[Virtual Presenter] We have important news to share: Our program offers essential services to individuals with intellectual/developmental disabilities. Our administrative agency ensures that the individual's identity will not be revealed without written consent or a court order, in accordance with the H&W and T-B-I Waivers DDRS HCBS Waivers. Providers must also follow these standards when offering waiver services or other necessary services. When a complaint is investigated, the ombudsman reports their findings to the complainant. If a complaint is not investigated, the ombudsman informs the complainant of the decision and reasons for not investigating. This allows individuals to have a voice and advocate for their rights. We have a toll-free hotline available for receiving complaints about individuals with intellectual/developmental disabilities on waivers. All complaints received must be passed on to the statewide waiver ombudsman. The ombudsman will notify the individual that the complaint process is separate from a Medicaid fair hearing, but both options are available for addressing concerns. We conduct provider compliance reviews for non-licensed waiver service providers and licensed providers who offer services outside the scope of their license. These reviews include a check of provider policies and adherence to state and federal requirements. If a provider fails to cooperate or complete required actions, they may face sanctions from the B-D-S Quality Assurance Director. This ensures that providers are accountable and individuals receive high-quality services. Additionally, we prepare an annual report detailing the program's operations, trends, and recommendations for improvement. This report is shared with the governor, legislative council, and D-D-R-S director to keep stakeholders informed. We are committed to the success of our program and serving individuals with intellectual/developmental disabilities.. 

Scene 1

Section 12: Health and Wellness (H&W) and Traumatic Brain Injury (TBI) Waivers 
DDRS HCBS Waivers 
Library Reference Number: PRPR10014 
215 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
administrative agency, providers of waiver services and providers of other necessary or appropriate 
services and ensures that the identity of the individual will not be disclosed without either the 
individual's written consent or a court order. 
• At the conclusion of an investigation of a complaint, the ombudsman reports the ombudsman’s 
findings to the complainant. If the ombudsman does not investigate a complaint, the ombudsman 
notifies the complainant of the decision not to investigate and the reasons for the decision. 
• The statewide waiver ombudsman prepares a report at least annually (or upon request), describing 
the operations of the program. A copy of the report is provided to the governor, the legislative 
council and the director of the DDRS. Trends are identified so that recommendations for needed 
changes in the service delivery system can be implemented. 
• The administrative agency is required to maintain a statewide toll-free telephone line continuously 
open to receive complaints regarding waiver individuals with intellectual/developmental disabilities. 
All complaints received from the toll-free line must be forwarded to the statewide waiver 
ombudsman, who will advise the individual that the complaint process is not a prerequisite or a 
substitute for a Medicaid fair hearing when the problem falls under the scope of the Medicaid fair 
hearing process. 
• A person who does any of the following commits a Class B misdemeanor: 
– Intentionally prevents the work of the ombudsman 
– Knowingly offers compensation to the ombudsman in an effort to affect the outcome of an 
investigation or a potential investigation 
– Knowingly or intentionally retaliates against an individual, a client, an employee, or another 
person who files a complaint or provides information to the ombudsman 
Provider Compliance Reviews 
FSSA DDRS or its designee or contractor conducts provider compliance reviews for all nonlicensed waiver 
service providers, as well as licensed providers that also offer services that fall outside the scope of the 
license. The provider compliance review includes a review of provider policies and adherence to state and 
federal requirements, as well as the provider’s own policies. Site visits are conducted as part of the 
compliance review for all congregate settings, such as, adult day centers, adult family care homes and 
assisted living facilities.  
FSSA DDRS or its designees administer compliance reviews that include an extensive review of provider 
care coordinator and service coordinator documentation, service delivery records, policies and procedures, 
and compliance with other waiver and state requirements.  
For licensed providers, this review is conducted by the Indiana Department of Health (IDOH). Nonlicensed 
providers are reviewed by FSSA DDRS. Both IDOH and FSSA DDRS have formal review and corrective 
action procedures submitted by the provider with approval or denial by the FSSA. If denied, the provider is 
required to resubmit the CAP within a two-week time frame. After it is approved, FSSA DDRS verifies 
successful implementation of the CAP. Any provider not successfully completing the corrective action 
process is decertified as a provider.  
A provider’s failure to cooperate with the review procedure or to complete the corrective action process 
results in a referral to the BDS Quality Assurance Director or designee as a formal complaint, which may 
result in sanctions up to and including termination as a waiver provider. 
Any provider decertified as a result of noncompliance with the provider agreement or failing to complete 
corrective actions is notified of the decision, and of the provider’s right to appeal. Documentation of all 
corrective actions taken with providers is maintained in OMPP’s provider certification platform. Prior to 
taking action to suspend or terminate a provider, alternative service options will be provided to any affected 
participants through their care manager.

[Audio] This presentation aims to showcase the services available for individuals with intellectual and developmental disabilities through a program overseen by the Family and Social Services Administration (F-S-S-A-). Slide 2 will cover the programs outlined in the Health and Wellness (H&W) and Traumatic Brain Injury (T-B-I--) Waivers, including care coordination and provider reviews. F-S-S-A conducts various audits, including self-audits, desk audits, and on-site audits, to ensure program integrity. These audits are based on data analysis, identification of outliers and problematic billing patterns, and referrals from other divisions and state agencies. The Program Integrity Unit works closely with all waiver divisions and maintains open communication for policy clarification and other concerns. Although the Fraud and Abuse Detection System (F-A-D-S-) contractor may be involved, F-S-S-A maintains overall oversight throughout the process. The Audit Division of F-S-S-A reviews waiver audit schedules and findings to avoid repetition and ensure consistent methodology. In addition to provider reviews, certified care managers approved by the Division of Aging provide care management services for individuals on Medicaid waivers. Until 2025, the 15 local Area Agencies on Aging (AAAs) serve as the single point of entry for Medicaid waivers. Once eligibility is determined and approved, the A-A-A will provide the necessary documentation for the H&W or T-B-I waiver. We appreciate your attention and look forward to sharing more about the services we offer for individuals with intellectual and developmental disabilities through this program.. 

Scene 2

DDRS HCBS Waivers 
Section 12: Health and Wellness (H&W) and Traumatic Brain Injury (TBI) Waivers 
216 
Library Reference Number: PRPR10014 
 
Published: Sept. 9, 2024 
 
Policies and procedures as of July 1, 2024 
 
Version: 11.1 
Section 12.4: Program Integrity and Financial Oversight 
The Family and Social Services Administration (FSSA) has expanded its program integrity activities using 
a multifaceted approach that includes provider self-audits, desk audits and on-site audits. The Program 
Integrity Unit analyzes claim data, allowing them to identify providers and claims that indicate aberrant 
billing patterns and other risk factors. Based on this information, audits are completed as needed. 
The program integrity audit process uses data mining, research, identification of outliers, problematic 
billing patterns, aberrant providers and issues that are referred by other divisions and state agencies. The 
Program Integrity Unit also meets with all waiver divisions and receives referrals on an ongoing basis to 
maintain open lines of communication and understanding in specific areas of concern, such as policy 
clarification. 
The Program Integrity Unit offers education regarding key program initiatives and audit issues at waiver 
provider meetings to promote ongoing compliance with federal and state guidelines, including all IHCP and 
waiver requirements is available in the Provider and Member Utilization Review provider reference module 
at in.gov/medicaid/providers. 
FSSA Audit Oversight 
Throughout the entire program integrity process, the FSSA maintains oversight. Although the Fraud and 
Abuse Detection System (FADS) contractor may be incorporated in the audit process, no audit is 
performed without the authorization of the FSSA. The FSSA’s oversight of the contractor’s aggregate data 
is used to identify common problems to be audited, determine benchmarks and offer data to peer providers 
for educational purposes, when appropriate. 
The Audit Division of the FSSA reviews waiver audit team schedules and findings to reduce redundancy 
and assure use of consistent methodology. 
Medicaid Fraud Control Audit Overview 
The Indiana Medicaid Fraud Control Unit (MFCU) is an investigative branch of the Attorney General’s 
Office. MFCU conducts investigations in the following areas: 
• Medicaid provider fraud 
• Misuse of Medicaid members’ funds 
• Patient abuse or neglect in Medicaid facilities 
When the MFCU identifies a provider that has violated regulations in one of these areas, the provider’s 
case is presented to the state or federal prosecutors for appropriate action. Providers can access information 
about the MFCU at in.gov/attorneygeneral. 
Section 12.5: Care Coordination for TBI and H&W 
Waivers 
For TBI and H&W waivers, care management services for persons on Medicaid waivers are provided by 
certified care managers, as approved by the Division of Aging (FSSA). Until 2025, the 15 local Area 
Agencies on Aging (AAAs) serve as the single point of entry for Medicaid waivers. After an applicant has 
been determined to meet the eligibility criteria and approved to receive Medicaid waiver services, the AAA 
will provide necessary documentation for the H&W or TBI waiver.

[Audio] This meeting is about discussing the services offered under Section 12 of the H&W and T-B-I Waivers DDRS HCBS Waivers. Our service coordinators and care coordinators are highly qualified to provide the best care for our clients. Service coordinators must have at least one year of experience with the program population, be a registered nurse or licensed practical nurse, and hold a bachelor's or associate degree. They also have to have experience in delivering healthcare, social services, or case management. Our care coordinators must receive training on recommended topics from the F-S-S-A if any issues with their services arise. Care management cannot be conducted by anyone who also provides in-home or community-based services under F-S-S-A waivers, or anyone with common ownership or control of such services under the Medicaid waiver program. It is important to note that reimbursement for care management services is only possible when the client becomes eligible for waiver services. Care managers must meet the F-S-S-A guiding principles, which include being responsive, efficient, and effective in service delivery, as well as promoting effective communication, respect, dignity, and personal empowerment for all individuals. They must also adhere to person-centered planning, informed choice, and fiscal stewardship, while providing quality customer service and complying with F-S-S-A standards. Failure to cooperate with the review procedure or complete corrective actions may result in sanctions or even termination as a waiver provider. This is a serious matter and we are dedicated to ensuring the best care for our clients. For any concerns, we have a toll-free telephone line available at all times. It is important to us to address and resolve any issues in a timely manner.. 

Scene 3

Section 12: Health and Wellness (H&W) and Traumatic Brain Injury (TBI) Waivers 
DDRS HCBS Waivers 
Library Reference Number: PRPR10014 
217 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
NOTE:  
Please see Section 10.6: Case Management for FSW and CIH Waiver for 
information on the similarly named but unique service of case management available 
under the Family Supports Waiver (FSW) and Community Integration and 
Habilitation (CIH) Waiver. 
The following are minimum qualifications for service coordinators (must meet one of these): 
• Be an RN or LPN  
• Have at least one year of experience serving the program population 
• Have bachelor’s degree or associate degree with one year of experience 
• Delivering healthcare/social services or case management 
The following are minimum qualifications for care coordinators: 
• If the Family and Social Services Administration (FSSA) identifies a systemic problem with a care 
manager’s services, the care manager must obtain training on the topics recommended by the FSSA. 
• Care management may not be conducted by any organization, entity or individual that also delivers 
other in-home and community-based services under the FSSA waiver programs, or any 
organization, entity, or individual with common ownership or control in any other organization, 
entity, or individual that also delivers other in-home and community-based services under the 
Medicaid waiver program. The exception is an AAA that has been granted permission by the FSSA 
to provide direct services to members. The FSSA uses the following definitions in determining 
common ownership, control or relation: 
– Common Ownership exists when an individual, individuals or any legal entity possesses 
ownership or equity of at least 5% in the provider entity, as well as the institution or organization 
serving the provider. 
– Control exists where an individual or organization has the power or the ability, directly or 
indirectly, to influence or direct the actions or policies of an organization or institution, whether 
or not the control is actually exercised. 
– Related means associated or affiliated with, or having the ability to control, or be controlled by. 
Reimbursement of care management services, as defined in this module, may not be made unless and until 
the client becomes eligible for waiver service. Care management service provided to individuals who are 
not eligible for FSSA waiver services will not be reimbursed as a waiver service. 
Care Management Monitoring Standards 
Each care manager must meet the following standards to fulfill the FSSA guiding principles: 
• Responsive, efficient, effective, quality, and timely service delivery 
• Effective communication 
• Respect, dignity, integrity and rights for all individuals 
• Person-centered planning, informed choice, and personal empowerment 
• Community-based services 
• Fiscal stewardship 
• Quality customer services 
Care managers are to comply with all applicable FSSA standards. The following subsection is excerpted 
from the Care Management Medicaid Waiver Provider Agreement.

[Audio] This presentation will discuss the DDRS HCBS Waivers, specifically Section 12, which covers the Health and Wellness (H&W) and Traumatic Brain Injury (T-B-I--) Waivers. It is our top priority to protect the privacy of all individuals receiving waivers. We ensure that their identity is kept confidential and only shared with their written consent or a court order. Any complaints are thoroughly investigated by our ombudsman, who then reports their findings to the complainant in a timely and professional manner. In addition to our strict privacy policies, we also have ongoing Medicaid H-C-B-S Waiver Care Management Standards that all care managers must adhere to. These standards include maintaining high levels of professionalism and ethical conduct, following all documents issued by the F-S-S-A-, and complying with federal, state, and local laws and regulations. Care managers are also required to complete annual training. Before being eligible for Medicaid reimbursement, care managers must complete a comprehensive orientation program that covers topics such as general care management, narrative, skilled needs, activities of daily living, and incident reporting. They are also required to complete an additional 18 hours of training annually, which can cover topics such as care coordination, documentation, medical terminology, and specific diagnoses or treatments that affect our diverse client base. It is important to note that certain training topics, such as care management orientation and required annual retraining, do not count towards the required 18 hours. Additionally, all training documentation is regularly reviewed in compliance surveys and at the request of the FSSA. Our commitment to privacy, professionalism, and ethical standards is evident in every aspect of our program. We strive to provide the best possible care to our waiver individuals and are constantly seeking ways to improve and enhance our services. Thank you for your attention.. 

Scene 4

DDRS HCBS Waivers 
Section 12: Health and Wellness (H&W) and Traumatic Brain Injury (TBI) Waivers 
218 
Library Reference Number: PRPR10014 
 
Published: Sept. 9, 2024 
 
Policies and procedures as of July 1, 2024 
 
Version: 11.1 
Ongoing Medicaid HCBS Waiver Care Management Standards 
HCBS waiver care managers need to maintain the following standards: 
• Maintain the highest professional and ethical standards in the conduct of their business. 
• Comply with all FSSA-issued documents, as well as all federal, state and local law as well as all 
FSSA policy, rules, regulations and guidelines, including the Health Insurance Portability and 
Accountability Act (HIPAA). 
• Complete the care management orientation as approved by the FSSA prior to being eligible for 
Medicaid reimbursement. This orientation is now provided online and can be accessed from the 
Care Manager Resources page at in.gov/fssa/da. Completion of the modules is verified through 
completion of the final certification test. Following completion of the test, care managers are issued 
a certificate of completion.  
• Complete required annual training as follows: 
– The following components of the online orientation must be reviewed annually by all active care 
managers: 
➢ LOC modules – general, narrative, skilled needs, and activities of daily living 
➢ Incident reporting module 
➢ Service definition module 
– An additional 18 hours of training must be completed annually by all active care managers. 
➢ These trainings do not have to be preapproved by the FSSA but must be relevant to core care 
management functions. 
➢ Training documentation is subject to review in compliance surveys and at the FSSA’s request. 
➢ Relevant topics can include the following: 
▪ Care coordination 
▪ Documentation 
▪ Medical terminology 
▪ Other public or privately funded long-term services and support programs or benefits 
▪ Specific diagnosis or treatment topics affecting a broad spectrum of the client base, 
including but not limited to: 
o Fall prevention 
o Adaptive equipment 
o Chronic obstructive pulmonary disease (COPD) 
o Congestive heart failure 
o Diabetes 
o Traumatic brain injury 
o Kidney disease 
o Alzheimer’s disease 
o Seizures 
o Stroke 
o Heart disease 
o Mental health issues 
o Behavioral issues 
– The following will not be accepted as part of the required training: 
➢ Care management orientation 
➢ Required annual retraining 
➢ Vendor fairs 
➢ Staff meetings (unless there is an outside speaker or expert speaking on a relevant topic, or 
someone who attended a state training as a trainer is sharing that information) 
➢ Presentations related to employment issues; for example, performance appraisal process and 
retirement

[Audio] The H&W and T-B-I Waivers DDRS HCBS Waivers include a program, outlined in Section 12, that offers services to individuals with intellectual/developmental disabilities. Any information about these individuals will be kept confidential, unless written consent or a court order is obtained. An ombudsman is responsible for reporting findings to the person who filed a complaint and will also inform them if the complaint is not being investigated. Additionally, a yearly report is created that describes the program, identifies any trends, and makes recommendations for changes. Complaints regarding waiver individuals can be made through a toll-free telephone line at any time. Compliance reviews are conducted for both non-licensed and licensed providers to ensure they are following state and federal requirements. If a provider does not cooperate with the review process or fails to complete corrective actions, they may be referred to the B-D-S Quality Assurance Director for a formal complaint. This could result in sanctions, including termination as a waiver provider. All actions taken with providers are documented in OMPP's certification platform. Before taking any action, alternative service options will be offered to affected participants through their care manager.. 

Scene 5

Section 12: Health and Wellness (H&W) and Traumatic Brain Injury (TBI) Waivers 
DDRS HCBS Waivers 
Library Reference Number: PRPR10014 
219 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
➢ Communications that are part of supervisory oversight; for example, reinforcement of or 
retraining on job requirements, review of state guidelines, informational or training, sessions 
specific to a case, and so on 
– Required training hours are prorated in a care manager’s first year and are in addition to new 
care manager orientation. 
– Individuals will choose their service provider, from a list furnished by the state, including their 
care manager, and have the right to change any provider, including their care manager. 
– A maximum response time between implementation of the initial service plan and the first 
monitoring contact will be no more than 30 calendar days. 
– Care managers will have face-to-face contact with each individual a minimum of every 90 days 
to assess the quality and effectiveness of the service plan. At least two of these face-to-face 
contacts per year will be in the home setting. 
– Care managers will document, in the chronological narrative, each contact with the individual 
and each contact with providers within seven days of activity.  
– Care managers will assist with facilitating and monitoring the formal and informal supports that 
are developed to support the individual’s health and welfare in the community. 
– Care managers will provide each individual or guardian with clear and easy instructions for 
contacting the care manager or care manager agency. The care manager will also provide 
additional information and procedures for individuals who may need assistance or have an 
emergency that occurs before or after business hours. This information will be located in the 
home in a location that is visible from the telephone. 
– Care managers will complete face-to-face annual assessments and update the service plan as 
needed, in collaboration with the individual, in a timely and appropriate manner to avoid gaps in 
service authorization. 
– Care managers will support the individual communicating their needs, strengths and preferences 
to the support team. 
– Care managers will ensure that person-centered planning is occurring on an ongoing basis. 
– Care managers will monitor the ongoing services to ensure that they meet the individual’s needs 
and preferences. 
– Care managers will base the service plan upon the individual’s needs, strengths and preferences. 
– Care managers will ensure that the individual and all providers have a current, comprehensive 
service plan a copy of relevant documentation, including instructions on how to request an 
appeal. 
– Care managers will review and explain to the individual or guardian the services that will be 
provided, and the individual or their designated representative will sign the service plan to show 
understanding of, and agreement with, the plan. The service plan will not be implemented prior 
to receiving state approval. 
– Care managers will initiate timely follow-up of identified problems, whether self-identified or 
referred by others. Critical or crisis issues, including incident reports, will be acted upon 
immediately, as specified by the FSSA. All follow-up and resolution will be documented in the 
activities under the case record in the Care Management for Social Services (CaMSS). 
– Care managers will comply with all automation standards and requirements as prescribed by the 
FSSA for documentation and processing of care management activities. 
– Care managers will maintain privacy and confidentiality of all individual records. No 
information will be released or shared with others without the individual or guardian’s written 
consent. 
– Care managers will provide to the state upon request, ready access to all care manager 
documentation, either electronic or hard copy. 
– Care manager documentation will demonstrate that the safety and welfare of the individual are 
being monitored on a regular basis.

[Audio] We are discussing how to support individuals with intellectual/developmental disabilities through the program outlined in the H&W and T-B-I Waivers. As an administrator, I ensure that the individual's identity is not disclosed without written consent or a court order. As an ombudsman, I report findings and notify if not investigating a complaint. An annual report is prepared describing the program's operations, identifying trends, and recommending changes. A toll-free telephone line is available to receive complaints regarding waiver individuals. Provider compliance reviews are conducted for all non-licensed waiver service providers and licensed providers that offer services outside the scope of their license. Compliance reviews include a review of provider policies and adherence to state and federal requirements. Any provider who fails to cooperate with the review procedure or complete the corrective action process is referred to the B-D-S Quality Assurance Director or designee as a formal complaint, which may result in sanctions up to and including termination as a waiver provider. Documentation of all corrective actions taken with providers is maintained in OMPP’s provider certification platform. Prior to taking action to suspend or terminate a provider, alternative service options will be provided to any affected participants through their care manager.. 

Scene 6

DDRS HCBS Waivers 
Section 12: Health and Wellness (H&W) and Traumatic Brain Injury (TBI) Waivers 
220 
Library Reference Number: PRPR10014 
 
Published: Sept. 9, 2024 
 
Policies and procedures as of July 1, 2024 
 
Version: 11.1 
Section 12.6: H&W and TBI Waiver Services, Codes and 
Rates 
Note: For general information about billing and reimbursement for DDRS HCBS waiver 
services – including eligibility verifcation, claim completion and submission, and 
electronic visit verification requirements – see Section 2.3: Billing and 
Reimbursement for Waiver Services. Billing guidance specific to assisted living 
facilities appears in the Special Billing Instructions for Assisted Living 
FacilitiesBilling Instructions section. 
Table 8 lists services available under the Health and Wellness (H&W) Waiver and/or the Traumatic Brain 
Injury (TBI) Waiver, and identifies the associated procedure codes and modifiers, as well as the rates or 
payment methodology, as applicable. 
For procedure codes, modifiers and rates related to the Family Supports Waiver (FSW) and Community 
Integration and Habilitation (CIH) Waiver, see Section 10.2: Medicaid Waiver Services, Codes and Rates 
of this module. 
Table 8 – Medicaid HCBS Waiver Services, Codes and Rates for H&W and TBI Waivers 
Service Description 
HCPCS 
Code 
Mod 
1 
Mod 
2 
Mod 
3 
H&W 
Rate 
TBI  
Rate 
Notes 
Residential-Based 
Habilitation 
97535 
U7 
 
 
N/A 
$9.45 
0.25 Hour 
Nutritional Supplements 
B4150 
U7 
 
 
Individual 
Individual 
$1,200 Per Year 
Behavioral 
Management/Behavior 
Program and Counseling – 
Level 1 
H0004 
U7 
U1 
 
N/A 
$18.56 
0.25 Hour 
Behavioral 
Management/Behavior 
Program and Counseling – 
Level 2 
H0004 
U7 
U2 
 
N/A 
$18.56 
0.25 Hour 
Caregiver Coaching 
H0004 
U7 
U4 
 
$15.75 
N/A 
0.25 Hour 
Max 32 quarter 
hours (8 hours)/ 
month; cap 
$320/month per 
member 
Supported Employment 
H2023 
U7 
 
 
N/A 
$11.91 
0.25 Hour 
Adult Day Services – 
Level 1 (Category 1) 
S5100 
U7 
U1 
UC 
$3.32 
$3.32 
0.25 Hour 
Adult Day Services – 
Level 2 (Category 1) 
S5100 
U7 
U2 
UC 
$3.74 
$3.74 
0.25 Hour 
Adult Day Services – 
Level 3 (Category 1) 
S5100 
U7 
U3 
UC 
$4.76 
$4.76 
0.25 Hour 
Adult Day Services – 
Level 1 (Category 2) 
S5100 
U7 
U1 
 
$2.93 
$2.93 
0.25 Hour 
Adult Day Services – 
Level 2 (Category 2) 
S5100 
U7 
U2 
 
$3.30 
$3.30 
0.25 Hour

[Audio] We offer various services for individuals with intellectual/developmental disabilities through our programs outlined in the H&W and T-B-I Waivers DDRS HCBS Waivers. We prioritize the privacy and confidentiality of the individuals we serve by ensuring that their identity will not be disclosed without written consent or a court order. Any provider who fails to cooperate with the review procedure or complete the corrective action process is considered a formal complaint, which may result in sanctions up to and including termination as a waiver provider. We have a toll-free telephone line to receive complaints regarding waiver individuals and investigate and prepare an annual report describing the operations of the program, identifying trends, and recommending changes. Our program offers a variety of services, including Adult Day Services – Level 3 (Category 2), Attendant Care (Agency), Attendant Care (NonAgency), Attendant Care (ConsumerDirected), Participant-Directed Home Care – Skilled, Participant-Directed Home Care – Unskilled, Home and Community Assistance (Agency), Home and Community Assistance (Non-Agency), Structured Family Caregiving (Level 1), Structured Family Caregiving (Level 2), Structured Family Caregiving (Level 3), Adult Family Care (Level 1), Adult Family Care (Level 2), Adult Family Care (Level 3), Personal Emergency Response System – Install, Personal Emergency Response System – Maintenance, Home Modification Assessment, Home Modifications – Install, Home Modifications – Maintenance, Home-Delivered Meals, and Library Reference Number: PRPR10014. We are committed to complying with all state and federal requirements and have policies and procedures in place to protect the identity of the individual. We value your feedback and are committed to providing the best services possible for individuals with intellectual/developmental disabilities. Thank you for your time and attention.. 

Scene 7

Section 12: Health and Wellness (H&W) and Traumatic Brain Injury (TBI) Waivers 
DDRS HCBS Waivers 
Library Reference Number: PRPR10014 
221 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
Service Description 
HCPCS 
Code 
Mod 
1 
Mod 
2 
Mod 
3 
H&W 
Rate 
TBI  
Rate 
Notes 
Adult Day Services – 
Level 3 (Category 2) 
S5100 
U7 
U3 
 
$4.20 
$4.20 
0.25 Hour 
Attendant Care (Agency) 
S5125 
U7 
UA 
 
$8.59 
$8.59 
0.25 Hour 
Attendant Care (Non-
Agency) 
S5125 
U7 
 
 
$8.21 
$8.21 
0.25 Hour 
Attendant Care 
(Nonemergency Medical 
Transportation/Companion) 
S5125 
U7 
UA 
UC 
$8.59 
$8.59 
0.25 Hour 
Attendant Care (Consumer-
Directed) 
S5125 
U7 
U1 
 
$8.21 
N/A 
0.25 Hour 
Attendant Care (Consumer-
Directed Overtime) 
S5125 
U7 
U1 
TU 
$1.81 
N/A 
0.25 Hour 
Participant-Directed Home 
Care – Skilled 
S5125 
U7 
U2 
UA 
$14.97 
N/A 
0.25 Hour 
Participant-Directed Home 
Care – Unskilled  
S5125 
U7 
U2 
U9 
$8.59 
N/A 
0.25 Hour 
Home and Community 
Assistance (Agency) 
S5130 
U7 
UA 
 
$7.93 
$7.93 
0.25 Hour 
Home and Community 
Assistance (Non-Agency) 
S5130 
U7 
 
 
$7.68 
$7.68 
0.25 Hour 
Structured Family 
Caregiving (Level 1) 
S5140 
U7 
U1 
 
$77.54 
$77.54 
Per Day 
Structured Family 
Caregiving (Level 2) 
S5140 
U7 
U2 
 
$99.71 
$99.71 
Per Day 
Structured Family 
Caregiving (Level 3) 
S5140 
U7 
U3 
 
$133.44 
$133.44 
Per Day 
Adult Family Care 
(Level 1) 
S5141 
U7 
U1 
 
$67.93 
$67.93 
Per Day 
Adult Family Care 
(Level 2) 
S5141 
U7 
U2 
 
$72.34 
$72.34 
Per Day 
Adult Family Care 
(Level 3) 
S5141  
U7 
U3 
 
$90.64 
$90.64 
Per Day 
Personal Emergency 
Response System – Install 
S5160 
U7 
 
 
$54.41 
$54.41 
One Time 
Personal Emergency 
Response System – 
Maintenance 
S5161 
U7 
 
 
$54.41 
$54.41 
Monthly 
Home Modification 
Assessment 
T1028 
U7 
 
 
$628.00 
$628.00 
Per Project 
Home Modifications – 
Install 
S5165 
U7 
NU 
 
Individual 
Individual 
$20,000 Lifetime 
Cap 
Home Modifications – 
Maintenance 
S5165 
U7 
U8 
 
Individual 
Individual 
$1,000 Per Year 
Home-Delivered Meals 
S5170 
U7 
 
 
$7.76 
$7.76 
Per Meal

[Audio] We offer services for individuals with intellectual/developmental disabilities. Our agency values the privacy of our clients and we are committed to ensuring their well-being. We prepare a report on our program's operations, identify trends, and recommend changes every year. We offer a toll-free telephone line for complaints about waiver individuals. We conduct compliance reviews for all non-licensed waiver service providers and licensed providers that provide services outside their scope of license. Providers that fail to cooperate with the review procedure or complete the corrective action process are referred to the B-D-S Quality Assurance Director or designee as a formal complaint, which may result in sanctions up to and including termination as a waiver provider. We document all corrective actions taken with providers in our provider certification platform. We always offer alternative service options to any affected participants through their care manager before taking action to suspend or terminate a provider. We are confident that our services can positively impact the lives of individuals with intellectual/developmental disabilities.. 

Scene 8

DDRS HCBS Waivers 
Section 12: Health and Wellness (H&W) and Traumatic Brain Injury (TBI) Waivers 
222 
Library Reference Number: PRPR10014 
 
Published: Sept. 9, 2024 
 
Policies and procedures as of July 1, 2024 
 
Version: 11.1 
Service Description 
HCPCS 
Code 
Mod 
1 
Mod 
2 
Mod 
3 
H&W 
Rate 
TBI  
Rate 
Notes 
Skilled Respite (LPN) 
T1005 
U7 
UA 
TE 
$13.69 
$13.69 
0.25 Hour 
Skilled Respite (RN) 
T1005 
U7 
UA 
TD 
$17.10 
$17.10 
0.25 Hour 
Nonmedical Transportation 
Nonassisted (Base Trip) 
T2003 
U7 
U1 
UB 
$12.12 
$12.12 
Base Trip 
Nonmedical Transportation 
Nonassisted (Mileage) 
T2003 
U7 
U1 
 
$1.06 
$1.06 
Mileage 
Nonmedical Transportation 
Assisted (Base Trip) 
T2003 
U7 
U2 
UB 
$20.19 
$20.19 
Base Trip 
Nonmedical Transportation 
Assisted (Mileage) 
T2003 
U7 
U2 
 
$1.54 
$1.54 
Mileage 
Structured Day Program – 
Group Setting 
T2021 
U7 
HQ 
 
N/A 
$2.35 
0.25 Hour 
Structured Day Program – 
Individual 
T2021 
U7 
 
 
N/A 
$10.05 
0.25 Hour 
Care Management 
T2022 
U7 
 
 
$189.56 
$189.56 
Monthly 
Integrated Health Care 
Coordination 
T2022 
U7 
U1 
 
$14.21 
$14.21 
0.25 Hour (16 
Hours/Month) 
Pest Control 
T2025 
U7 
U1 
 
Individual 
Individual 
$4,000 Per Year 
Specialized Medical 
Equipment – New DME 
T2029 
U7 
NU 
 
Individual 
Individual 
$15,000 Cap; no 
limit; subject to 
review 
Specialized Medical 
Equipment – Replacement 
or Repair 
T2029 
U7 
U8 
 
Individual 
Individual 
$1,000 Per Year 
Assisted Living – Level 1 
Monthly 
T2031 
U7 
U1 
UA 
$3,028.81 
$3,028.81 
Monthly 
Assisted Living – Level 2 
Monthly 
T2031 
U7 
U2 
UA 
$3,330.26 
$3,330.26 
Monthly 
Assisted Living – Level 3 
Monthly 
T2031 
U7 
U3 
UA 
$3,922.18 
$3,922.18 
Monthly 
Assisted Living – Level 1 
Daily 
T2031 
U7 
U1 
 
$101.98 
$101.98 
1 Day 
Assisted Living – Level 2 
Daily 
T2031 
U7 
U2 
 
$112.13 
$112.13 
1 Day 
Assisted Living – Level 3 
Daily 
T2031 
U7 
U3 
 
$132.06 
$132.06 
1 Day 
Community Transition 
T2038 
U7 
 
 
$2,500.00 
$2,500.00 
Lifetime Cap 
Vehicle Modifications 
T2039 
U7 
 
 
Individual 
Individual 
$15,000.00 every 
10 Years 
Vehicle Modifications – 
Maintenance 
T2039 
U7 
U8 
 
Individual 
Individual 
$1,000 Per Year

[Audio] We are committed to delivering exceptional services to our clients. Our program includes an ombudsman who reports any findings to the complainant and notifies them if the complaint is not investigated. This ensures that our clients have a voice and that their concerns are heard and addressed promptly. We take all complaints seriously and will take appropriate corrective action to ensure that our clients receive the best possible care. Our provider compliance reviews are conducted for all non-licensed waiver service providers and licensed providers that offer services outside the scope of their license. These reviews ensure that our providers meet the highest standards of quality and are providing services that are safe, effective, and beneficial to our clients. Any provider who refuses to cooperate with the review procedure or complete the corrective action process will be referred to the B-D-S Quality Assurance Director or designee as a formal complaint, which may result in sanctions up to and including termination as a waiver provider. We believe that our program is a crucial step towards providing high-quality services to individuals with intellectual/developmental disabilities. We are committed to continuously improving our services and to ensuring that our clients receive the best possible care. Thank you for your attention, and if you have any questions, please don't hesitate to ask.. 

Scene 9

Section 12: Health and Wellness (H&W) and Traumatic Brain Injury (TBI) Waivers 
DDRS HCBS Waivers 
Library Reference Number: PRPR10014 
223 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
The sections that follow lists service definitions and related information for the services currently approved 
for the H&W Waiver and TBI Waiver. Each service listed includes the following information as 
appropriate: 
• Service definition 
• Allowable activities 
• Service standards 
• Documentation standards 
• Limitations if applicable 
• Activities not allowed 
• Provider qualifications 
– A provider qualifications table identifies the waiver, the license or certification requirements, 
and any additional standards that apply. 
Section 12.7: Adult Day Services for H&W and TBI 
Waivers 
The following subsections provide information and requirements for Adult Day Services (ADS) for the 
H&W and TBI waivers. 
Service Definition 
ADS are community-based group programs designed to meet the needs of individuals who need 
structured, social integration through comprehensive and nonresidential programs. The service 
plan will identify the need through the person-centered assessment (PCA) process and evident 
through the assessment tool. The purpose for ADS is to provide health, social, recreational, 
supervision, support services and personal care. Meals, specifically, and as appropriate, breakfast, 
lunch, and nutritious snacks are required. Participants attend ADS on a planned basis. The three 
levels of ADS are Basic, Enhanced and Intensive. 
Allowable Activities 
Basic Adult Day Services (Level 1) services include the following activities: 
• Monitoring of all activities of daily living (ADLs) defined as dressing, bathing, grooming, eating, 
walking and toileting with hands-on assistance provided as needed 
• Comprehensive, therapeutic activities for those with cognitive impairment in a safe environment 
• Initial health assessment conducted by a registered nurse (RN) consultant prior to beginning services 
at the adult day, and intermittent monitoring of health status 
• Monitoring of medication or medication administration 
• Minimum staff ratio: One staff for each eight individuals 
• RN consultant available 
Enhanced Adult Day Services (Level 2) includes: Level 1 service requirements must be 
met. Additional services include: 
• Hands-on assistance with two or more ADLs or hands-on assistance with bathing or other personal 
care

[Audio] Intensive Adult Day Services (Level 3) includes additional services such as hands-on assistance or monitoring with all A-D-Ls and personal care, one or more direct health interventions required, rehabilitation and restorative services, including physical therapy, speech/language therapy, and occupational therapy (coordinated or available), and therapeutic intervention to address dynamic psychosocial needs, such as depression or family issues affecting care. The minimum staff ratio for Intensive Adult Day Services (Level 3) is one staff for each four individuals, with an RN consultant available.. 

Scene 10

DDRS HCBS Waivers 
Section 12: Health and Wellness (H&W) and Traumatic Brain Injury (TBI) Waivers 
224 
Library Reference Number: PRPR10014 
 
Published: Sept. 9, 2024 
 
Policies and procedures as of July 1, 2024 
 
Version: 11.1 
• Initial health assessment conducted by RN consultant prior to beginning services as well as regular 
monitoring or intervention with health status 
• Medication assistance 
• Psychosocial needs assessed and addressed, including counseling as needed for individuals and 
caregivers 
• Therapeutic structure and intervention for participants with mild to moderate cognitive impairments 
in a safe environment 
• Minimum staff ratio: One staff for each six individuals 
• RN Consultant available 
• Minimum of one full-time licensed practical nurse (LPN) staff person with monthly RN supervision 
Intensive Adult Day Services (Level 3) includes: Level 1 and Level 2 service requirements 
must be met. Additional services include: 
• Hands-on assistance or monitoring with all ADLs and personal care 
• One or more direct health interventions required 
• Rehabilitation and restorative services, including physical therapy, speech/language therapy and 
occupational therapy (coordinated or available) 
• Therapeutic intervention to address dynamic psychosocial needs, such as depression or family issues 
affecting care 
• Therapeutic interventions for those with moderate to severe cognitive impairments 
• Minimum staff ratio: One staff for each four individuals 
• RN consultant available 
• Minimum of one full-time LPN staff person with monthly RN supervision 
• Minimum of one qualified full-time staff person to address participants’ psychosocial needs 
Service Standards 
ADS must follow a written service plan addressing specific needs determined by the client’s assessment. 
The ADS provider is responsible for sharing the client’s service plan with the client’s care manager to 
ensure continuity of care.  
Documentation Standards 
Care managers must maintain the following documentation: 
• Justification for the service is documented. 
– The documented need for the service is to include, but not be limited, to the following: 
➢ Describe the structure needed for the participant (medical, social, recreational) 
➢ Types of ADL care the participant may require and level of assistance needed 
• Level of service as determined in the PCA, which is given to provider. 
Limitations 
ADS are allowed for a maximum of 10 hours per day.

[Audio] As an author and voiceover script writer, I am here to provide you with an overview of the services that we can provide for individuals with intellectual/developmental disabilities through the program outlined in Section 12 of the waivers. We offer a range of services for individuals with intellectual/developmental disabilities. These services include provider compliance reviews, which are conducted for all non-licensed waiver service providers and licensed providers that offer services outside the scope of their license. Compliance reviews include a review of provider policies and adherence to state and federal requirements. Any provider who fails to cooperate with the review procedure or complete the corrective action process is referred to the B-D-S Quality Assurance Director or designee as a formal complaint, which may result in sanctions up to and including termination as a waiver provider. It is important to note that documentation of all corrective actions taken with providers is maintained in OMPP’s provider certification platform. Prior to taking action to suspend or terminate a provider, alternative service options will be provided to any affected participants through their care manager. We have strict qualifications for our providers. These qualifications include being licensed or certified, complying with the Adult Day Services Provision and Certification Standards, and adhering to other standards, such as financial information, liability insurance, maintenance of personnel records, and operations manual. We also offer accreditation from the Indiana Association of Adult Day Service as part of the adult-day provider credentialing through the F-S-S-A-. All providers, both new and existing, are given the option of receiving accreditation from the Indiana Association of Adult Day Service. We understand the importance of protecting individuals with intellectual/developmental disabilities, and we take this responsibility seriously. We have policies and procedures in place to protect individuals from unusual occurrences and to report on any incidents. We also have a notice of termination of services policy, a transfer of individual’s record upon change of provider policy, and a provider organizational chart policy. We are committed to providing high-quality care and services for individuals with intellectual/developmental disabilities. We have a quality assurance and quality improvement system in place, and we regularly review and update our policies and procedures to ensure that we are meeting the needs of our clients. Thank you for considering our services. If you have any further questions, please do not hesitate to contact us.. 

Scene 11

Section 12: Health and Wellness (H&W) and Traumatic Brain Injury (TBI) Waivers 
DDRS HCBS Waivers 
Library Reference Number: PRPR10014 
225 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
Activities Not Allowed 
Services to participants receiving Assisted Living waiver service. 
Note:  Therapies provided through this service will not duplicate therapies provided under 
any other service. 
 
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 legally responsible 
individuals or LRIs) as outlined in C-2-d and C-2-e of the H&W and TBI waivers.  
Provider Qualifications 
Provider qualifications for ADS are presented in Table 9. 
Table 9 – Provider Qualifications for Adult Day Service 
Waiver 
Provider 
Licensure/ 
Certification 
Other Standards 
H&W/TBI 
FSSA-
approved 
ADS 
provider  
All adult-day 
providers, 
both new and 
existing 
providers, are 
given the 
option of 
receiving 
accreditation 
from the 
Indiana 
Association 
of Adult Day 
Service as 
part of the 
adult-day 
provider 
credentialing 
through the 
FSSA. 
Must comply with the Adult Day Services Provision and 
Certification Standards 
FSSAFSSA approved  
455 IAC 2 Provider qualifications: Becoming an approved 
provider; maintaining approval  
455 IAC 2 Provider qualifications: General requirements  
455 IAC 2 Provider qualifications: General requirements 
for direct care staff  
455 IAC 2 Procedures for protecting individuals  
455 IAC 2 Unusual occurrence; reporting  
455 IAC 2 Transfer of individual’s record upon change of 
provider  
455 IAC 2 Notice of termination of services  
455 IAC 2 Provider organizational chart  
455 IAC 2 Collaboration and quality control 
455 IAC 2 Data collection and reporting standards  
455 IAC 2 Quality assurance and quality improvement 
system  
455 IAC 2 Financial information  
455 IAC 2 Liability insurance  
455 IAC 2 Maintenance of personnel records  
455 IAC 2 Adoption of personnel policies  
455 IAC 2 Operations manual  
455 IAC 2 Maintenance of records of services provided  
455 IAC 2 Individual’s personal file; site of service 
delivery  
Section 12.8: Adult Family Care for H&W and TBI 
Waivers 
The following subsections provide information and requirements for Adult Family Care (AFC) services for 
the H&W and TBI waivers.

[Audio] Our program offers a variety of services for individuals with intellectual and developmental disabilities. Our services are carefully designed to provide the highest quality of care while respecting the privacy of our participants. We ensure that the identity of each individual is kept confidential, unless written consent or a court order is obtained. This is to respect the privacy of our participants and maintain their autonomy. Additionally, our program has an ombudsman responsible for reporting any findings to the complainant, ensuring transparency, and giving our participants a voice in the program. We prepare an annual report that describes the operations of our program, identifies trends, and recommends changes for improvement. This ensures that our program is always evolving to meet the needs of our participants. To address any concerns, we have a toll-free telephone line open to receive complaints regarding waiver individuals. We conduct compliance reviews for all non-licensed waiver service providers and licensed providers offering services outside the scope of their license. If a provider fails to cooperate with the review process or complete the corrective action, they will be referred to the B-D-S Quality Assurance Director for further action. All actions taken with providers are carefully documented and maintained in our provider certification platform. Before taking any action to suspend or terminate a provider, we always provide alternative service options to any affected participants through their care manager. Overall, our program is dedicated to providing excellent services for individuals with intellectual and developmental disabilities. We are committed to ensuring their privacy, protecting their rights, and continually improving our services to meet their unique needs.. 

Scene 12

DDRS HCBS Waivers 
Section 12: Health and Wellness (H&W) and Traumatic Brain Injury (TBI) Waivers 
226 
Library Reference Number: PRPR10014 
 
Published: Sept. 9, 2024 
 
Policies and procedures as of July 1, 2024 
 
Version: 11.1 
Service Definition 
AFC is a comprehensive service in which a participant resides with an unrelated caregiver. The participant 
and up to three other participants who have physical and/or cognitive disabilities and are not members of 
the provider’s or primary caregiver’s family, and/or reside in a home that is owned, rented or managed by 
the AFC provider. 
There are three service levels of Adult Family Care each with a unique rate. The applicable rate is 
determined through completion of the Adult Family Care/Structured Family Caregiving Level of Service 
Assessment (AFC/SFC LOS Assessment). Care Managers complete this assessment at least annually to 
accurately reflect the relative support need of the individual. The AFC/SFC LOS Score determines the 
reimbursement rate to be utilized in the participant’s next service plan. 
The breakdown is as follows: 
• Level 1 – AFC/SFC LOS Assessment Score of 0–35 
• Level 2 – AFC/SFC LOS Assessment Score of 36–60 
• Level 3 – AFC/SFC LOS Assessment Score of 61+ 
AFC is designed to provide options for alternatives to long-term care for individuals who meet nursing 
facility level of care and whose needs can be met in a home-like environment.  
The goal of the service is to provide necessary care while emphasizing the participant’s independence. 
This goal is reached through a cooperative relationship between the participant (or the participant’s legal 
guardian), the participant’s HCBS Medicaid waiver care manager, and the AFC provider. The participant’s 
needs must be addressed in a manner that supports and enables the individual to maximize abilities to 
function at the highest possible level of independence. 
Another goal of this service is to preserve the dignity, self-respect, and privacy of the participant by 
ensuring high-quality care in a non-institutional setting. Care is to be furnished in a way that fosters the 
independence of each participant to facilitate aging in place in a home environment that will provide the 
participant with a range of care options as their needs change. 
Participants selecting AFC service may also receive the following services through the waiver: 
• Care Management service  
• Adult Day Services  
• Specialized Medical Equipment and Supplies  
• Healthcare coordination  
Note:  Participants living in AFC settings are entitled to retain at least their personal needs 
allowances (PNAs) as established by the state of Indiana. The PNA is currently 
$52.00 per month per Indiana Code IC 12-15-7-2. 
 
A provider, after ensuring that the participants retain their PNAs, may bill 
participants up to the current maximum federal Supplemental Security Income (SSI). 
Providers may not charge Medicaid waiver participants a room-and-board rate that 
exceeds the maximum SSI rate. 
Allowable Activities 
The following are included in the daily per diem for AFC: 
• Attendant care related to ADLs

[Audio] We will discuss the services that can be provided to individuals with intellectual and developmental disabilities through the program outlined in Section 12 of the H&W and T-B-I Waivers DDRS HCBS Waivers. The administrative agency ensures the confidentiality of the individual's identity, unless written consent or a court order is obtained. The ombudsman reports any findings to the complainant and notifies them if the complaint is not being investigated. An annual report is prepared to describe the operations of the program, identify any trends, and make recommendations for any necessary changes. We have a toll-free telephone line that is continuously open to receive complaints regarding waiver individuals. Provider compliance is ensured through regular reviews of all non-licensed waiver service providers and licensed providers offering services outside the scope of their license. These reviews include a thorough examination of provider policies and adherence to state and federal requirements. Any provider who fails to cooperate with the review procedure or complete the corrective action process is referred to the B-D-S Quality Assurance Director or designee as a formal complaint. This may result in sanctions, including termination as a waiver provider. All documentation of corrective actions taken with providers is maintained in OMPP's provider certification platform. Before taking any action to suspend or terminate a provider, alternative service options will be provided to any affected participants through their care manager. Finally, we will focus on the specific services offered under Section 12 of the H&W and T-B-I Waivers DDRS HCBS Waivers. These include home and community assistance related to instrumental activities of daily living (IADLs) and medication oversight, to the extent permitted by state law. It is important for all A-F-C services to follow a written service plan that addresses the specific needs of the participant, as determined by their P-C-A--. These services must also meet the level of service needs for each individual. It is required for the provider to live in the A-F-C home unless another provider has been contracted prior. These service standards ensure that each individual receives the necessary care and support to improve their quality of life. Thank you.. 

Scene 13

Section 12: Health and Wellness (H&W) and Traumatic Brain Injury (TBI) Waivers 
DDRS HCBS Waivers 
Library Reference Number: PRPR10014 
227 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
• Home and Community Assistance care related to instrumental activities of daily living (IADLs) 
• Medication oversight (to the extent permitted under state law) 
Service Standards 
These service standards must be followed for AFC: 
• AFC services must follow a written service plan addressing specific needs determined by the 
participant’s PCA. 
• Services must address the participant’s level of service needs. 
• Provider must live in the AFC home, unless another provider-contracted primary caregiver, who 
meets all provider qualifications, lives in the AFC home. 
• Backup services must be provided by a qualified participant familiar with the participant’s needs for 
those times when the primary caregiver is absent from the home or otherwise cannot provide the 
necessary level of care (LOC). 
• AFC provides an environment that has the qualities of a home, including the following: 
– Privacy 
– Safe place that is free of environmental hazards such as pests 
– Habitable environment 
– Comfortable surroundings 
– Opportunity to modify one’s living area to suit one’s participant preferences 
• Rules managing or organizing the home activities in the AFC home must be provided to the 
participant prior to the start of AFC services and may not be so restrictive as to interfere with a 
participant’s rights under state and federal law; these rules are developed by the provider, the 
provider-contracted primary caregiver, or both and approved by the Medicaid waiver program. 
• Participant-focused activity plans are developed by the provider with the participant or the 
participant’s representative. 
• Providers or provider’s employees who provide medication oversight, as addressed under Allowable 
Activities, must receive necessary instruction from a doctor, nurse, or pharmacist on the 
administration of controlled substances prescribed to the participant. 
Documentation Standards 
Level of service is determined in the PCA. The care manager must follow these documentation standards: 
• Document the medical need for AFC and types of ADL and IADL care the participant may require. 
• Document the expected AFC activity to meet the individual’s needs, which is accurately shown in 
the intermediate LOC E-screen. 
• If the participant requires skilled care, the care manager must justify how the skilled-care need will 
be met and by whom with the required documentation, describing: 
– Reason to use attendant care services 
– Who will be providing this service 
– Activities that are expected to be performed and frequency 
• Give the completed PCA to the provider.

[Audio] The final slide of our presentation focuses on the necessary documentation that providers must adhere to when offering services to individuals with intellectual and developmental disabilities through the program outlined in Section 12 of the H&W and T-B-I Waivers DDRS HCBS Waivers. The administrative agency responsible ensures that the individual's identity remains confidential unless written consent or a court order is given. The ombudsman will report their findings to the complainant and inform them if a complaint is not being investigated. Additionally, an annual report is prepared to describe the program's operations, identify any trends, and make recommendations for changes. It is crucial for providers to follow the documentation standards set by the program. This includes daily documentation to support services provided by the A-F-C in addressing the needs identified in the P-C-A--. This may involve the participant's status, such as their health, mental health, medication, diet, sleep patterns, and social activity. Monthly updates are also required, covering any changes in the participant's status, participation in consumer-focused activities, and medication management records, if applicable. All documentation must be thorough and accurate. Moreover, compliance reviews are carried out for all non-licensed waiver service providers and licensed providers that offer services outside the scope of their license. These reviews ensure that providers comply with state and federal requirements. Any provider who does not cooperate with the review process or complete the corrective action process may face sanctions, including termination as a waiver provider. Documentation of all corrective actions taken with providers is recorded in OMPP's provider certification platform. Before taking any action to suspend or terminate a provider, alternative service options will be provided to any affected participants through their care manager. We appreciate your attendance at this presentation on DDRS HCBS Waivers Section 12: Health and Wellness and Traumatic Brain Injury Waivers. We hope that this information has been valuable and informative. Thank you.. 

Scene 14

DDRS HCBS Waivers 
Section 12: Health and Wellness (H&W) and Traumatic Brain Injury (TBI) Waivers 
228 
Library Reference Number: PRPR10014 
 
Published: Sept. 9, 2024 
 
Policies and procedures as of July 1, 2024 
 
Version: 11.1 
The provider must follow these documentation standards: 
• Daily documentation to support services rendered by the AFC to address needs identified in the 
PCA: 
– Participant’s status, including health, mental health, medication, diet, sleep patterns, social 
activity 
– Updates, including health, mental health, medication, diet, sleep patterns, social activity 
– Participation in consumer-focused activities 
– Medication management records, if applicable 
• Monthly updated service plans provided to the participant’s care manager from the AFC caregiver 
– Notification to the participant’s care manager, within 48 hours of any changes in participants 
care plan 
• Maintenance of participant’s personal records to include: 
– Social Security number 
– Medical insurance number 
– Birth date 
– Emergency contacts 
– All medical information available including all known current prescription and nonprescription 
drug medication  
– Most recent prior residence 
– Hospital preference 
– Primary care physician 
– Mortuary (if known) 
– Religious affiliation and place of worship, if applicable 
• Participant’s personal records must contain copies of all the applicable documents, which the AFC 
caregiver will also provide to the participant’s care manager on an ongoing basis if there are changes 
to these documents: 
– Advance directive 
– Living will 
– Power of attorney 
– Health care representative 
– Do not resuscitate (DNR) order 
– Letters of guardianship 
Note: If applicable, copies of personal record must be: 
 
• 
Placed in a prominent place in the participant’s file  
 
• 
Sent with the participant when transferred for medical care or upon moving 
from the residence and in accordance with state law 
Activities Not Allowed 
The following activities are not allowed or reimbursed under AFC: 
• Services provided in the home of a caregiver who is related by blood or related legally to the 
participant 
• Services provided when the owner of the organization is a parent of a minor child participant, the 
spouse of a participant, the attorney-in-fact (POA) of a participant, the health care representative 
(HCR) of a participant, or the legal guardian of a participant

 part 17

This presentation aims to showcase the services available for individuals with intellectual and developmental disabilities through a program overseen by the Family and Social Services Administration (F-S-S-A-). Slide 2 will cover the programs outlined in the Health and Wellness (H&W) and Traumatic Brain Injury (T-B-I--) Waivers, including care coordination and provider reviews. F-S-S-A conducts various audits, including self-audits, desk audits, and on-site audits, to ensure program integrity. These audits are based on data analysis, identification of outliers and problematic billing patterns, and referrals from other divisions and state agencies. The Program Integrity Unit works closely with all waiver divisions and maintains open communication for policy clarification and other concerns. Although the Fraud and Abuse Detection System (F-A-D-S-) contractor may be involved, F-S-S-A maintains overall oversight throughout the process. The Audit Division of F-S-S-A reviews waiver audit schedules and findings to avoid repetition and ensure consistent methodology. In addition to provider reviews, certified care managers approved by the Division of Aging provide care management services for individuals on Medicaid waivers. Until 2025, the 15 local Area Agencies on Aging (AAAs) serve as the single point of entry for Medicaid waivers. Once eligibility is determined and approved, the A-A-A will provide the necessary documentation for the H&W or T-B-I waiver. We appreciate your attention and look forward to sharing more about the services we offer for individuals with intellectual and developmental disabilities through this program.

avatar

This meeting is about discussing the services offered under Section 12 of the H&W and T-B-I Waivers DDRS HCBS Waivers. Our service coordinators and care coordinators are highly qualified to provide the best care for our clients. Service coordinators must have at least one year of experience with the program population, be a registered nurse or licensed practical nurse, and hold a bachelor's or associate degree. They also have to have experience in delivering healthcare, social services, or case management. Our care coordinators must receive training on recommended topics from the F-S-S-A if any issues with their services arise. Care management cannot be conducted by anyone who also provides in-home or community-based services under F-S-S-A waivers, or anyone with common ownership or control of such services under the Medicaid waiver program. It is important to note that reimbursement for care management services is only possible when the client becomes eligible for waiver services. Care managers must meet the F-S-S-A guiding principles, which include being responsive, efficient, and effective in service delivery, as well as promoting effective communication, respect, dignity, and personal empowerment for all individuals. They must also adhere to person-centered planning, informed choice, and fiscal stewardship, while providing quality customer service and complying with F-S-S-A standards. Failure to cooperate with the review procedure or complete corrective actions may result in sanctions or even termination as a waiver provider. This is a serious matter and we are dedicated to ensuring the best care for our clients. For any concerns, we have a toll-free telephone line available at all times. It is important to us to address and resolve any issues in a timely manner.

This presentation will discuss the DDRS HCBS Waivers, specifically Section 12, which covers the Health and Wellness (H&W) and Traumatic Brain Injury (T-B-I--) Waivers. It is our top priority to protect the privacy of all individuals receiving waivers. We ensure that their identity is kept confidential and only shared with their written consent or a court order. Any complaints are thoroughly investigated by our ombudsman, who then reports their findings to the complainant in a timely and professional manner. 
In addition to our strict privacy policies, we also have ongoing Medicaid H-C-B-S Waiver Care Management Standards that all care managers must adhere to. These standards include maintaining high levels of professionalism and ethical conduct, following all documents issued by the F-S-S-A-, and complying with federal, state, and local laws and regulations. Care managers are also required to complete annual training. 
Before being eligible for Medicaid reimbursement, care managers must complete a comprehensive orientation program that covers topics such as general care management, narrative, skilled needs, activities of daily living, and incident reporting. They are also required to complete an additional 18 hours of training annually, which can cover topics such as care coordination, documentation, medical terminology, and specific diagnoses or treatments that affect our diverse client base. 
It is important to note that certain training topics, such as care management orientation and required annual retraining, do not count towards the required 18 hours. Additionally, all training documentation is regularly reviewed in compliance surveys and at the request of the FSSA. 
Our commitment to privacy, professionalism, and ethical standards is evident in every aspect of our program. We strive to provide the best possible care to our waiver individuals and are constantly seeking ways to improve and enhance our services. Thank you for your attention.

The H&W and T-B-I Waivers DDRS HCBS Waivers include a program, outlined in Section 12, that offers services to individuals with intellectual/developmental disabilities. Any information about these individuals will be kept confidential, unless written consent or a court order is obtained. An ombudsman is responsible for reporting findings to the person who filed a complaint and will also inform them if the complaint is not being investigated. Additionally, a yearly report is created that describes the program, identifies any trends, and makes recommendations for changes. Complaints regarding waiver individuals can be made through a toll-free telephone line at any time. Compliance reviews are conducted for both non-licensed and licensed providers to ensure they are following state and federal requirements. If a provider does not cooperate with the review process or fails to complete corrective actions, they may be referred to the B-D-S Quality Assurance Director for a formal complaint. This could result in sanctions, including termination as a waiver provider. All actions taken with providers are documented in OMPP's certification platform. Before taking any action, alternative service options will be offered to affected participants through their care manager.

We are discussing how to support individuals with intellectual/developmental disabilities through the program outlined in the H&W and T-B-I Waivers. As an administrator, I ensure that the individual's identity is not disclosed without written consent or a court order. As an ombudsman, I report findings and notify if not investigating a complaint. An annual report is prepared describing the program's operations, identifying trends, and recommending changes. A toll-free telephone line is available to receive complaints regarding waiver individuals. Provider compliance reviews are conducted for all non-licensed waiver service providers and licensed providers that offer services outside the scope of their license. Compliance reviews include a review of provider policies and adherence to state and federal requirements. Any provider who fails to cooperate with the review procedure or complete the corrective action process is referred to the B-D-S Quality Assurance Director or designee as a formal complaint, which may result in sanctions up to and including termination as a waiver provider. Documentation of all corrective actions taken with providers is maintained in OMPP’s provider certification platform. Prior to taking action to suspend or terminate a provider, alternative service options will be provided to any affected participants through their care manager.

We offer various services for individuals with intellectual/developmental disabilities through our programs outlined in the H&W and T-B-I Waivers DDRS HCBS Waivers. We prioritize the privacy and confidentiality of the individuals we serve by ensuring that their identity will not be disclosed without written consent or a court order. Any provider who fails to cooperate with the review procedure or complete the corrective action process is considered a formal complaint, which may result in sanctions up to and including termination as a waiver provider. We have a toll-free telephone line to receive complaints regarding waiver individuals and investigate and prepare an annual report describing the operations of the program, identifying trends, and recommending changes. Our program offers a variety of services, including Adult Day Services – Level 3 (Category 2), Attendant Care (Agency), Attendant Care (NonAgency), Attendant Care (ConsumerDirected), Participant-Directed Home Care – Skilled, Participant-Directed Home Care – Unskilled, Home and Community Assistance (Agency), Home and Community Assistance (Non-Agency), Structured Family Caregiving (Level 1), Structured Family Caregiving (Level 2), Structured Family Caregiving (Level 3), Adult Family Care (Level 1), Adult Family Care (Level 2), Adult Family Care (Level 3), Personal Emergency Response System – Install, Personal Emergency Response System – Maintenance, Home Modification Assessment, Home Modifications – Install, Home Modifications – Maintenance, Home-Delivered Meals, and Library Reference Number: PRPR10014. We are committed to complying with all state and federal requirements and have policies and procedures in place to protect the identity of the individual. We value your feedback and are committed to providing the best services possible for individuals with intellectual/developmental disabilities. Thank you for your time and attention.

We offer services for individuals with intellectual/developmental disabilities. Our agency values the privacy of our clients and we are committed to ensuring their well-being. We prepare a report on our program's operations, identify trends, and recommend changes every year. We offer a toll-free telephone line for complaints about waiver individuals. We conduct compliance reviews for all non-licensed waiver service providers and licensed providers that provide services outside their scope of license. Providers that fail to cooperate with the review procedure or complete the corrective action process are referred to the B-D-S Quality Assurance Director or designee as a formal complaint, which may result in sanctions up to and including termination as a waiver provider. We document all corrective actions taken with providers in our provider certification platform. We always offer alternative service options to any affected participants through their care manager before taking action to suspend or terminate a provider. We are confident that our services can positively impact the lives of individuals with intellectual/developmental disabilities.

We are committed to delivering exceptional services to our clients. Our program includes an ombudsman who reports any findings to the complainant and notifies them if the complaint is not investigated. This ensures that our clients have a voice and that their concerns are heard and addressed promptly. We take all complaints seriously and will take appropriate corrective action to ensure that our clients receive the best possible care. Our provider compliance reviews are conducted for all non-licensed waiver service providers and licensed providers that offer services outside the scope of their license. These reviews ensure that our providers meet the highest standards of quality and are providing services that are safe, effective, and beneficial to our clients. Any provider who refuses to cooperate with the review procedure or complete the corrective action process will be referred to the B-D-S Quality Assurance Director or designee as a formal complaint, which may result in sanctions up to and including termination as a waiver provider. We believe that our program is a crucial step towards providing high-quality services to individuals with intellectual/developmental disabilities. We are committed to continuously improving our services and to ensuring that our clients receive the best possible care. Thank you for your attention, and if you have any questions, please don't hesitate to ask.

Intensive Adult Day Services (Level 3) includes additional services such as hands-on assistance or monitoring with all A-D-Ls and personal care, one or more direct health interventions required, rehabilitation and restorative services, including physical therapy, speech/language therapy, and occupational therapy (coordinated or available), and therapeutic intervention to address dynamic psychosocial needs, such as depression or family issues affecting care. The minimum staff ratio for Intensive Adult Day Services (Level 3) is one staff for each four individuals, with an RN consultant available.

As an author and voiceover script writer, I am here to provide you with an overview of the services that we can provide for individuals with intellectual/developmental disabilities through the program outlined in Section 12 of the waivers. 

We offer a range of services for individuals with intellectual/developmental disabilities. These services include provider compliance reviews, which are conducted for all non-licensed waiver service providers and licensed providers that offer services outside the scope of their license. Compliance reviews include a review of provider policies and adherence to state and federal requirements. Any provider who fails to cooperate with the review procedure or complete the corrective action process is referred to the B-D-S Quality Assurance Director or designee as a formal complaint, which may result in sanctions up to and including termination as a waiver provider. 

It is important to note that documentation of all corrective actions taken with providers is maintained in OMPP’s provider certification platform. Prior to taking action to suspend or terminate a provider, alternative service options will be provided to any affected participants through their care manager. 

We have strict qualifications for our providers. These qualifications include being licensed or certified, complying with the Adult Day Services Provision and Certification Standards, and adhering to other standards, such as financial information, liability insurance, maintenance of personnel records, and operations manual. 

We also offer accreditation from the Indiana Association of Adult Day Service as part of the adult-day provider credentialing through the F-S-S-A-. All providers, both new and existing, are given the option of receiving accreditation from the Indiana Association of Adult Day Service. 

We understand the importance of protecting individuals with intellectual/developmental disabilities, and we take this responsibility seriously. We have policies and procedures in place to protect individuals from unusual occurrences and to report on any incidents. We also have a notice of termination of services policy, a transfer of individual’s record upon change of provider policy, and a provider organizational chart policy. 

We are committed to providing high-quality care and services for individuals with intellectual/developmental disabilities. We have a quality assurance and quality improvement system in place, and we regularly review and update our policies and procedures to ensure that we are meeting the needs of our clients. 

Thank you for considering our services. If you have any further questions, please do not hesitate to contact us.

Our program offers a variety of services for individuals with intellectual and developmental disabilities. Our services are carefully designed to provide the highest quality of care while respecting the privacy of our participants. We ensure that the identity of each individual is kept confidential, unless written consent or a court order is obtained. This is to respect the privacy of our participants and maintain their autonomy. Additionally, our program has an ombudsman responsible for reporting any findings to the complainant, ensuring transparency, and giving our participants a voice in the program. We prepare an annual report that describes the operations of our program, identifies trends, and recommends changes for improvement. This ensures that our program is always evolving to meet the needs of our participants. To address any concerns, we have a toll-free telephone line open to receive complaints regarding waiver individuals. We conduct compliance reviews for all non-licensed waiver service providers and licensed providers offering services outside the scope of their license. If a provider fails to cooperate with the review process or complete the corrective action, they will be referred to the B-D-S Quality Assurance Director for further action. All actions taken with providers are carefully documented and maintained in our provider certification platform. Before taking any action to suspend or terminate a provider, we always provide alternative service options to any affected participants through their care manager. Overall, our program is dedicated to providing excellent services for individuals with intellectual and developmental disabilities. We are committed to ensuring their privacy, protecting their rights, and continually improving our services to meet their unique needs.

We will discuss the services that can be provided to individuals with intellectual and developmental disabilities through the program outlined in Section 12 of the H&W and T-B-I Waivers DDRS HCBS Waivers. The administrative agency ensures the confidentiality of the individual's identity, unless written consent or a court order is obtained. The ombudsman reports any findings to the complainant and notifies them if the complaint is not being investigated. An annual report is prepared to describe the operations of the program, identify any trends, and make recommendations for any necessary changes. We have a toll-free telephone line that is continuously open to receive complaints regarding waiver individuals. 
                                    Provider compliance is ensured through regular reviews of all non-licensed waiver service providers and licensed providers offering services outside the scope of their license. These reviews include a thorough examination of provider policies and adherence to state and federal requirements. Any provider who fails to cooperate with the review procedure or complete the corrective action process is referred to the B-D-S Quality Assurance Director or designee as a formal complaint. This may result in sanctions, including termination as a waiver provider. 
                                    All documentation of corrective actions taken with providers is maintained in OMPP's provider certification platform. Before taking any action to suspend or terminate a provider, alternative service options will be provided to any affected participants through their care manager. 
                                    Finally, we will focus on the specific services offered under Section 12 of the H&W and T-B-I Waivers DDRS HCBS Waivers. These include home and community assistance related to instrumental activities of daily living (IADLs) and medication oversight, to the extent permitted by state law. It is important for all A-F-C services to follow a written service plan that addresses the specific needs of the participant, as determined by their P-C-A--. These services must also meet the level of service needs for each individual. It is required for the provider to live in the A-F-C home unless another provider has been contracted prior. These service standards ensure that each individual receives the necessary care and support to improve their quality of life. Thank you.

The final slide of our presentation focuses on the necessary documentation that providers must adhere to when offering services to individuals with intellectual and developmental disabilities through the program outlined in Section 12 of the H&W and T-B-I Waivers DDRS HCBS Waivers. The administrative agency responsible ensures that the individual's identity remains confidential unless written consent or a court order is given. The ombudsman will report their findings to the complainant and inform them if a complaint is not being investigated. Additionally, an annual report is prepared to describe the program's operations, identify any trends, and make recommendations for changes. It is crucial for providers to follow the documentation standards set by the program. This includes daily documentation to support services provided by the A-F-C in addressing the needs identified in the P-C-A--. This may involve the participant's status, such as their health, mental health, medication, diet, sleep patterns, and social activity. Monthly updates are also required, covering any changes in the participant's status, participation in consumer-focused activities, and medication management records, if applicable. All documentation must be thorough and accurate. Moreover, compliance reviews are carried out for all non-licensed waiver service providers and licensed providers that offer services outside the scope of their license. These reviews ensure that providers comply with state and federal requirements. Any provider who does not cooperate with the review process or complete the corrective action process may face sanctions, including termination as a waiver provider. Documentation of all corrective actions taken with providers is recorded in OMPP's provider certification platform. Before taking any action to suspend or terminate a provider, alternative service options will be provided to any affected participants through their care manager. We appreciate your attendance at this presentation on DDRS HCBS Waivers Section 12: Health and Wellness and Traumatic Brain Injury Waivers. We hope that this information has been valuable and informative. Thank you.