Family Caregiving. Only agencies may be Structured Family Caregiving providers, with the Structured Family Caregiving settings being approved, supervised, trained, and paid by the approved agency provider. To ensure compliance with the program, the provider agency must conduct two visits per month to the home – one by a registered nurse (R-N---) or licensed practical nurse (L-P-N--) and one by a Structured Family Caregiving home manager. The provider agency must keep daily notes that can be accessed by the state. Additional Information: Structured Family Caregiving services described in this section are available under the C-I-H Waiver. Structured Family Caregiving is not available under the FSW. There are three service levels of Structured Family Caregiving each with a unique rate. The Algo score assigned to the individual will determine the appropriate level of Structured Family Caregiving service and reimbursement to be used in the person-centered individualized support plan (P-C-I-S-P) at the individual’s next annual anniversary date. Reimbursable activities under Structured Family Caregiving services include personal care and services, homemaker or chore services, attendant care and companion care services, medication oversight, support by a substitute caregiver who has met all principal caregiver qualifications, transporting the participant when indicated in the PCISP, and other appropriate supports as described in the PCISP.. 

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Published: Sept. 9, 2024 
 
Policies and procedures as of July 1, 2024 
 
Version: 11.1 
individual. Guardians of adult individuals are allowed to provide Structured Family Caregiving with the 
agreement of the Individualized Support Team (IST). 
Necessary support services are provided by the principal caregiver (family caregiver) as part of Structured 
Family Caregiving. Only agencies may be Structured Family Caregiving providers, with the Structured 
Family Caregiving settings being approved, supervised, trained and paid by the approved agency provider. 
The provider agency must conduct two visits per month to the home – one by a registered nurse (RN) or 
licensed practical nurse (LPN) and one by a Structured Family Caregiving home manager. The provider 
agency must keep daily notes that can be accessed by the state. Separate payment will not be made for 
homemaker or chore services furnished to an individual receiving Structured Family Caregiving, because 
these services are integral to and inherent in the provision of Structured Family Caregiving services. 
Additional Information: 
• 
Structured Family Caregiving services described in this section are available under 
the CIH Waiver. Structured Family Caregiving is not available under the FSW. 
• 
For unique information related to Structured Family Caregiving services available 
under the H&W and TBI Waivers, see Section 12.28: Structured Family Caregiving 
for H&W and TBI Waivers.  
Service Levels and Rates  
There are three service levels of Structured Family Caregiving each with a unique rate. The Algo score 
assigned to the individual will determine the appropriate level of Structured Family Caregiving service and 
reimbursement to be used in the person-centered individualized support plan (PCISP) at the individual’s 
next annual anniversary date. 
• Level 1 – Appropriate for individuals choosing Structured Family Caregiving having an Algo score 
of 0 or 1 
• Level 2 – Appropriate for individuals choosing Structured Family Caregiving and having an Algo 
score of 2 
• Level 3 – Appropriate for individuals choosing Structured Family Caregiving and having an Algo 
score of 3, 4, 5 or 6 
Reimbursable Activities 
Reimbursable activities under Structured Family Caregiving services include the following: 
• Personal care and services 
• Homemaker or chore services 
• Attendant care and companion care services 
• Medication oversight 
• Support by a substitute caregiver who has met all principal caregiver qualifications 
• Transporting the participant when indicated in the PCISP (Note: When provided, such 
transportation is incidental and not duplicative of any other Indiana Medicaid State Plan or waiver 
service.) 
• Other appropriate supports as described in the PCISP

[Audio] We understand that structured family caregiving services are an essential component of DDRS HCBS Waivers. Providers must ensure compliance with regulations and accreditation from approved organizations. These services include training and ongoing support to the family caregiver/foster parent, and ensuring the safety and well-being of the individual through regular inspections of the environment. The provider must ensure that structured family caregiving services are reflected in the PCISP, and the services must address the needs identified in the person-centered planning process. The provider must also approve any providers of respite care chosen by the family or individual, and determine the total amount per month paid to the family caregiver. The agency's administrative/supervision fee is determined by the remaining total amount, and includes the following duties: publishing written policies and procedures regarding structured family caregiving support services, maintaining financial and service records to document services provided to the individual, establishing criteria for the acceptance of the family caregiver or foster parent, providing initial training and ongoing training, consultation, and supervision to the family caregiver/foster parent, and ensuring the safety and well-being of the individual by inspection of the environment. The structured family caregiving services documentation must include written policies and procedures, including for screening and accepting family caregivers/foster parents, maintenance of financial and service records to document services provided to the individual, provision of training to family caregivers according to agency policies/procedures, and reimbursement of the family caregiver/foster parent. Under structured family caregiving services, families must provide the following documentation: one dated entry per day detailing an issue concerning the individual, tying those into measurable progress toward the individual's outcome (as identified in the PCISP), and including any significant issues concerning the individual.. 

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DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
Library Reference Number: PRPR10014 
169 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
Service Standards 
The following service standards apply to Structured Family Caregiving: 
• Structured Family Caregiving services must be reflected in the PCISP. 
• Services must address the needs (for example, intellectual/developmental needs, vocational needs 
and so forth) identified in the person-centered planning process and must be outlined in the PCISP. 
• Ten percent of the total per diem amount is intended for use by the provider for respite care as 
needed. It is the provider’s responsibility to approve any providers of respite chosen by the family or 
the individual. 
• The provider determines the total amount per month paid to the family caregiver. 
• The agency’s administrative/supervision fee comes from the remaining total amount and includes 
the following duties:  
– Publish written policies and procedures regarding Structured Family Caregiving support services 
– Maintain financial and service records to document services provided to the individual 
– Establish a criteria for the acceptance of the family caregiver or foster parent; screen potential 
family caregivers/foster parents for qualities of stability, maturity and experiences so as to 
ensure the safety and well-being of the individual; and obtain a criminal background and 
reference check 
– Coordinate/provide adequate initial training and ongoing training, consultation, and supervision 
to the family caregiver/foster parent 
– Provide for the safety and well-being of the individual by inspection of environment for 
compliance with the DDRS policies and procedures, including, but not limited to, the provider 
and case management standards found in 460 IAC 6 Supported Living Services and Supports 
requirements 
– Reimburse the family caregiver/foster parent 
Documentation Standards 
Structured Family Caregiving services documentation must include: 
• Written policies and procedures, including for screening and accepting family caregivers/foster 
parents 
• Maintaining financial and service records to document services provided to the individual 
• Documenting provision of training to family caregivers according to agency policies/procedures 
• Reimbursement of family caregiver/foster parent 
• One entry per individual per week 
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. 
Documentation by Families 
Under Structured Family Caregiving services, families must provide the following documentation: 
• One dated entry per day detailing an issue concerning the individual 
• The entry should detail any outcome-oriented activities, tying those into measurable progress toward 
the individual’s outcome (as identified in the PCISP)  
• The entry should also include any significant issues concerning the individual, including:

[Audio] We are here today to discuss the expectations and qualifications for providers offering DDRS HCBS Waivers. Our presentation will provide an overview of the definitions and requirements for the F-S-W and C-I-H Waivers, as well as any limitations and activities that are not permitted. Furthermore, we will address the qualifications needed for providers, including enrollment as an active Medicaid provider, FSSA DDRS-approval, compliance with Indiana Administrative Code, and insurance. Provider training and staff qualifications must also meet specific standards, guidelines, policies, and manuals. Lastly, licensure is required for providers delivering waiver-funded services. Our presentation aims to inform providers about the requirements and expectations for providing DDRS HCBS Waivers services in Indiana.. 

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DDRS HCBS Waivers 
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Published: Sept. 9, 2024 
 
Policies and procedures as of July 1, 2024 
 
Version: 11.1 
– Health and safety management  
– Intellectual/developmental challenges and experiences aimed at increasing an individual’s ability 
to live a lifestyle that is compatible with the individual’s interest and abilities 
– Modification or improvement of functional skills 
– Guidance and direction for social/emotional support 
– Facilitation of both the physical and social integration of an individual into typical family 
routines and rhythms 
Limitations 
Separate payment will not be made for homemaker or chore services furnished to an individual receiving 
Structured Family Caregiving, because these services are integral to and inherent in the provision of 
Structured Family Caregiving services.  
Activities Not Allowed 
Structured Family Caregiving services will not be provided to household members other than to the waiver 
individuals. Reimbursement is not available through Structured Family Caregiving in the following 
circumstances: 
• Services provided by a caregiver who is the spouse of the individual or the parent of the minor 
individual. 
• The service of Residential Habilitation and Support (whether paid hourly or daily) is not available to 
individuals receiving Structured Family Caregiving services. 
• Transportation services through the waiver may not be separately billed in conjunction with 
Structured Family Caregiving services. 
• The limit is a maximum of four waiver individuals per Structured Family Caregiving household. 
• Respite services through this waiver may not be used in conjunction with Structured Family 
Caregiving services. 
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 6-10-5 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 6-5-3 Adult Foster Care Services Provider Qualifications 
– 460 IAC 6-14-5 Requirements for Direct Care Staff 
– 460 IAC 6-14-4 Staff Training and 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 
• Where licensure is required, providers rendering waiver funded services must obtain/maintain 
Indiana-specific licensure

[Audio] We will be discussing the requirements for providers of Transportation services for F-S-W and C-I-H Waivers. Transportation services are critical for individuals with disabilities as they enable them to access non-medical community services, resources, destinations, or places of employment, as well as maintain or improve their mobility within the community. To ensure compliance with regulations and maintain quality standards, providers of Transportation services must adhere to certain requirements. Transportation services are available under the F-S-W and C-I-H Waiver, and there is no prohibition against using Transportation services to get to or from a place of employment, provided this is reflected in the PCISP. Transportation may be used to reach any non-medical destination or activity outlined within the PCISP. There are three levels of Transportation services: Level 1, Level 2, and Level 3. Level 1 transportation involves a private, commercial or public transit vehicle that is not specially equipped. Level 2 transportation involves a private, commercial or public transit vehicle specially designed to accommodate wheelchairs. Level 3 transportation involves a vehicle specially designed to accommodate an individual who for medical reasons must remain prone during transportation. Providers of Transportation services must document the level of Transportation service needed in the PCISP. Reimbursable activities under Transportation services include two one-way trips per day to or from a non-medical community service or resource or place of employment as specified on the P-C-I-S-P and provided by an approved provider of R-H-S--, Day Habilitation, Adult Day Services, or Transportation services. Bus passes or alternate methods of transportation may be used for Level 1 or Level 2. Bus passes may be purchased on a monthly basis or on a per-ride basis, whichever is most cost-effective in meeting the individual’s transportation needs as outlined in the PCISP. It is important to note that Transportation services described in this section are available under the F-S-W and C-I-H Waiver. Transportation may be used in conjunction with other services, including Day Habilitation and Adult Day Services, but 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). In summary, providers of Transportation services for F-S-W and C-I-H Waivers must adhere to certain requirements and documentation standards to ensure compliance with regulations and maintain quality standards. Transportation services are critical for individuals with disabilities and play an important role in enabling them to access non-medical community services, resources, destinations, or places of employment, as well as maintain or improve their mobility within the community.. 

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DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
Library Reference Number: PRPR10014 
171 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
Section 10.31: Transportation for FSW and CIH Waiver 
The following subsections provide information and requirements for Transportation services for the FSW 
and CIH Waiver. 
Service Definition 
Transportation services are services to transfer individuals in a vehicle from the point of pick-up to a 
destination point. Transportation services enable individuals to access nonmedical community services, 
resources, destinations or places of employment, as well as maintain or improve their mobility within the 
community, increase independence and community participation and prevent institutionalization as 
specified by the PCISP. 
Depending on the needs of the individual, there are three levels of transportation. The level of 
Transportation service needed must be documented in the PCISP. 
• Level 1: Transportation in a private, commercial or public transit vehicle that is not specially 
equipped. 
• Level 2: Transportation in a private, commercial or public transit vehicle specially designed to 
accommodate wheelchairs. 
• Level 3: Transportation in a vehicle specially designed to accommodate an individual who for 
medical reasons must remain prone during transportation (such as ambulette). 
Additional Information: 
• 
Transportation services described in this section are available under the FSW and CIH 
Waiver. 
• 
There is no prohibition against using Transportation services to get to or from a place 
of employment providing this is reflected in the PCISP. 
• 
Transportation may be used to reach any nonmedical destination or activity outlined 
within the PCISP.  
• 
For information on Transportation services available under the H&W and TBI 
Waivers, see Section 12.30: Transportation for H&W and TBI Waivers. 
Reimbursable Activities 
Reimbursable activities under Transportation services include the following: 
• Two one-way trips per day to or from a nonmedical community service or resource or place of 
employment as specified on the PCISP and provided by an approved provider of RHS (a service 
currently available only under the CIH Waiver), Day Habilitation, Adult Day Services or 
Transportation services. 
• Bus passes or alternate methods of transportation may be used for Level 1 or Level 2. Bus passes 
may be purchased on a monthly basis or on a per-ride basis, whichever is most cost-effective in 
meeting the individual’s transportation needs as outlined in the PCISP. 
• May be used in conjunction with other services, including Day Habilitation and Adult Day Services. 
• 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).

[Audio] We are currently discussing qualifications and requirements for providers offering DDRS HCBS Waivers. To be eligible, providers must follow specific regulations, receive accreditation from approved organizations, and meet service definition and requirement standards for F-S-W and C-I-H Waivers. Transportation services are subject to PCISP, and documentation must include a service note with the individual/waiver individual name, I-H-C-P Member ID, date of service, provider rendering service, pick-up point, and destination. If contract transportation is used, log and invoice support must be provided. No person is excluded from participating in nonmedical waiver transportation services, and annual limits are applied. Thank you for your attention.. 

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DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
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Library Reference Number: PRPR10014 
 
Published: Sept. 9, 2024 
 
Policies and procedures as of July 1, 2024 
 
Version: 11.1 
Note: Whenever possible, family, neighbors, friends or community agencies that can 
provide Transportation services without charge will be used. 
Service Standards 
The following service standards apply to Transportation services: 
• Transportation services are offered in addition to medical transportation required under 42 CFR 
431.53 and Transportation services under the Indiana Medicaid State Plan, defined at 42 CFR 
440.170(a) (if applicable), and shall not replace them. 
• Transportation services under the waiver shall be offered in accordance with the PCISP, and when 
unpaid transportation is not available. 
• Whenever possible, family, neighbors, friends or community agencies that can provide this service 
without charge will be used. 
Documentation Standards 
Documentation for Transportation services must include the following: 
• Service notes 
– A service note can include multiple discrete services as long as discrete services are clearly 
identified.  
– A service note entry for this service can be part of a comprehensive daily note with other 
services recorded, as long it is clearly separated from other services in the note. 
– A service note must include the following: 
➢ Individual/waiver individual name 
➢ IHCP Member ID of the individual 
➢ Date of service 
➢ Provider rendering service 
➢ Pick-up point and destination 
• If contract transportation is used, contractor must provide log and invoice support that includes dates 
of transportation provided. 
• If bus passes or alternative methods of transportation are used, invoices and attendance logs must 
support days for which round trips are billed to the waiver. 
Limitations 
Note that no individual is excluded from participating in nonmedical waiver Transportation services. 
Annual limits are applied to the nonmedical waiver Transportation services. 
• For the CIH Waiver, the costs of nonmedical Transportation services are paid for outside of and in 
addition to the individual’s annual allocation amount that is determined by their Algo score. 
– The annual limits for each level of nonmedical waiver Transportation under the CIH Waiver are: 
➢ $7,530 for Level 1 Transportation 
➢ $8,255 for Level 2 Transportation 
➢ $8,980 for Level 3 Transportation

 part 13

Our presentation will focus on the specifications for Respite services under the F-S-W and C-I-H Waiver. Respite services are accessible to individuals who are unable to care for themselves and are provided on a short-term basis. These services can be provided in the individual’s home or place of residence, in the respite caregiver’s home, in a camp setting, in a DDRS-approved Day Habilitation facility, or in a nonprivate residential setting.

Respite nursing care (R-N---) or Respite nursing care L-P-N--) services may only be delivered when skilled care is necessary, as documented in the PCISP. It is crucial to remember that Respite must be documented in the PCISP, and providers must adhere to the service standards outlined in our presentation. We hope that these requirements will help ensure the safe and effective delivery of Respite services to individuals in need.

avatar

We will be discussing qualifications, compliance with regulations, and the need for accreditation from approved organizations for providers of DDRS HCBS Waivers. When it comes to service definitions and requirements for F-S-W and C-I-H Waivers, there are certain documentation standards that must be followed. A service note can include multiple discrete services, as long as discrete services are clearly identified. A service note must include the individual name, I-H-C-P Member ID of the individual, date of service, provider rendering service, and primary location of services rendered. Additionally, an activity summary for each block of time this service is rendered must exist and must include duration, service, a brief description of activities, significant medical or behavioral incidents requiring intervention, or any other situation that is uncommon for the individual. A staff signature must be present for each block of time claimed on a service note. A new entry is not required unless a different discrete service is provided.

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. For Group Services, the provider must be able to verify, in a concise format, that the ratio for each claimed time frame of service did not exceed the maximum allowable ratio, whether or not all group individuals use a waiver funding stream. Electronic signatures are acceptable if the provider has a log on file showing the staff member's electronic signature, actual signature, and printed name.

It's important to note that waiver-funded Respite services may not be rendered in a nursing facility. The following activities are not allowed under Respite: reimbursement for room and board, services provided to an individual living in a licensed facility-based setting, the cost of registration fees or the cost of recreational activities, when the service of structured family caregiving is being furnished to the individual or when the individual is in children's foster care, other family members may not receive care or support from the provider while Respite is being provided/billed for the waiver individuals, Respite used as day/child care, Respite care is not intended to be provided on a continuous, long-term basis as part of daily services that would enable the unpaid caregiver to go to work or to attend school, and Respite care shall not be used to provide services to an individual while the individual is attending school. Thank you for listening, and we hope this information has been helpful. Please refer to PRPR10014 for more information on policies and procedures as of July 1, 2024, version 11.1.

We are currently discussing the requirements for providers of DDRS HCBS Waivers. In this section of the presentation, we will be focusing on Section 10: Service Definitions and Requirements for F-S-W and C-I-H Waivers.

Firstly, it is essential to note that respite care should not be used to replace skilled nursing services that should be provided under the Indiana Medicaid State Plan. Additionally, respite care must not duplicate any other service being provided under the individual’s PCISP. Services furnished to a minor by a parent, stepparent, or legal guardian, and services furnished to an individual by the individual’s spouse are also prohibited.

In terms of provider qualifications, providers must be enrolled as an active Medicaid provider and be FSSA DDRS-approved. They must also comply with Indiana Administrative Code, 460 I-A-C 6, which includes requirements for documentation of criminal histories, insurance, and financial status of providers. Providers must also comply with any applicable B-D-S service standards, guidelines, policies, and/or manuals.

Where licensure/certification is required, providers rendering waiver-funded services must obtain/maintain Indiana-specific licensure/certification. For L-P-Ns and RNs, this means meeting requirements set forth in IC 25-23. For home health agencies, this means meeting requirements set forth in IC 16-27-1 for Home Health Agency, IC 25-23-1 for RN and LPN; IC 16-27-1.5 for Home Health Aide, Registered.

Moving on to Section 10.28, we will discuss specialized medical equipment and supplies for the F-S-W and C-I-H waiver. These include devices, controls, or appliances specified in the P-C-I-S-P that enable individuals to increase their ability to perform activities of daily living or to perceive, control, or communicate with the environment in which they live. It is crucial for providers to understand these requirements and ensure that they are in compliance with them to provide the best possible care for their Medicaid clients. Thank you for your attention to this section of the presentation.

Hello everyone,

I will be discussing the requirements for providers of Specialized Medical Equipment and Supplies under DDRS HCBS Waivers. These waivers are designed to provide additional services to individuals who require specialized medical equipment and supplies.

To be a provider of Specialized Medical Equipment and Supplies, you must meet certain qualifications. Firstly, you must be licensed and certified to provide these services. You must also have a team of trained professionals who are knowledgeable about the equipment and supplies they are providing.

In addition to qualifications, providers must also comply with various regulations. These regulations ensure that the services provided are safe, effective, and meet the needs of the individuals receiving them. Providers must follow all applicable laws and regulations, including those related to patient safety, privacy, and confidentiality.

Another requirement for providers of Specialized Medical Equipment and Supplies is accreditation from approved organizations. Providers must be accredited by organizations that have been approved by the state of Indiana. These organizations set standards for the equipment and supplies provided and ensure that they are of high quality and meet the needs of the individuals receiving them.

Now, let's move on to Section 10 of the DDRS HCBS Waivers: Service Definitions and Requirements for F-S-W and C-I-H Waivers. This section outlines the items necessary for life support or to address physical conditions, as well as ancillary supplies and equipment necessary to the proper functioning of such items. Additionally, it describes other durable and nondurable medical equipment not available under the Indiana Medicaid State Plan that is necessary to address individual functional limitations.

When providing Specialized Medical Equipment and Supplies, providers must approve all items before they are rendered. This ensures that the equipment and supplies are of direct medical or remedial benefit to the individual and meet applicable standards of manufacture, design, and installation.

It's important to note that Specialized Medical Equipment and Supplies services are available under the F-S-W and C-I-H Waivers. Sensory items, seizure detection devices, G-P-S tracking devices, and other electronic devices that are not currently specified as items covered or reimbursable in the waiver or current R-F-A policy may be electronically submitted for consideration. For information on Specialized Medical Equipment and Supplies services available under the H&W and T-B-I Waivers, please refer to Section 12.26.

Reimbursable activities under Specialized Medical Equipment and Supplies services include items necessary for life support, adaptive equipment and supplies, ancillary supplies and equipment needed for the proper functioning of Specialized Medical Equipment and Supplies, durable medical equipment not available under Indiana Medicaid State Plan, and nondurable medical equipment not available under Indiana Medicaid State Plan.

Providers are responsible for offering interpreter services if needed by the individual. Per the Introduction to the I-H-C-P provider reference module, providers make available free aids and services to people with disabilities to communicate effectively with the provider, including qualified interpreters, written information in other formats, and free language services to people whose primary language is not English.

Finally, providers are responsible for following all applicable service standards. Equipment and supplies must be of direct medical or remedial benefit to the individual, and all items shall meet applicable standards of manufacture, design, and installation.

In conclusion, providers of Specialized Medical Equipment and Supplies must be licensed and certified, comply with various regulations, and be accredited by approved organizations. They must also follow all applicable service standards when providing Specialized Medical Equipment and Supplies. By following these requirements, providers can ensure that they are providing high-quality services that meet the needs of the individuals receiving them. Thank you for your attention. If you have any questions, please feel free to ask.

We would like to welcome everyone to the DDRS HCBS Waiver presentation. Today, we will discuss the requirements for providers of DDRS HCBS Waivers, including qualifications, compliance with regulations, and the need for accreditation from approved organizations. We request you to review the following:

Service Definitions and Requirements:

* Any individual item exceeding $500 requires an evaluation by a qualified professional such as a physician, nurse, occupational therapist, physical therapist, speech and language therapist, or rehabilitation engineer.
* Annual maintenance service is available and is limited to $1000 per year. If the need for maintenance exceeds $1000, the case manager will work with other available funding streams and community agencies to fulfill the need.

Documentation Standards:

* Specialized Medical Equipment and Supplies documentation must include the following: 
	 plus  Identified need in P-C-I-S-P and the service authorization 
	 plus  Identified direct medical benefit for the individual 
	 plus  Documentation of the request for Indiana Medicaid State Plan PA 
	 plus  Documentation of the reason of denial of Indiana Medicaid State Plan PA 
	 plus  Signed and approved Request for Approval to Authorize Services (State Form 45750) 

Limitations:

* Service and repair up to $1000 per year are permitted for maintenance and repair of previously obtained specialized medical equipment that was funded by a H-C-B-S waiver. If the need for maintenance exceeds $1000, the case manager will work with other available funding streams and community agencies to fulfill the need.
* Specialized Medical Equipment and Supplies has a lifetime cap of $15000 under the Family Supports Waiver (F-S-W--).
* Specialized Medical Equipment and Supplies has no lifetime cap under the Community Integration and Habilitation (C-I-H--) Waiver 

Activities Not Allowed:

* Equipment and services that are available under the Indiana Medicaid State Plan 
* Equipment and services that are not of direct medical or remedial benefit to the individual 
* Equipment and services that are not reflected in the PCISP 
* Equipment and services that do not address needs identified in the person-centered planning process 
* Equipment and services that have not been approved on a Request for Approval to Authorize Services (R-F-A--) form 
* Service provided by the parent of a minor child participant or the spouse of a participant (also known as LRIs)

In conclusion, providers of DDRS HCBS Waivers must comply with various regulations and requirements to ensure that their services are of direct medical or remedial benefit to the individual and are reflected in the person-centered planning process. It is important to follow the documentation standards and limitations to ensure that the services are provided in a timely and efficient manner. Thank you for your attention, and we hope that you have found this presentation informative.

We are here today to discuss the qualifications for providers in Indiana. 

                                For provider qualifications, we require that providers be enrolled as an active Medicaid provider and be FSSA DDRS-approved. They must also comply with any applicable B-D-S service standards, guidelines, policies, and manuals, including FSSA DDRS policies and this module, accessible from the I-H-C-P Provider Reference Modules page at in.gov/medicaid/providers.

                                We have specific requirements for the provision of Speech/Language Therapy services under the F-S-W and C-I-H Waivers. These services are only provided to individuals ages 21 and over by a licensed speech pathologist under 460 I-A-C 6. Reimbursable activities under Speech/Language Therapy services include screening, assessment, and direct therapeutic intervention and treatment for speech and hearing disabilities such as delayed speech, stuttering, spastic speech, aphasic disorders, injuries, lip reading or signing, or the use of hearing aids.

                                Our goal is to ensure that providers of DDRS HCBS Waivers in Indiana meet the highest standards of quality and compliance. We hope that this presentation has provided a comprehensive understanding of the requirements for providers in Indiana. Thank you for your attention.

Good afternoon everyone, and welcome to our presentation on DDRS HCBS Waivers. Today, we will be discussing the service definitions and requirements for F-S-W and C-I-H Waivers, as well as the service standards for Speech/Language Therapy.

Speech/Language Therapy services are provided to individuals who have been examined by a certified audiologist or a certified speech therapist and have recommended a formal speech and language program. The need for such services must be documented by an appropriate assessment and authorized in the individual’s PCISP.

To be eligible for Speech/Language Therapy services, individuals must have a certified audiologist or a certified speech therapist examine them and recommend a formal speech and language program. The need for such services must be documented by an appropriate assessment and authorized in the individual’s PCISP.

Speech/Language Therapy services documentation must include the following: documentation of an appropriate assessment, services provided under both the Indiana Medicaid State Plan and the waiver outlined in the PCISP, BDS-approved provider, appropriate credentials for the service provider, attendance record, therapist logs and/or chart detailing services provided, dates and times, and 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.

It's important to note that individuals under the age of 21 should access Speech/Language Therapy services through EPSDT. One hour of billed therapy service must include a minimum of 45 minutes of direct patient care/therapy, with the balance of the hour spent in related patient services. This waiver service is only provided to individuals ages 21 and over. All medically necessary Speech/Language Therapy services for children under the age of 21 are covered in the Indiana Medicaid State Plan benefit pursuant to the E-P-S-D-T benefit.

In conclusion, providers of DDRS HCBS Waivers must meet certain qualifications, comply with various regulations, and be accredited from approved organizations. Speech/Language Therapy services must adhere to specific service standards, including documentation requirements and limitations for individuals under the age of 21. Thank you for your attention, and we look forward to continuing our presentation.

Welcome to our presentation. Today, we will be discussing the requirements for providers of DDRS HCBS Waivers. These waivers are designed to provide additional funding for services and programs that are not covered by traditional Medicaid. To be eligible for a DDRS HCBS Waiver, providers must enroll as an active Medicaid provider, be DDRS-approved, and comply with various regulations, including Indiana Administrative Code, 460 I-A-C 6, Indiana licensure, and any applicable B-D-S service standards and policies.
                                    
                                    It is important to note that certain activities are not allowed under Speech/Language Therapy, including therapy services delivered in a nursing facility, and services provided by the parent of a minor child participant or the spouse of a participant.
                                    
                                    We also need to discuss structured family caregiving for the C-I-H Waiver. This means a living arrangement in which an individual lives in the private home of a principal caregiver who may be a nonfamily member (foster care) or a family member who is not the individual's spouse, the parent of the individual who is a minor, or the legal guardian of the minor.
                                    
                                    To be eligible for a DDRS HCBS Waiver, providers must meet all of these requirements. These waivers can provide important funding for programs and services that are not covered by traditional Medicaid, and can help to improve the overall quality of care for individuals in need.

We are here today to discuss the requirements for DDRS HCBS Waivers, specifically regarding service definitions and requirements for F-S-W and C-I-H Waivers. 

Individuals who are guardians of adult individuals are allowed to provide Structured Family Caregiving with the agreement of the Individualized Support Team (I-S-T--). Necessary support services are provided by the principal caregiver (family caregiver) as part of Structured Family Caregiving. 

Only agencies may be Structured Family Caregiving providers, with the Structured Family Caregiving settings being approved, supervised, trained, and paid by the approved agency provider. 

To ensure compliance with the program, the provider agency must conduct two visits per month to the home – one by a registered nurse (R-N---) or licensed practical nurse (L-P-N--) and one by a Structured Family Caregiving home manager. The provider agency must keep daily notes that can be accessed by the state. 

Additional Information: 

Structured Family Caregiving services described in this section are available under the C-I-H Waiver. Structured Family Caregiving is not available under the FSW. 

There are three service levels of Structured Family Caregiving each with a unique rate. The Algo score assigned to the individual will determine the appropriate level of Structured Family Caregiving service and reimbursement to be used in the person-centered individualized support plan (P-C-I-S-P) at the individual’s next annual anniversary date. 

Reimbursable activities under Structured Family Caregiving services include personal care and services, homemaker or chore services, attendant care and companion care services, medication oversight, support by a substitute caregiver who has met all principal caregiver qualifications, transporting the participant when indicated in the PCISP, and other appropriate supports as described in the PCISP.

We understand that structured family caregiving services are an essential component of DDRS HCBS Waivers. Providers must ensure compliance with regulations and accreditation from approved organizations. These services include training and ongoing support to the family caregiver/foster parent, and ensuring the safety and well-being of the individual through regular inspections of the environment.

The provider must ensure that structured family caregiving services are reflected in the PCISP, and the services must address the needs identified in the person-centered planning process. The provider must also approve any providers of respite care chosen by the family or individual, and determine the total amount per month paid to the family caregiver.

The agency's administrative/supervision fee is determined by the remaining total amount, and includes the following duties: publishing written policies and procedures regarding structured family caregiving support services, maintaining financial and service records to document services provided to the individual, establishing criteria for the acceptance of the family caregiver or foster parent, providing initial training and ongoing training, consultation, and supervision to the family caregiver/foster parent, and ensuring the safety and well-being of the individual by inspection of the environment.

The structured family caregiving services documentation must include written policies and procedures, including for screening and accepting family caregivers/foster parents, maintenance of financial and service records to document services provided to the individual, provision of training to family caregivers according to agency policies/procedures, and reimbursement of the family caregiver/foster parent.

Under structured family caregiving services, families must provide the following documentation: one dated entry per day detailing an issue concerning the individual, tying those into measurable progress toward the individual's outcome (as identified in the PCISP), and including any significant issues concerning the individual.

We are here today to discuss the expectations and qualifications for providers offering DDRS HCBS Waivers. Our presentation will provide an overview of the definitions and requirements for the F-S-W and C-I-H Waivers, as well as any limitations and activities that are not permitted. Furthermore, we will address the qualifications needed for providers, including enrollment as an active Medicaid provider, FSSA DDRS-approval, compliance with Indiana Administrative Code, and insurance. Provider training and staff qualifications must also meet specific standards, guidelines, policies, and manuals. Lastly, licensure is required for providers delivering waiver-funded services. Our presentation aims to inform providers about the requirements and expectations for providing DDRS HCBS Waivers services in Indiana.

We will be discussing the requirements for providers of Transportation services for F-S-W and C-I-H Waivers. Transportation services are critical for individuals with disabilities as they enable them to access non-medical community services, resources, destinations, or places of employment, as well as maintain or improve their mobility within the community. To ensure compliance with regulations and maintain quality standards, providers of Transportation services must adhere to certain requirements.
                                    Transportation services are available under the F-S-W and C-I-H Waiver, and there is no prohibition against using Transportation services to get to or from a place of employment, provided this is reflected in the PCISP. Transportation may be used to reach any non-medical destination or activity outlined within the PCISP.
                                    There are three levels of Transportation services: Level 1, Level 2, and Level 3. Level 1 transportation involves a private, commercial or public transit vehicle that is not specially equipped. Level 2 transportation involves a private, commercial or public transit vehicle specially designed to accommodate wheelchairs. Level 3 transportation involves a vehicle specially designed to accommodate an individual who for medical reasons must remain prone during transportation.
                                    Providers of Transportation services must document the level of Transportation service needed in the PCISP. Reimbursable activities under Transportation services include two one-way trips per day to or from a non-medical community service or resource or place of employment as specified on the P-C-I-S-P and provided by an approved provider of R-H-S--, Day Habilitation, Adult Day Services, or Transportation services. Bus passes or alternate methods of transportation may be used for Level 1 or Level 2. Bus passes may be purchased on a monthly basis or on a per-ride basis, whichever is most cost-effective in meeting the individual’s transportation needs as outlined in the PCISP.
                                    It is important to note that Transportation services described in this section are available under the F-S-W and C-I-H Waiver. Transportation may be used in conjunction with other services, including Day Habilitation and Adult Day Services, but 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).
                                    In summary, providers of Transportation services for F-S-W and C-I-H Waivers must adhere to certain requirements and documentation standards to ensure compliance with regulations and maintain quality standards. Transportation services are critical for individuals with disabilities and play an important role in enabling them to access non-medical community services, resources, destinations, or places of employment, as well as maintain or improve their mobility within the community.

We are currently discussing qualifications and requirements for providers offering DDRS HCBS Waivers. To be eligible, providers must follow specific regulations, receive accreditation from approved organizations, and meet service definition and requirement standards for F-S-W and C-I-H Waivers. Transportation services are subject to PCISP, and documentation must include a service note with the individual/waiver individual name, I-H-C-P Member ID, date of service, provider rendering service, pick-up point, and destination. If contract transportation is used, log and invoice support must be provided. No person is excluded from participating in nonmedical waiver transportation services, and annual limits are applied. Thank you for your attention.