[Virtual Presenter] We are pleased to present this slide deck which outlines the policies and procedures for home modifications under the DDRS HCBS Waiver program. This program offers a range of modifications, including stair lifts, single-room air conditioners/air purifiers, widening doorways, and replacing windows. It is important to note that any modifications provided through the H-C-B-S waiver are subject to a yearly maintenance limit of $500. Any modifications or items not listed above will need to be reviewed and approved by the state division director or state agency designee. Let us explore each of these modifications individually. Firstly, we will discuss stair lifts. These will be provided if they are necessary for the individual to access areas of their home in order to receive direct medical or remedial benefits, as stated in their service authorization and P-C-I-S-P under the C-I-H Waiver. Next, we will examine single-room air conditioners or air purifiers. These will be provided if they are necessary for the individual's medical or remedial needs, as documented by a prescription from their primary care physician. It is important to note that the size of the air conditioner must be suitable for the room it is intended to cool. For the modification of widening doorways, this will be done for the purpose of safe egress. Exterior modifications are limited to one per individual primary residence, only when there are no other accessible doors available. Interior modifications, on the other hand, may include bedroom, bathroom, and/or kitchen doorways, with the option of a pocket door if there is not enough space for a traditional swinging door. Finally, for any necessary window replacements, we will be using plexiglass or other shatterproof materials for safety purposes. Thank you for your attention to this information regarding the DDRS HCBS Waiver program and its policies and procedures for home modifications. If you have any further questions or concerns, please do not hesitate to reach out to the state division director or state agency designee for assistance.. 

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• Stair lift – If required for access to areas of the home necessary to meet the direct medical or 
remedial benefit of the individual per service authorization (and PCISP under CIH Waiver). 
• Single-room air conditioners/single- room air purifiers – If required for access to areas of the home 
necessary to meet the direct medical or remedial benefit of the individual per service authorization 
(and PCISP under CIH Waiver): 
– There is a documented medical reason for the individual’s need to maintain a constant external 
temperature. The documentation necessary for this equipment includes a prescription from the 
primary care physician.  
– The room air conditioner size is consistent with the room size (square feet) capacity to be 
cooled. 
• Widen doorway – To allow safe egress: 
– Exterior – Modification limited to one per individual primary residence when no other accessible 
door exists. 
– Interior – Modification of bedroom, bathroom and/or kitchen door/doorway as needed to allow 
for access. (A pocket door may be appropriate when there is insufficient room to allow for the 
door swing). 
• Windows – Replacement of glass with plexiglass or other shatterproof material when there is a 
documented medical/behavioral reasons. 
• Upon the completion of the modification, painting, wall coverings, doors, trim, flooring and so forth 
will be matched (to the degree possible) to the previous color/style/design. 
• Maintenance – Limited to $500 annually for the repair and service of home modifications that have 
been provided through a HCBS waiver: 
– Requests for service must detail parts cost and labor cost. 
– If the need for maintenance exceeds $500, the case manager will work with other available 
funding streams and community agencies to fulfill the need. If service costs exceed the annual 
limit, those parts and labor costs funded through the waiver must be itemized clearly to 
differentiate the waiver service provision from those parts and labor funded through a nonwaiver 
funding source. 
• Items requested which are not listed above, must be reviewed and decision rendered by the state 
division director or state agency designee. 
Modifications/Items – Noncovered 
Examples/descriptions of modifications/items not covered include, but are not limited to the following: 
• Adaptations or improvements that are not of direct medical or remedial benefit to the individual 
– Central heating and air conditioning 
– Routine home maintenance 
– Installation of standard (non-ADA or ADAAG) home fixtures (for example, sinks, commodes, 
tub, wall, window and door coverings, and so forth) which replace existing standard (non-ADA 
or ADAAG) home fixtures 
– Roof repair 
– Structural repair 
– Garage doors 
– Elevators 
– Ceiling track lift systems 
– Driveways, decks, patios, sidewalks, household furnishings 
– Replacement of carpeting and other floor coverings 
– Storage (for example, cabinets, shelving, closets), sheds

[Audio] The DDRS HCBS Waiver program is designed to provide individuals with disabilities the opportunity to reside comfortably and securely in their own homes. The program allows certain home modifications to be made to enhance accessibility and functionality. The policies and procedures for home modifications under the DDRS HCBS Waiver program will be outlined on slide 2. These modifications include stair lifts, single-room air conditioners/air purifiers, widening doorways, and replacing windows. The completed modifications will be reviewed by the state division director or state agency designee to ensure the best fit for each individual. Maintenance for modifications provided through the H-C-B-S Waiver is limited to $500 annually, and any modifications or items not listed above will be reviewed and a decision will be made by the state division director or state agency designee. Examples of non-covered modifications and items include central air conditioning, routine home maintenance, and standard home fixtures. Moving on to section 11, we will discuss the R-F-A (Request for Approval) policies for the DDRS HCBS Waivers. Swimming pools, spas, or hot tubs are not covered under the program. Additionally, video monitoring systems, adaptive switches or buttons for entertainment, employment, or education devices, and home security systems are also not included in the modifications. Modifications that create living space or facilities where they did not previously exist, such as installing a bathroom in a garage or basement, are not covered. Similarly, duplicating existing accessibility, such as a second accessible bathroom or second means of egress, is also not included. Any adaptations that have not been approved on a Request for Approval to Authorize Services form will not be covered. Lastly, please note that individuals living in foster homes, group homes, assisted living facilities, or homes for special services, which includes any licensed residential facility, are not eligible for home modifications under the DDRS HCBS Waiver program. The responsibility for such modifications rests with the facility owner or operator.. 

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– Swimming pools, spas or hot tubs  
– Video monitoring system  
– Adaptive switches or buttons to control devices intended for entertainment, employment or 
education 
– Home security systems 
• Modifications that create living space or facilities where they did not previously exist (for example, 
installation of a bathroom in a garage/basement and so forth) 
• Modifications that duplicate existing accessibility (for example, second accessible bathroom, a 
second means of egress from home and so forth) 
• Modifications that will add square footage to the home 
• Completion of, or modifications to, new construction or significant remodeling/reconstruction 
unless there is documented evidence of a significant change in the individual’s medical or remedial 
needs that now require the requested modification 
• Adaptations that have not been approved on a Request for Approval to Authorize Services form 
• Individuals living in foster homes, group homes, assisted living facilities or homes for special 
services (any licensed residential facility) 
Note:  The responsibility for home modifications rests with the facility owner or operator. 
• Individuals living in a provider owned residence 
Note:  The responsibility for home modifications rests with the facility owner or operator. 
Decision-Making Authority 
Each division, with approval from the FSSA Office of the Secretary, shall identify designees to render 
decisions based on the articles in this policy. The designees are responsible for preparing and presenting 
testimony for all fair hearings – see Section 8: Appeal Process. The case management entity, working as an 
agent of the state, shall not attend fair hearings in opposition of the state, unless requested by the individual 
when there is no other advocate to represent the individual at the hearing. If the case manager does attend 
the hearing, working as an agent of the state, they must also uphold the established federal, state, local and 
FSSA standards and division specific guidelines and/or policies. Additionally, the case manager must 
submit a letter, in writing to the administrative law judge at the fair hearing, explaining their role at the 
hearing. 
Each division shall implement a quality assurance plan. In the event of inappropriate authorizations being 
granted, any or all of the following actions may be required: 
• A corrective action plan 
• Reimbursement to Medicaid 
• Loss of decision-making authority

[Audio] There are two waivers under the DDRS HCBS program that impact the use of Specialized Medical Equipment and Supplies: the Community Integration and Habilitation (C-I-H--) Waiver and the Family Supports Waiver (F-S-W--). This subsection focuses on the waiver policy notification and the authority that guides the policy. The Clarification of the Specialized Medical Equipment and Supplies Policy impacts these two waivers. The effective date for this policy is December 1st, 2007, and it replaces all previous policies related to the authorization of Specialized Medical Equipment and Supplies. Individuals enrolled in the DDRS HCBS Waiver program need Specialized Medical Equipment and Supplies, such as sensory items, seizure detection devices, G-P-S tracking devices, and other electronic devices that are not currently specified as covered or reimbursable under the waiver or current R-F-A policy. These items can be electronically submitted for consideration under Specialized Medical Equipment and Supplies via the Request for Approval to Authorize Services form. For modifications provided through a H-C-B-S waiver, maintenance is limited to $500 annually. Any modifications or items not listed in the waiver policy will be reviewed and a decision will be made by the state division director or state agency designee. The policies and procedures in place are designed to ensure the safety and well-being of individuals enrolled in the H-C-B-S waiver program. The state division director or state agency designee will carefully review each request for specialized medical equipment and supplies to ensure that it is necessary and beneficial for the individual's overall health and independence. Thank you for your attention to this important section of the presentation.. 

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Section 11.2: Specialized Medical Equipment and 
Supplies for the FSW and CIH Waiver 
Waiver Policy Notification 
Authority: 42 CFR 441.302 
Policy Topic: Specialized Medical Equipment and Supplies Policy Clarification 
Impacts the following HCBS waivers:  
• Community Integration and Habilitation (CIH) Waiver  
• Family Supports Waiver (FSW)  
• Effective Date: Dec. 1, 2007, and replaces all previous policies related to the authorization of 
Specialized Medical Equipment and Supplies 
Note: 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 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 this section. 
Description 
Specialized Medical Equipment and Supplies are medically prescribed items required by the individual’s 
PCISP and service authorization, which are necessary to assure the health, welfare and safety of the 
individual, which enable the individual to function with greater independence in the home, and without 
which the individual would require institutionalization.  
Under the FSW, a lifetime cap of $15,000 is available for Specialized Medical Equipment and Supplies. 
There is no lifetime cap for Specialized Medical Equipment and Supplies under the CIH Waiver. 
Choice of Provider 
The individual chooses which approved/certified providers will submit bids or estimates for this service. 
The provider with the lowest bid will be chosen, unless there is strong written justification from the case 
manager detailing why a provider with a higher bid should be selected. 
Requirements 
• All Specialized Medical Equipment and Supplies must be approved by the waiver program prior to 
the service being rendered.  
• Individuals requesting authorization for this service through utilization of HCBS waivers must first 
exhaust eligibility for the desired equipment or supplies through Indiana Medicaid State Plan, which 
may require prior authorization (PA): 
– There should be no duplication of services between HCBS waiver and Indiana Medicaid State 
Plan. 
– The refusal of a Medicaid vendor to accept the Medicaid reimbursement through the Indiana 
Medicaid State Plan is not a justification for waiver purchase. 
– Preference for a specific brand name is not a medically necessary justification for waiver 
purchase. Indiana Medicaid State Plan often covers like equipment but may not cover the

[Audio] Section 11 of the DDRS HCBS Waivers outlines the policies and procedures for Request for Authorization (R-F-A--) and reimbursement for home modifications. When a person requests a specific brand for a modification, they are limited to the Indiana Medicaid State Plan covered service/brand. This means that reimbursement for the requested item will be based on the Indiana Medicaid State Plan fee schedule. If the requested item is not covered under the Indiana Medicaid State Plan, it will not be reimbursed. To learn more about coverage under the Indiana Medicaid State Plan, please refer to Indiana Administrative Code 405 I-A-C 5-19. All requests for items to be purchased through a Medicaid waiver must include documentation of an Indiana Medicaid State Plan PA request and decision. Specialized Medical Equipment and Supplies will only be authorized if they are determined to be medically necessary and have a direct medical or remedial benefit for the waiver individual. This determination takes into account several factors, including cost-effectiveness and individualized, specific needs that are not in excess. Additionally, for items over $1000, three bids must be obtained. If this is not possible, it must be documented.. 

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specific brand requested. When this occurs, the individual is limited to the Indiana Medicaid 
State Plan covered service/brand. 
– Reimbursement is limited to the Indiana Medicaid State Plan fee schedule, if the requested item 
is covered under the Indiana Medicaid State Plan. 
– See Indiana Administrative Code 405 IAC 5-19 for additional information regarding Indiana 
Medicaid State Plan coverage. All requests for items to be purchased through a Medicaid waiver 
must be accompanied by documentation of Indiana Medicaid State Plan PA request and 
decision, if the requested item is covered under the state plan. 
• Specialized Medical Equipment and Supplies shall be authorized only when it is determined to be 
medically necessary and shall have direct medical or remedial benefit for the waiver individual. This 
determination includes the following considerations: 
– The request is the most cost effective or conservative means to meet the individual’s specific 
needs. 
– The request is individualized, specific and consistent with, but not in excess of, the individual’s 
needs. 
– Three bids must be obtained for items over $1,000. 
– If three bids cannot be obtained, it must be documented to show what efforts were made to 
secure the three bids and explain why fewer than three bids were obtained (including provider 
name, dates of contact, response received). 
– For requested items under $1,000, one bid is required, and pricing must be consistent with the 
fair market price. 
– Bids must be itemized to include a picture of the product and detailed product information, 
including make/model number of the item as shown in the example in Table 6.  
Table 6 – Bid Itemization Example – Specialized Medical Equipment and Supplies 
Scope 
Make/Model Number  
Material  
Adapted plates/bowls 
 
$$ 
Interpreter service  
 
$$ 
Wheelchair  
 
$$ 
Portable generator  
 
$$ 
Total Cost:   
$$ 
• Requests will be denied if the state division director or state agency designee determines the 
documentation does not support the service requested.  
Service Standards 
• Specialized Medical Equipment and Supplies must be of direct medical or remedial benefit to the 
individual. 
• All items shall meet applicable standards of manufacture, design and service specifications. 
• Under the FSW and CIH Waiver, requests for items over $500 require that the individual first be 
evaluated by a qualified professional such as a physician, nurse, occupational therapist, physical 
therapist, speech and language therapist or rehabilitation engineer as required per the approved 
waiver.

[Audio] This section of our presentation focuses on the policies for home modifications under the DDRS HCBS Waiver program. We will discuss the documentation standards and reimbursement guidelines for these modifications. First, we will discuss the documentation requirements for home modifications. This includes a service authorization, a physician's prescription or clinical evaluation, and a P-C-I-S-P under the F-S-W or C-I-H Waiver. Additionally, if applicable, the Indiana Medicaid State Plan prior authorization request and decision must be included. We will also discuss the reimbursement process for Specialized Medical Equipment and Supplies. Reimbursement is available for these supplies if they meet certain criteria, such as adhering to the service and documentation standards outlined in this policy, being allowed under current Medicaid waiver guidelines, not being available under the Rehabilitation Act of 1973, and being included in the individual's approved P-C-I-S-P and service authorization. It is important for providers to ensure that the service and documentation standards are met before requesting reimbursement. Thank you for listening to this section on the R-F-A policies for the DDRS HCBS Waivers. We will now move on to Section 12 of our presentation.. 

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Documentation Standards  
Documentation standards include the following: 
• The identified direct benefit or need must be documented within all the following: 
– Service authorization 
– Physician prescription and/or clinical evaluation as deemed appropriate 
– PCISP under the FSW and CIH Waiver  
• Indiana Medicaid State Plan prior authorization request and the decision rendered, if applicable 
• Signed and approved Request for Approval to Authorize Services (RFA) 
• Signed and approved service authorization 
• Provider of services must maintain receipts for all incurred expenses related to this service 
• Must be in compliance with FSSA and division-specific guidelines and/or policies 
Reimbursement 
Reimbursement is available for Specialized Medical Equipment and Supplies that satisfy each of the 
following: 
• Service and documentation standards outlined within this policy 
• Allowable under current Medicaid waiver guidelines 
• Not available under the Rehabilitation Act of 1973, as amended 
• Included in the individual’s approved PCISP/service authorization 
• Authorized on the RFA and linked to the PCISP/service authorization 
• Included on a state-approved and signed service authorization 
• Completed by an approved Medicaid waiver service provider (that is approved to perform this 
service) 
Items − Covered 
Justification and documentation are required to demonstrate that the request is necessary to meet the 
individual’s identified needs. 
• Communication Devices – Computer adaptations for keyboard, picture boards and so forth.  
• The RFA must be accompanied by documentation of Indiana Medicaid State Plan PA request and 
decision rendered under the Indiana Medicaid State Plan. 
• Generators (portable) – When either ventilator, daily use of oxygen via a concentrator, continuous 
infusion of nutrition (tube feeding), or medication through an electric pump are medical 
requirements of the individual. The generator is limited to the kilo-wattage necessary to provide 
power to the essential life-sustaining equipment and is limited to one generator per individual per 
10-year period. 
• Interpreter service – Provided in circumstances where the interpreter assists the individual in 
communication during specified scheduled meetings for service planning (for example, waiver case 
conferences, team meetings) and is not available to facilitate communication for other service 
provision.

[Audio] Our presentation today will cover the policies and procedures for home modifications offered through the DDRS HCBS Waiver program. The program provides a variety of modifications including stair lifts, air conditioners/purifiers, doorways, and windows. To ensure the modifications match the home's color, style, and design, they will be carefully reviewed. The maintenance for these modifications is limited to $500 per year. Any modifications or items not listed above will undergo a review for approval. In regards to R-F-A policies, we also offer self-help devices, such as tables and reachers, prescribed by physical or occupational therapists. Additionally, strollers are available upon request for individuals who require them for transportation but do not need a full-time mobility device. Our manual wheelchairs can also be provided for safe mobility, with an annual maintenance limit of $1000. Posture and feeding chairs, prescribed by a physician or therapist, are also available. It's important to note that while not currently covered, special items such as sensory equipment, seizure detection devices, and G-P-S trackers can be considered for coverage through the Request for Approval to Authorize Services form. Lastly, please be aware that items such as hospital beds, mattresses, therapy equipment, and electronics, including CD players and cameras, are not covered under the waiver or R-F-A policy.. 

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• Self-help devices – Including over the bed tables, reachers, adaptive plates, bowls, cups, drinking 
glasses and eating utensils that are prescribed by a physical therapist or occupational therapist. 
• Strollers – When needed because individual’s primary mobility device does not fit into the 
individual’s vehicle/mode of transportation, or when the individual does not require the full-time 
use of a mobility device, but a stroller is needed to meet the mobility needs of the individual outside 
of the home setting. The RFA must be accompanied by documentation of Indiana Medicaid State 
Plan PA request and decision rendered under the Indiana Medicaid State Plan. 
• Manual wheelchairs – When required to facilitate safe mobility. The RFA must be accompanied by 
documentation of Indiana Medicaid State Plan PA request and decision rendered under Indiana 
Medicaid State Plan. 
• Maintenance – Limited to $1,000 annually for the repair and service of items that have been 
provided through a HCBS waiver: 
– Requests for service must detail parts cost and labor cost. 
– 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. If service costs exceed the annual 
limit, those parts and labor costs funded through the waiver must be itemized clearly to 
differentiate the waiver service provision from those parts and labor provided through a 
nonwaiver funding source. 
Posture chairs and feeding chairs – As prescribed by physician, occupational therapist or physical therapist. 
The RFA must be accompanied by documentation of Indiana Medicaid State Plan PA request and decision 
rendered under Indiana Medicaid State Plan.  
Note:  While not currently listed as covered items - 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 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 this section. As an 
interim step toward RFA policy updates, BDS will develop a Specialized Medical 
Equipment and Supplies fact sheet citing things individuals and families may wish to 
consider prior to submitting a request. 
Items – Noncovered 
The following items and equipment are not covered: 
• Hospital beds, air fluidized suspension mattresses/beds 
• Therapy mats  
• Parallel bars 
• Scale 
• Activity streamers 
• Paraffin machines or baths 
• Therapy balls 
• Books, games, toys 
• Electronics – such as CD players, radios, cassette players, tape recorders, televisions, VCRs and 
DVDs, cameras or film, videotapes, and other similar items 
• Computers and software

[Audio] As the presenter, we are gathered here to discuss the policies and procedures for home modifications covered under the DDRS HCBS Waiver program. These modifications include stair lifts, single-room air conditioners/air purifiers, widened doorways, and window replacements. The completed modifications will be closely reviewed by the state division director or state agency designee to ensure they match the color, style, and design of the original home as closely as possible. However, maintenance for these modifications is limited to $500 annually. Any modifications or items that are not listed, such as central air conditioning, routine home maintenance, and standard home fixtures, will also be reviewed and decided upon by the state division director or state agency designee. Moving on to the R-F-A policies for DDRS HCBS Waivers, we cover a wide range of items and equipment under this service. This includes adaptive switches and buttons, exercise equipment, furniture, appliances, indoor and outdoor play equipment, and positioning devices. Additionally, items that can be authorized through the Indiana Medicaid State Plan are also covered. However, any equipment or items that are purchased or obtained by the individual, their family members, or other nonwaiver providers are not covered unless specifically authorized through this service. In rare circumstances, a new or unexpected item may be presented for consideration as a covered item under this service. In order to do so, a written proposal justifying the need for the item must be submitted to the FSSA OMPP for further review and consideration by the F-S-S-A Policy Governance Board. The proposal should be directed to the Director of Agency Coordination and Integration at the Office of Medicaid Policy and Planning. These are the necessary steps to obtain coverage for any new or unanticipated items under this service.. 

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• Adaptive switches and buttons 
• Exercise equipment such as treadmills or exercise bikes 
• Furniture 
• Appliances – such as refrigerator, stove, hot water heater 
• Indoor and outdoor play equipment such as swing sets, swings, slides, bicycles adaptive tricycles, 
trampolines, playhouses, merry-go-rounds 
• Swimming pools, spas, hot tubs, portable whirlpool pumps 
• Tempur-Pedic mattresses, positioning devices, pillows 
• Bathtub lifts 
• Motorized scooters 
• Barrier creams, lotions, personal cleaning cloths 
• Totally enclosed cribs and barred enclosures used for restraint purposes 
• Medication dispensers 
• Any equipment or items that can be authorized through Indiana Medicaid State Plan 
• Any equipment or items purchased or obtained by the individual, the individual’s family members 
or other nonwaiver providers 
Note: In rare circumstances, a new or unanticipated item may be presented for 
consideration as a covered item under this service. Prior to submission of an RFA for 
this item, a written proposal justifying the need for this item must be sent to the FSSA 
OMPP for submission to the FSSA Policy Governance Board for consideration and 
determination of appropriateness as a covered item. The written proposal should be 
directed to:  
 
Director of Agency Coordination and Integration 
 
Office of Medicaid Policy and Planning 
 
402 W. Washington Street, Room W374 
 
Indianapolis, IN 46204-2739  
 
These requests should be extremely rare and should not include items on the 
noncovered list, which have been previously vetted at the state and determined to be 
noncovered items. 
Decision-Making Authority 
• Each division, with approval from the FSSA Office of the Secretary, shall identify a designee or 
designeess to render decisions based upon the articles within this policy.  
• The designees are responsible for preparing and presenting testimony for all fair hearings. 
• The case management entity, working as an agent of the state, shall not attend fair hearings in 
opposition of the state, unless requested by the individual when there is no other advocate to 
represent the individual at the hearing. If the case manager does attend the hearing, working as an 
agent of the state, the case manager must also uphold the established federal, state, local and FSSA 
standards and the division-specific guidelines and/or policies. Additionally, the case manager must 
submit a letter in writing to the administrative law judge at the fair hearing, as to what their role is at 
the hearing.

[Audio] This presentation focuses on slide 8, where we will discuss the policies and procedures for home modifications under the DDRS HCBS Waiver program. These modifications are vital for individuals with disabilities to safely navigate their homes and access their communities. Our objective is to ensure that these modifications are closely matched to the color, style, and design of the individual's home. The state division director or state agency designee will make the decision on these modifications. Any modifications or items not included in our program will also be assessed and decided upon by the state division director or state agency designee. These may include central air conditioning, routine home maintenance, and standard home fixtures. Moving on to section 11 of our policy, each division is required to implement a Quality Assurance Plan to ensure appropriate authorizations are being granted. In the case of any inappropriate authorizations, the following actions may be taken: a corrective action plan, reimbursement to Medicaid, or a loss of decision-making authority. Section 11.3 specifically addresses vehicle modifications for the F-S-W and C-I-H Waivers. This policy clarification, in accordance with 42 CFR 441.302, affects both the Community Integration and Habilitation (C-I-H--) Waiver and the Family Supports Waiver (F-S-W--). This policy was implemented on December 1, 2007, and replaces all previous policies related to the authorization of vehicle modifications. Vehicle Modifications, or V-M-O-D-, refer to the addition of adaptive equipment or structural changes to a motor vehicle that allow individuals with disabilities to safely transport in a vehicle. These modifications are necessary to increase an individual's ability to function in a home and community-based setting, ensuring accessibility for individuals with mobility challenges. This concludes our presentation on the DDRS HCBS Waiver program and its policies. Thank you for your attention.. 

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• Each division shall implement a Quality Assurance Plan. In the event of inappropriate 
authorizations being granted, any or all of the following actions may be required: 
– A corrective action plan (CAP) 
– Reimbursement to Medicaid 
– Loss of decision-making authority 
Section 11.3: Vehicle Modifications for FSW and CIH 
Waiver 
Waiver Policy Notification 
Authority: 42 CFR 441.302 
Policy Topic: Vehicle Modification Policy Clarification 
Impacts the following HCBS waivers:  
• Community Integration and Habilitation (CIH) Waiver  
• Family Supports Waiver (FSW)  
• Effective Date: Dec. 1, 2007, and replaces all previous policies related to the authorization of 
Vehicle Modifications. 
Description 
Vehicle Modifications (VMOD) are the addition of adaptive equipment or structural changes to a motor 
vehicle that permit an individual with a disability to safely transport in a motor vehicle. Vehicle 
Modifications, as specified in the person-centered individualized support plan (PCISP) and service 
authorization, may be authorized when necessary to increase an individual’s ability to function in a home- 
and community-based setting to ensure accessibility of the individual with mobility impairments. These 
services must be necessary to prevent or delay institutionalization. The necessity of such items must be 
documented in the plan of care by a physician’s order. Members needing vehicle modifications to attend 
post-secondary education or job-related services should be referred to Vocational Rehabilitation (VR).  
A cap of $15,000 is available for one vehicle per every 10-year period for an individual’s household. In 
addition to the applicable cap, $1,000 will be allowable annually for repair, replacement or an adjustment to 
an existing modification that was funded by an HCBS waiver. 
Vehicle Ownership 
The vehicle to be modified must meet all the following: 
• The individual or primary caregiver is the titled owner. 
• The vehicle is registered and/or licensed under state law. 
• The vehicle has appropriate insurance as required by state law. 
• The vehicle is the individual’s sole or primary means of transportation. 
• The vehicle is less than 10 years old and has less than 100,000 miles on the odometer. 
• The vehicle is not registered to or titled by an FSSA-approved provider agency. 
• Only one vehicle per an individual may be modified per every 10-year period.

[Audio] Section 11 of the presentation addresses the R-F-A policies for the DDRS HCBS Waiver program. This section discusses the significant topic of choosing a provider for home modifications. It is vital that the individual has the freedom to select from approved or certified providers who will submit bids or estimates for this service. It is worth noting that the provider with the lowest bid will be selected, unless the case manager provides a well-justified written explanation as to why a provider with a higher bid should be chosen. This process ensures fairness and transparency. Moving on to the requirements for vehicle modifications, it is imperative that all modifications are approved by the H-C-B-S waiver program before services are provided. This is to guarantee that the modifications meet the necessary standards and regulations. Additionally, any vehicle modification requests must meet the following criteria: firstly, the modification must be based on and tailored to meet the individual's specific needs. This means that only one vehicle per individual's household may be modified. Moreover, the vehicle must be less than 10 years old and have less than 100000 miles on the odometer. This is to ensure that the modified vehicle is safe and reliable for the individual. Lastly, all vehicle modifications must be deemed medically necessary and/or have direct medical or remedial benefits for the waiver individual. This determination will take into account the cost-effectiveness and individualized approach of the modification, as well as ensuring that it is not excessive. Thank you for your attention to these crucial policies for the DDRS HCBS Waiver program. We are committed to providing the best care for individuals with disabilities, and these policies and procedures help us ensure that their needs are met in an equitable and efficient manner.. 

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Section 11: RFA Policies 
DDRS HCBS Waivers 
Library Reference Number: PRPR10014 
195 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
Choice of Provider 
The individual chooses which approved/certified providers will submit bids or estimates for this service. 
The provider with the lowest bid will be chosen, unless there is strong written justification from the case 
manager detailing why a provider with a higher bid should be selected. 
Requirements 
• All vehicle modifications must be approved by the HCBS waiver program prior to services being 
rendered.  
• Vehicle modification requests must meet and abide by the following: 
– The vehicle modification is based on, and designed to meet, the individual’s specific needs: 
➢ Only one vehicle per an individual’s household may be modified. 
➢ The vehicle is less than 10 years old and has less than 100,000 miles on the odometer. 
• All vehicle modifications shall be authorized only when it is determined to be medically necessary 
and/or shall have direct medical or remedial benefit for the waiver individual. This determination 
includes the following considerations: 
– The modification is the most cost effective or conservative means to meet the individual’s 
specific needs. 
– The modification is individualized, specific and consistent with, but not in excess of, the 
individual’s needs. 
– Two modification bids must be obtained for all modifications over $1,000. 
– If two bids cannot be obtained, it must be documented to show what efforts were made to secure 
the three bids and explain why fewer than three bids were obtained (for example, provider name, 
dates of contact, response received). 
– For modifications under $1,000, one bid is required, and pricing must be consistent with the fair 
market price for such modifications. 
– All bids must be itemized to include the items as shown in the example in Table 7. 
Table 7 – Bid Itemization Example – Vehicle Modification 
Make:  
Model:  
Mileage:  
Year:  
 
Scope of Work 
Materials Cost 
Related Labor 
Lift 
$$ 
$$ 
Tie down  
$$ 
$$ 
Total Cost:  $$$$$ 
 
• Many automobile manufacturers offer a rebate for individuals purchasing a new vehicle requiring 
modifications for accessibility. To obtain the rebate the individual is required to submit to the 
manufacturer documented expenditures of modifications. If the rebate is available, it must be 
applied to the cost of the modifications. 
• Requests for modifications may be denied if the state division director or state agency designee 
determines the documentation does not support the service requested.  
Service Standards 
• Vehicle Modifications must be of direct medical or remedial benefit to the individual. 
• All items must meet applicable manufacturer, design and service standards.

[Audio] During our presentation, we will now discuss Section 11, which outlines the policies and procedures for home modifications in the DDRS HCBS Waiver program. These modifications, such as stair lifts, single-room air conditioners/air purifiers, widening doorways, and replacing windows, are essential for ensuring the safety and accessibility of individuals with disabilities. It is important to note that the completed modifications will be carefully reviewed and approved by the state division director or state agency designee in order to match the color, style, and design as closely as possible. Additionally, it is crucial for all modifications provided through the H-C-B-S waiver to be properly maintained. Therefore, there is a limitation of $500 annually for maintenance expenses. Please be aware that any modifications or items not listed above will also require review and approval by the state division director or state agency designee. This includes non-covered examples such as central air conditioning, routine home maintenance, and standard home fixtures. Moving on to the next section, we will discuss the documentation standards for the R-F-A (Request for Approval to Authorize Services). According to our policy, the identified direct benefit or need must be documented within the PCISP/service authorization, as well as a physician's prescription and/or clinical evaluation when necessary. When submitting the R-F-A--, it is important to include the following information: ownership of the vehicle to be modified or the relationship of the vehicle owner to the individual, make, model, mileage, and year of the vehicle, a signed and approved R-F-A--, a signed and approved PCISP/service authorization, and receipts for all authorized expenses related to the modification. Furthermore, any necessary documentation to comply with F-S-S-A and division-specific guidelines and policies must also be included. Reimbursement is available for modifications that meet the service and documentation standards outlined in this policy, are allowable under current Medicaid waiver guidelines, and not covered under the Rehabilitation Act of 1973, as amended. These modifications must also be included in the individual's approved PCISP/service authorization and authorized on the R-F-A--, linked to the PCISP/service authorization.. 

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DDRS HCBS Waivers 
Section 11: RFA Policies 
196 
Library Reference Number: PRPR10014 
 
Published: Sept. 9, 2024 
 
Policies and procedures as of July 1, 2024 
 
Version: 11.1 
Documentation Standards 
• The identified direct benefit or need must be documented within all the following: 
– PCISP/service authorization 
– Physician prescription and/or clinical evaluation as deemed appropriate 
• Documentation/explanation of service within the Request for Approval to Authorize Services (RFA) 
must include:  
– Ownership of vehicle to be modified or vehicle owner’s relationship to the individual and the 
following information: 
➢ Make, model, mileage and year of vehicle to be modified 
➢ Signed and approved RFA 
➢ Signed and approved PCISP/service authorization 
➢ Receipts for all authorized expenses related to the modification 
➢ Any documentation needed to be in compliance with FSSA and division-specific guidelines 
and/or policies 
Reimbursement 
Reimbursement is available for modifications that satisfy each of the following: 
• Service and documentation standards outlined within this policy 
• Allowable under current Medicaid waiver guideline 
• Not available under the Rehabilitation Act of 1973, as amended 
• Included in the individual’s approved PCISP/service authorization 
• Authorized on the RFA and linked to the PCISP/service authorization 
• Included on a state-approved and signed service authorization 
• Completed by a BDS-approved HCBS Medicaid waiver provider (that is approved to perform this 
service) 
Modifications/Items – Covered 
Justification and documentation are required to demonstrate that the modification is necessary to meet the 
individual’s identified needs for the following: 
• Wheelchair lifts 
• Wheelchair tie-downs (if not included with lift) 
• Wheelchair/scooter hoist 
• Wheelchair/scooter carrier for roof or back of vehicle 
• Raised roof and raised door openings 
• Lowered floor van conversions 
• Wheelchair ramp for vehicle 
• Power transfer seat base (excludes mobility base) 
• Maintenance is limited to $1,000 annually for repair and service of items that have been funded 
through a HCBS waiver:  
– Requests for service must differentiate between parts and labor costs.

[Audio] Section 11 of our presentation covers the R-F-A policies for DDRS HCBS waivers, specifically for home modifications such as stair lifts, air conditioners/purifiers, widened doorways, and window replacements. It's important to note that these modifications must meet the state's standards for color, style, and design, and will be reviewed by either the state division director or state agency designee. We understand that maintenance for these modifications may be a concern, so for any needs exceeding $500 per year, our case managers will work with other funding sources and community agencies to find a solution. If the cost of services exceeds the annual limit, we request that parts and labor funded through the waiver be itemized separately from those funded through nonwaiver sources for transparency in our accounting. Lastly, any requests for items or modifications not previously listed must be reviewed and decided upon by the state division director or state agency designee, including CB radios, cell phones, alarm systems, auto loan payments, insurance coverage, and routine maintenance for the vehicle. Please note that this list is not exhaustive and may be updated in the future. Thank you for your attention during this portion of our presentation. Proceed to section 12 for more information on our policies and procedures.. 

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Section 11: RFA Policies 
DDRS HCBS Waivers 
Library Reference Number: PRPR10014 
197 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
– 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. If service costs exceed the annual 
limit, those parts and labor costs funded through the waiver must be itemized clearly to 
differentiate the waiver service provision from those parts and labor provided through a 
nonwaiver funding source. 
Items requested that are not listed above must be reviewed and decision rendered by the state division 
director or state agency designee.  
Modifications/Items – Noncovered* 
Examples/descriptions of modifications/items not covered include, but are not limited to, the following:  
• Purchase, installation or maintenance of CB radios, cellular phones, global positioning/tracking 
devices or other mobile communication devices 
• Repair or replacement of modified equipment damaged or destroyed in an accident 
• Alarm systems 
• Auto loan payments 
• Insurance coverage 
• Driver’s license, title registration or license plates 
• Emergency road service 
• Routine maintenance and repairs related to the vehicle itself 
*Note: Until policy is updated – 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 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 this section. As an interim step 
toward RFA policy updates, BDS will develop a Specialized Medical Equipment and 
Supplies fact sheet citing things individuals and families may wish to consider prior 
to submitting a request. 
Decision-Making Authority 
• Each division, with approval from the FSSA Office of the Secretary, shall identify a designees or 
designees to render decisions based upon the articles within this policy.  
• The designees are responsible for preparing and presenting testimony for all fair hearings – see 
Section 8: Appeal Process. 
• The case management entity, working as an agent of the state, shall not attend fair hearings in 
opposition of the state. 
• Each division shall implement a Quality Assurance Plan. In the event of inappropriate 
authorizations being granted, any or all of the following actions may be required: 
– A corrective action plan (CAP) 
– Reimbursement to Medicaid 
– Loss of decision-making authority

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[Audio] Section 12 discusses the Health and Wellness (H&W) and Traumatic Brain Injury (T-B-I--) waivers. The purpose of today's presentation is to provide an overview of the policies and procedures for home modifications under the DDRS HCBS Waiver program. These modifications include stair lifts, single-room air conditioners/air purifiers, widening doorways, and replacing windows. It is acknowledged that these modifications play a crucial role in helping individuals with disabilities maintain their independence and safety at home. It is important to note that for the completed modifications, efforts will be made to match the color, style, and design as closely as possible. The state division director or state agency designee will review and make a decision about these modifications. However, the maintenance for modifications provided through a H-C-B-S waiver is limited to $500 annually. It should also be noted that any modifications or items not mentioned above will be reviewed and decided upon by the state division director or state agency designee. Examples of non-covered modifications and items include central air conditioning, routine home maintenance, and standard home fixtures. Moving on to Section 12.1, the eligibility requirements for the H&W and T-B-I waivers will be highlighted. In order to receive Home and Community-Based Services (H-C-B-S-) waiver coverage, individuals must meet the qualifications for an institutional level of care (L-O-C--) and be enrolled in the Indiana Health Coverage Programs (I-H-C-P-). Additional requirements may apply, depending on the specific waiver program. It is worth noting that until 2025, the Area Agencies on Aging (AAAs) will serve as the entry points for the H&W and T-B-I waivers. The initial functional eligibility and level of care (L-O-C--) assessment will be carried out by the A-A-A-s-. Additionally, the Division of Disability & Rehabilitative Services (D-D-R-S-) within the Indiana Family and Social Services Administration (F-S-S-A-) also supports the Health and Wellness (H&W) and Traumatic Brain Injury (T-B-I--) Waiver, along with the Family Supports Waiver (F-S-W--) and Community Integration and Habilitation (C-I-H--) Waiver. For more information about the services available under the F-S-W and C-I-H Waivers, please refer to Section 10: Service Definitions and Requirements for F-S-W and C-I-H Waivers, as well as Section 11: R-F-A Policies. These sections, along with Sections 1-9, also contain specific information.. 

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Library Reference Number: PRPR10014 
199 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
Section 12: Health and Wellness (H&W) and 
Traumatic Brain Injury (TBI) Waivers 
The Division of Disability & Rehabilitative Services (DDRS) within the Indiana Family and Social 
Services Administration (FSSA) supports the Health and Wellness (H&W) and Traumatic Brain Injury 
(TBI) Waiver, in addition to the Family Supports Waiver (FSW) and Community Integration and 
Habilitation (CIH) Waiver.  
Note: For information specific to services available under the FSW and CIH Waiver, see 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers and 
Section 11: RFA Policies. Sections 1–9 also contain some information specific to the 
FSW and CIH Waiver, as well as some general information applicable to all four 
waivers. 
Section 12.1: Eligibility for H&W and TBI Waiver 
Services 
To be eligible for Home- and Community-Based Services (HCBS) waiver coverage, individuals must 
qualify for an institutional level of care (LOC) and must be enrolled in the Indiana Health Coverage 
Programs (IHCP). Additional requirements apply, based on the specific waiver program. 
Until 2025, the Area Agencies on Aging (AAAs) are the entry points for the H&W and TBI waivers. Initial 
functional eligibility and level of care (LOC) are determined by the entry point agencies, unless the 
participant has been in a nursing facility for at least 90 days. In that instance, if a participant has already 
received a long-term LOC designation for a nursing facility stay, then that determination will serve as the 
initial LOC evaluation. 
Individuals determined eligible for the H&W or TBI Waiver must be enrolled in Traditional Medicaid – a 
fee-for-service (FFS) program with full Indiana Medicaid State Plan benefits. Financial eligibility is 
determined by the Division of Family Resources (DFR).  
Before the waiver benefit plan can be assigned in the Core Medicaid Management Information System 
(CoreMMIS), the member must first have FFS Traditional Medicaid coverage, the waiver benefit plan and 
the initial service plan must be approved, and a start date established. The waiver benefit plan with the start 
date is then entered into CoreMMIS by the FSSA. 
Note: The fiscal agent cannot add or correct a waiver benefit plan assignment in 
CoreMMIS nor terminate a managed care enrollment. 
All service providers must verify IHCP eligibility for each member before initiating services. If a member 
does not have an active HCBS waiver benefit plan and/or is not enrolled in an appropriate IHCP Medicaid 
program on the date on which waiver services were provided, any claim submitted for those services may 
not be paid. Waiver liability and transfer-of-property penalty may also impact waiver claim payment. For 
more information, see Verifying IHCP Member Eligibility for HCBS Waiver Services, in Section 2 of this 
module.

[Audio] Section 12 of the DDRS HCBS Waivers focuses on eligibility requirements for the Health and Wellness (H&W) and Traumatic Brain Injury (T-B-I--) Waivers. These waivers have specific criteria that must be met in order for individuals to qualify. For the H&W Waiver, the key requirement is meeting the criteria for nursing facility (N-F---) level of care. For the T-B-I Waiver, individuals must meet either NF level of care criteria or intermediate care facility for individuals with intellectual disabilities (ICF/IID) level of care criteria, as outlined in the Indiana Administrative Code 405 I-A-C 1-3-1. Under Indiana law, nursing facilities can receive reimbursement for eligible individuals who require skilled or intermediate nursing care. This includes daily skilled nursing services ordered by a physician, as well as intermediate nursing care for stable or recovering patients. In order to be eligible for the H&W Waiver, individuals must also be functionally eligible, meaning they have a medical need for services such as skilled nursing care, personal care, and home modifications. These modifications, which include stair lifts, air conditioners, widened doorways, and window replacements, will be carefully reviewed by the state division director or agency designee to ensure they match the aesthetic of the home. It should be noted that maintenance for these modifications is limited to $500 per year, and any non-covered items, such as central air conditioning or routine home maintenance, will be reviewed and decided upon by the state division director or agency designee. In conclusion, the DDRS HCBS Waivers have specific requirements for the H&W and T-B-I Waivers, including level of care and functional eligibility, in order for individuals to qualify. Thank you for your attention during this presentation.. 

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DDRS HCBS Waivers 
Section 12: Health and Wellness (H&W) and Traumatic Brain Injury (TBI) Waivers 
200 
Library Reference Number: PRPR10014 
 
Published: Sept. 9, 2024 
 
Policies and procedures as of July 1, 2024 
 
Version: 11.1 
Level of Care (LOC) Requirements 
Level-of-care (LOC) requirements for the H&W and TBI waivers are as follows:  
• Persons must meet the criteria for nursing facility (NF) LOC as a key component of eligibility for 
the H&W Waiver. 
• Persons seeking eligibility for the TBI Waiver must meet either NF LOC criteria or intermediate 
care facility for individuals with intellectual disabilities (ICF/IID) LOC criteria. 
The criteria necessary to meet NF LOC or ICF/IID LOC are outlined in Indiana Administrative Code 
405 IAC 1-3-1. 
Indiana law allows reimbursement to nursing facilities for eligible individuals who require skilled or 
intermediate nursing care. Skilled nursing services, as ordered by a physician, must be required and 
provided on a daily basis, essentially seven days a week. Intermediate nursing care includes care for 
patients with long-term illnesses or disabilities that are relatively stable, or care for patients nearing 
recovery and discharge who continue to require some professional medical or nursing supervision and 
attention. 
An individual is functionally eligible for the H&W Waiver if the need for medical or nursing supervision 
and attention is determined by any of the following findings from the functional screening: 
• Need for direct assistance at least five days per week due to unstable, complex medical conditions 
• Need for direct assistance for three or more substantial medical conditions including activities of 
daily living 
All applicants to the H&W Waiver are screened for NF LOC. Indiana has established the Eligibility Screen 
(E-Screen), a tool that is used to determine whether an individual meets the basic criteria for NF LOC. The 
E-Screen must be completed by the care manager from the Area Agency on Aging (AAA), as part of the 
LOC packet. An E-Screen will not be accepted by the computer system if all the pages of the E-Screen 
have not been addressed.  
All initial evaluations for the H&W waiver are completed by the AAA care manager, and determinations 
are rendered by the care manager supervisor, unless the participant has been in a nursing facility for at least 
90 days. In that instance, if a participant has already received a long-term LOC designation for a nursing 
facility stay, then that determination will serve as the initial evaluation. All initial LOC approvals are 
reviewed and verified by the FSSA staff before service implementation. 
Medicaid Eligibility and Disability Determinations 
To receive HCBS waiver services, an individual must be enrolled in the IHCP.  
If an individual has a disability determination from the Social Security Administration (SSA), the state uses 
the SSA determination for Medicaid eligibility purposes. Individuals considered disabled by the SSA are 
considered disabled by the IHCP. However, by law, the IHCP determines eligibility for individuals who 
apply to Indiana Medicaid without having received SSA disability determination. The following conditions 
apply: 
• For those between 18–64, the IHCP requires an approval, active application or appeal to the SSA on 
file with the FSSA as part of the eligibility process.  
• Individuals 18–64 who are found eligible for the IHCP are required to have an approval, active 
application or appeal to SSA on file with the FSSA. 
• If the SSA’s disability determination differs from the IHCP determination, the SSA determination is 
considered final. As a 1634 state, Indiana is required to defer to all SSA disability determinations. 
For example, if the Medicaid agency’s MRT deemed an individual to be nondisabled but the SSA

 part 15

The DDRS HCBS Waiver program is designed to provide individuals with disabilities the opportunity to reside comfortably and securely in their own homes. The program allows certain home modifications to be made to enhance accessibility and functionality. The policies and procedures for home modifications under the DDRS HCBS Waiver program will be outlined on slide 2. These modifications include stair lifts, single-room air conditioners/air purifiers, widening doorways, and replacing windows. The completed modifications will be reviewed by the state division director or state agency designee to ensure the best fit for each individual. Maintenance for modifications provided through the H-C-B-S Waiver is limited to $500 annually, and any modifications or items not listed above will be reviewed and a decision will be made by the state division director or state agency designee. Examples of non-covered modifications and items include central air conditioning, routine home maintenance, and standard home fixtures. Moving on to section 11, we will discuss the R-F-A (Request for Approval) policies for the DDRS HCBS Waivers. Swimming pools, spas, or hot tubs are not covered under the program. Additionally, video monitoring systems, adaptive switches or buttons for entertainment, employment, or education devices, and home security systems are also not included in the modifications. Modifications that create living space or facilities where they did not previously exist, such as installing a bathroom in a garage or basement, are not covered. Similarly, duplicating existing accessibility, such as a second accessible bathroom or second means of egress, is also not included. Any adaptations that have not been approved on a Request for Approval to Authorize Services form will not be covered. Lastly, please note that individuals living in foster homes, group homes, assisted living facilities, or homes for special services, which includes any licensed residential facility, are not eligible for home modifications under the DDRS HCBS Waiver program. The responsibility for such modifications rests with the facility owner or operator.

avatar

There are two waivers under the DDRS HCBS program that impact the use of Specialized Medical Equipment and Supplies: the Community Integration and Habilitation (C-I-H--) Waiver and the Family Supports Waiver (F-S-W--). This subsection focuses on the waiver policy notification and the authority that guides the policy. The Clarification of the Specialized Medical Equipment and Supplies Policy impacts these two waivers. The effective date for this policy is December 1st, 2007, and it replaces all previous policies related to the authorization of Specialized Medical Equipment and Supplies. Individuals enrolled in the DDRS HCBS Waiver program need Specialized Medical Equipment and Supplies, such as sensory items, seizure detection devices, G-P-S tracking devices, and other electronic devices that are not currently specified as covered or reimbursable under the waiver or current R-F-A policy. These items can be electronically submitted for consideration under Specialized Medical Equipment and Supplies via the Request for Approval to Authorize Services form. For modifications provided through a H-C-B-S waiver, maintenance is limited to $500 annually. Any modifications or items not listed in the waiver policy will be reviewed and a decision will be made by the state division director or state agency designee. The policies and procedures in place are designed to ensure the safety and well-being of individuals enrolled in the H-C-B-S waiver program. The state division director or state agency designee will carefully review each request for specialized medical equipment and supplies to ensure that it is necessary and beneficial for the individual's overall health and independence. Thank you for your attention to this important section of the presentation.

Section 11 of the DDRS HCBS Waivers outlines the policies and procedures for Request for Authorization (R-F-A--) and reimbursement for home modifications. When a person requests a specific brand for a modification, they are limited to the Indiana Medicaid State Plan covered service/brand. This means that reimbursement for the requested item will be based on the Indiana Medicaid State Plan fee schedule. If the requested item is not covered under the Indiana Medicaid State Plan, it will not be reimbursed. To learn more about coverage under the Indiana Medicaid State Plan, please refer to Indiana Administrative Code 405 I-A-C 5-19. All requests for items to be purchased through a Medicaid waiver must include documentation of an Indiana Medicaid State Plan PA request and decision. Specialized Medical Equipment and Supplies will only be authorized if they are determined to be medically necessary and have a direct medical or remedial benefit for the waiver individual. This determination takes into account several factors, including cost-effectiveness and individualized, specific needs that are not in excess. Additionally, for items over $1000, three bids must be obtained. If this is not possible, it must be documented.

This section of our presentation focuses on the policies for home modifications under the DDRS HCBS Waiver program. We will discuss the documentation standards and reimbursement guidelines for these modifications.  First, we will discuss the documentation requirements for home modifications. This includes a service authorization, a physician's prescription or clinical evaluation, and a P-C-I-S-P under the F-S-W or C-I-H Waiver. Additionally, if applicable, the Indiana Medicaid State Plan prior authorization request and decision must be included.  We will also discuss the reimbursement process for Specialized Medical Equipment and Supplies. Reimbursement is available for these supplies if they meet certain criteria, such as adhering to the service and documentation standards outlined in this policy, being allowed under current Medicaid waiver guidelines, not being available under the Rehabilitation Act of 1973, and being included in the individual's approved P-C-I-S-P and service authorization. It is important for providers to ensure that the service and documentation standards are met before requesting reimbursement. Thank you for listening to this section on the R-F-A policies for the DDRS HCBS Waivers. We will now move on to Section 12 of our presentation.

Our presentation today will cover the policies and procedures for home modifications offered through the DDRS HCBS Waiver program. The program provides a variety of modifications including stair lifts, air conditioners/purifiers, doorways, and windows. To ensure the modifications match the home's color, style, and design, they will be carefully reviewed. The maintenance for these modifications is limited to $500 per year. Any modifications or items not listed above will undergo a review for approval. In regards to R-F-A policies, we also offer self-help devices, such as tables and reachers, prescribed by physical or occupational therapists. Additionally, strollers are available upon request for individuals who require them for transportation but do not need a full-time mobility device. Our manual wheelchairs can also be provided for safe mobility, with an annual maintenance limit of $1000. Posture and feeding chairs, prescribed by a physician or therapist, are also available. It's important to note that while not currently covered, special items such as sensory equipment, seizure detection devices, and G-P-S trackers can be considered for coverage through the Request for Approval to Authorize Services form. Lastly, please be aware that items such as hospital beds, mattresses, therapy equipment, and electronics, including CD players and cameras, are not covered under the waiver or R-F-A policy.

As the presenter, we are gathered here to discuss the policies and procedures for home modifications covered under the DDRS HCBS Waiver program. These modifications include stair lifts, single-room air conditioners/air purifiers, widened doorways, and window replacements. The completed modifications will be closely reviewed by the state division director or state agency designee to ensure they match the color, style, and design of the original home as closely as possible. However, maintenance for these modifications is limited to $500 annually.

Any modifications or items that are not listed, such as central air conditioning, routine home maintenance, and standard home fixtures, will also be reviewed and decided upon by the state division director or state agency designee. Moving on to the R-F-A policies for DDRS HCBS Waivers, we cover a wide range of items and equipment under this service. This includes adaptive switches and buttons, exercise equipment, furniture, appliances, indoor and outdoor play equipment, and positioning devices. 

Additionally, items that can be authorized through the Indiana Medicaid State Plan are also covered. However, any equipment or items that are purchased or obtained by the individual, their family members, or other nonwaiver providers are not covered unless specifically authorized through this service. In rare circumstances, a new or unexpected item may be presented for consideration as a covered item under this service. In order to do so, a written proposal justifying the need for the item must be submitted to the FSSA OMPP for further review and consideration by the F-S-S-A Policy Governance Board. The proposal should be directed to the Director of Agency Coordination and Integration at the Office of Medicaid Policy and Planning. These are the necessary steps to obtain coverage for any new or unanticipated items under this service.

This presentation focuses on slide 8, where we will discuss the policies and procedures for home modifications under the DDRS HCBS Waiver program. These modifications are vital for individuals with disabilities to safely navigate their homes and access their communities. Our objective is to ensure that these modifications are closely matched to the color, style, and design of the individual's home. The state division director or state agency designee will make the decision on these modifications. Any modifications or items not included in our program will also be assessed and decided upon by the state division director or state agency designee. These may include central air conditioning, routine home maintenance, and standard home fixtures. 

Moving on to section 11 of our policy, each division is required to implement a Quality Assurance Plan to ensure appropriate authorizations are being granted. In the case of any inappropriate authorizations, the following actions may be taken: a corrective action plan, reimbursement to Medicaid, or a loss of decision-making authority. Section 11.3 specifically addresses vehicle modifications for the F-S-W and C-I-H Waivers. This policy clarification, in accordance with 42 CFR 441.302, affects both the Community Integration and Habilitation (C-I-H--) Waiver and the Family Supports Waiver (F-S-W--). This policy was implemented on December 1, 2007, and replaces all previous policies related to the authorization of vehicle modifications. 

Vehicle Modifications, or V-M-O-D-, refer to the addition of adaptive equipment or structural changes to a motor vehicle that allow individuals with disabilities to safely transport in a vehicle. These modifications are necessary to increase an individual's ability to function in a home and community-based setting, ensuring accessibility for individuals with mobility challenges. 

This concludes our presentation on the DDRS HCBS Waiver program and its policies. Thank you for your attention.

Section 11 of the presentation addresses the R-F-A policies for the DDRS HCBS Waiver program. This section discusses the significant topic of choosing a provider for home modifications. It is vital that the individual has the freedom to select from approved or certified providers who will submit bids or estimates for this service. It is worth noting that the provider with the lowest bid will be selected, unless the case manager provides a well-justified written explanation as to why a provider with a higher bid should be chosen. This process ensures fairness and transparency. Moving on to the requirements for vehicle modifications, it is imperative that all modifications are approved by the H-C-B-S waiver program before services are provided. This is to guarantee that the modifications meet the necessary standards and regulations. Additionally, any vehicle modification requests must meet the following criteria: firstly, the modification must be based on and tailored to meet the individual's specific needs. This means that only one vehicle per individual's household may be modified. Moreover, the vehicle must be less than 10 years old and have less than 100000 miles on the odometer. This is to ensure that the modified vehicle is safe and reliable for the individual. Lastly, all vehicle modifications must be deemed medically necessary and/or have direct medical or remedial benefits for the waiver individual. This determination will take into account the cost-effectiveness and individualized approach of the modification, as well as ensuring that it is not excessive. Thank you for your attention to these crucial policies for the DDRS HCBS Waiver program. We are committed to providing the best care for individuals with disabilities, and these policies and procedures help us ensure that their needs are met in an equitable and efficient manner.

During our presentation, we will now discuss Section 11, which outlines the policies and procedures for home modifications in the DDRS HCBS Waiver program. These modifications, such as stair lifts, single-room air conditioners/air purifiers, widening doorways, and replacing windows, are essential for ensuring the safety and accessibility of individuals with disabilities. It is important to note that the completed modifications will be carefully reviewed and approved by the state division director or state agency designee in order to match the color, style, and design as closely as possible. Additionally, it is crucial for all modifications provided through the H-C-B-S waiver to be properly maintained. Therefore, there is a limitation of $500 annually for maintenance expenses. Please be aware that any modifications or items not listed above will also require review and approval by the state division director or state agency designee. This includes non-covered examples such as central air conditioning, routine home maintenance, and standard home fixtures. Moving on to the next section, we will discuss the documentation standards for the R-F-A (Request for Approval to Authorize Services). According to our policy, the identified direct benefit or need must be documented within the PCISP/service authorization, as well as a physician's prescription and/or clinical evaluation when necessary. When submitting the R-F-A--, it is important to include the following information: ownership of the vehicle to be modified or the relationship of the vehicle owner to the individual, make, model, mileage, and year of the vehicle, a signed and approved R-F-A--, a signed and approved PCISP/service authorization, and receipts for all authorized expenses related to the modification. Furthermore, any necessary documentation to comply with F-S-S-A and division-specific guidelines and policies must also be included. Reimbursement is available for modifications that meet the service and documentation standards outlined in this policy, are allowable under current Medicaid waiver guidelines, and not covered under the Rehabilitation Act of 1973, as amended. These modifications must also be included in the individual's approved PCISP/service authorization and authorized on the R-F-A--, linked to the PCISP/service authorization.

Section 11 of our presentation covers the R-F-A policies for DDRS HCBS waivers, specifically for home modifications such as stair lifts, air conditioners/purifiers, widened doorways, and window replacements. It's important to note that these modifications must meet the state's standards for color, style, and design, and will be reviewed by either the state division director or state agency designee. We understand that maintenance for these modifications may be a concern, so for any needs exceeding $500 per year, our case managers will work with other funding sources and community agencies to find a solution. If the cost of services exceeds the annual limit, we request that parts and labor funded through the waiver be itemized separately from those funded through nonwaiver sources for transparency in our accounting. Lastly, any requests for items or modifications not previously listed must be reviewed and decided upon by the state division director or state agency designee, including CB radios, cell phones, alarm systems, auto loan payments, insurance coverage, and routine maintenance for the vehicle. Please note that this list is not exhaustive and may be updated in the future. Thank you for your attention during this portion of our presentation. Proceed to section 12 for more information on our policies and procedures.

Section 12 discusses the Health and Wellness (H&W) and Traumatic Brain Injury (T-B-I--) waivers. The purpose of today's presentation is to provide an overview of the policies and procedures for home modifications under the DDRS HCBS Waiver program. These modifications include stair lifts, single-room air conditioners/air purifiers, widening doorways, and replacing windows. It is acknowledged that these modifications play a crucial role in helping individuals with disabilities maintain their independence and safety at home. 

It is important to note that for the completed modifications, efforts will be made to match the color, style, and design as closely as possible. The state division director or state agency designee will review and make a decision about these modifications. However, the maintenance for modifications provided through a H-C-B-S waiver is limited to $500 annually. It should also be noted that any modifications or items not mentioned above will be reviewed and decided upon by the state division director or state agency designee. Examples of non-covered modifications and items include central air conditioning, routine home maintenance, and standard home fixtures. 

Moving on to Section 12.1, the eligibility requirements for the H&W and T-B-I waivers will be highlighted. In order to receive Home and Community-Based Services (H-C-B-S-) waiver coverage, individuals must meet the qualifications for an institutional level of care (L-O-C--) and be enrolled in the Indiana Health Coverage Programs (I-H-C-P-). Additional requirements may apply, depending on the specific waiver program. 

It is worth noting that until 2025, the Area Agencies on Aging (AAAs) will serve as the entry points for the H&W and T-B-I waivers. The initial functional eligibility and level of care (L-O-C--) assessment will be carried out by the A-A-A-s-. Additionally, the Division of Disability & Rehabilitative Services (D-D-R-S-) within the Indiana Family and Social Services Administration (F-S-S-A-) also supports the Health and Wellness (H&W) and Traumatic Brain Injury (T-B-I--) Waiver, along with the Family Supports Waiver (F-S-W--) and Community Integration and Habilitation (C-I-H--) Waiver. 

For more information about the services available under the F-S-W and C-I-H Waivers, please refer to Section 10: Service Definitions and Requirements for F-S-W and C-I-H Waivers, as well as Section 11: R-F-A Policies. These sections, along with Sections 1-9, also contain specific information.

Section 12 of the DDRS HCBS Waivers focuses on eligibility requirements for the Health and Wellness (H&W) and Traumatic Brain Injury (T-B-I--) Waivers. These waivers have specific criteria that must be met in order for individuals to qualify. For the H&W Waiver, the key requirement is meeting the criteria for nursing facility (N-F---) level of care. For the T-B-I Waiver, individuals must meet either NF level of care criteria or intermediate care facility for individuals with intellectual disabilities (ICF/IID) level of care criteria, as outlined in the Indiana Administrative Code 405 I-A-C 1-3-1. Under Indiana law, nursing facilities can receive reimbursement for eligible individuals who require skilled or intermediate nursing care. This includes daily skilled nursing services ordered by a physician, as well as intermediate nursing care for stable or recovering patients. In order to be eligible for the H&W Waiver, individuals must also be functionally eligible, meaning they have a medical need for services such as skilled nursing care, personal care, and home modifications. These modifications, which include stair lifts, air conditioners, widened doorways, and window replacements, will be carefully reviewed by the state division director or agency designee to ensure they match the aesthetic of the home. It should be noted that maintenance for these modifications is limited to $500 per year, and any non-covered items, such as central air conditioning or routine home maintenance, will be reviewed and decided upon by the state division director or agency designee. In conclusion, the DDRS HCBS Waivers have specific requirements for the H&W and T-B-I Waivers, including level of care and functional eligibility, in order for individuals to qualify. Thank you for your attention during this presentation.