[Virtual Presenter] We'll be discussing the guidelines and qualifications for Home Modification Assessment services. We'll be outlining the restrictions on using the service for living arrangements owned by providers and disqualifying services provided by parents or spouses of participants. Under Section 12 of the H&W and T-B-I waivers, providers can use the Home Modification Assessment service only for living arrangements owned or leased by someone else. Payment will not be made for Home Modifications under this service. Additionally, Home Modification Assessment services provided by parents of minor child participants or spouses of participants (also known as L-R-I-s-) will not be reimbursed. In terms of provider qualifications, we'll be presenting the requirements for Home Modification Assessment services, which include a license or certification, financial information, liability insurance, and professional qualifications and documentation of qualifications. The National Association of Home Builders offers the In-Place Specialist (C-A-P-S-) Certification, which is a requirement for some providers. Additionally, some providers must comply with applicable building codes and permits, have a certificate in Home Modifications, and undergo compliance checks every three years. Overall, these guidelines and qualifications aim to ensure that Home Modification Assessment services are provided by qualified and trustworthy providers who adhere to important regulations and standards.. 

Scene 1

Section 12: Health and Wellness (H&W) and Traumatic Brain Injury (TBI) Waivers 
DDRS HCBS Waivers 
Library Reference Number: PRPR10014 
257 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
• This service must not be used for living arrangements that are owned or leased by providers of 
waiver services. 
• Payment will not be made for Home Modifications under this 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 LRIs) as outlined in C-2-d and C-2-e of the H&W and TBI 
waivers. 
Provider Qualifications 
Provider qualifications for Home Modification Assessment services are presented in Table 19. 
Table 19 – Provider Qualifications for Home Modification Assessment 
Waiver 
Provider 
Licensure/ 
Certification 
Other Standards 
H&W/TBI 
FSSA-approved 
Home Modification 
Assessment 
Individual  
One of the following: 
• License: IC 
2520.2 Home 
Inspector 
• Certified Aging-
In-Place Specialist 
(CAPS 
Certification – 
National 
Association of 
Home Builders) 
• Executive 
Certificate in 
Home 
Modifications 
(University of 
Southern 
California)  
Verification required 
every three years  
FSSA Approved  
455 IAC 2 Becoming an approved 
provider; maintaining approval  
455 IAC 2 Provider qualifications: General 
requirements 
455 IAC 2 Financial information  
455 IAC 2 Liability insurance  
455 IAC 2 Professional qualifications and 
requirements; documentation of 
qualifications  
455 IAC 2 Warranty required  
Compliance with applicable building 
codes and permits  
H&W/TBI 
Architect 
IC 25-4 
FSSA Approved 
455 IAC 2 Becoming an approved 
provider; maintaining approval  
455 IAC 2 Provider qualifications: General 
requirements 
455 IAC 2 Financial information  
455 IAC 2 Liability insurance  
455 IAC 2 Professional qualifications and 
requirements; documentation of 
qualifications  
455 IAC 2 Warranty required  
Compliance with applicable building 
codes and permits

[Audio] We are excited to present the next slide in our presentation on Home Modification Assessment services. This slide will outline the guidelines and qualifications for providers of this service, as well as the restrictions and disqualifications for using the service for living arrangements owned by providers and services provided by a parent or spouse of a participant. Under Section 12 of the DDRS HCBS Waivers, Home Modifications are physical adaptations to the home that are necessary to ensure the health, welfare, and safety of the participant and enable them to function with greater independence in their home. When the participant owns a home, home modifications are considered. Rented homes or apartments or family-owned homes are allowed to be modified only when a signed agreement from the property owner is obtained. The signed agreement must be submitted along with all other required documentation. Disputes between different parties may not be within the scope of the Bureau of Disabilities Services to be able to intervene in a resolution. The participant chooses the certified providers to submit bids for the Home Modifications. If the participant chooses to continue with the Home Modification after receiving the bids, then the lowest bid that meets the minimum requirements shall be chosen. There is a minimum requirement to gather two bids for any expected amount over $5000. Modifications allowed under the Home Modifications service may include but are not limited to adaptive door openers and locks, bathroom modification, home control units, and kitchen modification. Home safety devices such as door alarms are also allowed. It’s important to note that services provided by a parent or spouse of a participant will not be reimbursed, and there are specific provider qualifications and standards outlined in the H&W and T-B-I waivers. Providers must comply with all requirements and guidelines outlined in these waivers to be eligible for reimbursement. In summary, Home Modifications are physical adaptations to the home that are necessary to ensure the health, welfare, and safety of the participant and enable them to function with greater independence in their home. Providers must comply with all requirements and guidelines outlined in the H&W and T-B-I waivers to be eligible for reimbursement, and services provided by a parent or spouse of a participant will not be reimbursed.. 

Scene 2

DDRS HCBS Waivers 
Section 12: Health and Wellness (H&W) and Traumatic Brain Injury (TBI) Waivers 
258 
Library Reference Number: PRPR10014 
 
Published: Sept. 9, 2024 
 
Policies and procedures as of July 1, 2024 
 
Version: 11.1 
Section 12.18: Home Modifications for H&W and TBI 
Waivers 
The following subsections provide information and requirements for Home Modifications for the H&W 
and TBI waivers. 
Service Definition 
Home Modifications are physical adaptations to the home, as required by the participant’s service plan, 
which are necessary to ensure the health, welfare, and safety of the participant, and which enable the 
participant to function with greater independence in their home. Without these Home Modifications, the 
participant would require institutionalization. Incidental structural repairs to facilitate modifications may be 
included in this service. 
Home Ownership 
Home Modifications are considered when the participant owns a home. Rented homes or apartments or 
family-owned homes are allowed to be modified only when a signed agreement from the property owner is 
obtained. The signed agreement must be submitted along with all other required documentation. Disputes 
between different parties may not be within the scope of the Bureau of Disabilities Services to be able to 
intervene in a resolution. 
Choice of Provider 
The participant chooses the certified providers to submit bids for the Home Modifications. If the participant 
chooses to continue with the Home Modification after receiving the bids, then the lowest bid that meets the 
minimum requirements shall be chosen, such as, time frame to start service. There is a minimum 
requirement to gather two bids for any expected amount over $5,000. 
Allowable Activities 
Modifications allowed under the Home Modifications service may include but are not limited to the 
following: 
• Adaptive door openers and locks 
• Bathroom modification – including but not limited to: 
– Removal of existing bathtub, toilet and/or sink 
– Installation of roll-in shower, grab bars, toilet and sink 
– Installation of replacement incidental items (such as flooring, storage space and cabinets) that 
are necessary due to the bath modification 
• Home control units – Adaptive switches and buttons to operate medical equipment, communication 
devices, heat and air conditioning, and lights for an individual living alone or who is alone without a 
caregiver for a substantial portion of the day. 
• Kitchen modification, including but not limited to: 
– Removal of existing cabinets and sink 
– Installation of sink and cabinet 
– Installation of replacement incidental items (such as flooring, storage space and cabinets) if 
necessary due to kitchen modification 
• Home safety devices such as: 
– Door alarms

[Audio] Our objective is to enhance the quality of life for individuals with health and wellness requirements and those with traumatic brain injury. We believe that our guidelines and qualifications will assist in ensuring that our Home Modification Assessment services are offered safely, effectively, and efficiently. Thank you for taking our presentation into account.. 

Scene 3

Section 12: Health and Wellness (H&W) and Traumatic Brain Injury (TBI) Waivers 
DDRS HCBS Waivers 
Library Reference Number: PRPR10014 
259 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
– Anti-scald devices 
– Hand-held shower head 
– Grab bars for the bathroom 
• Ramp – including but not limited to: portable (considered for rental property only) and permanent 
• Single room air or portable conditioners/single room air purifiers: 
• Vertical lift and/or stair lift 
• Widening of doorways, including: 
– Exterior or interior bedroom, bathroom, kitchen door or any internal doorway as needed to allow 
for access. Pocket doors may be requested. 
• Windows – replacement of glass with Plexi-glass or other shatterproof material when there is a 
documented medical or behavioral reasons 
• Matching interior – Upon completion of the modification, the room being modified will be matched 
to the previous color/style/design to the degree possible with the same paint, wall texture, wall 
coverings, doors, trim, flooring and so on. 
Items requested that are not listed in this section must be reviewed and a decision rendered by the state 
FSSA director or state agency designee. Requests for modifications at two or more locations may only be 
approved at the discretion of the BDS director or designee. Requests for modifications may be denied if the 
State BDS Director or State agency designee determines the documentation does not support residential 
stability and/or the service requested.  
Service Standards 
The care manager must follow these service standards: 
• Document the need for Home Modification Assessment. 
• Share expected modification requests identified by the participant determined through the PCA to 
the assessor. 
• All home modifications must be approved by the waiver program prior to services being rendered. 
• Collect two bids if the cost is over $5,000. 
• If only one bid is obtained, the care manager must document the date of contact, the provider name 
and why a bid was not obtained from another provider. 
• Notify the FSSA of any discrepancies or complaints about the work while it is being completed. 
Notice must be provided to the FSSA within 48 hours upon learning of the issues. 
• Ensure that before and after drawings are submitted for bathroom, kitchen and ramps. 
• Ensure that bid contains warranty information. 
• If a home assessor is available in the county where the participant lives, then all participants must 
receive a Home Modification Assessment if a provider is available in that county, with a certified 
waiver provider selected by the participant prior to any subsequent home modifications as well as a 
home modification inspection upon completion of the work. 
The provider must meet these standards: 
• The need for home modification must be indicated in the participant’s service plan. 
• Proposed specifications for modification must conform to the requirements and limitations of the 
current approved service definition for Home Modifications services.

[Audio] We are here to discuss the guidelines and qualifications for providers of Home Modification Assessment services. These guidelines set out specific requirements to ensure that home modification services are safe, effective, and meet the needs of participants. In this presentation, we will be covering the guidelines and qualifications for providers of Home Modification Assessment services, including restrictions on using the service for living arrangements owned by providers and disqualification for services provided by a parent or spouse of a participant. We will also be discussing the documentation standards and limitations that apply to these services, including a lifetime cap of $20000 for home modifications and an annual allowance of $1000 for repairs, replacements, or adjustments to existing home modifications. We hope that this presentation will provide you with a better understanding of the guidelines and qualifications for providers of Home Modification Assessment services. Thank you for your attention.. 

Scene 4

DDRS HCBS Waivers 
Section 12: Health and Wellness (H&W) and Traumatic Brain Injury (TBI) Waivers 
260 
Library Reference Number: PRPR10014 
 
Published: Sept. 9, 2024 
 
Policies and procedures as of July 1, 2024 
 
Version: 11.1 
• Providers are required to provide a written warranty for a new product or service in the form of a 
binding document stating that, for a period of not less than one year, the service provider shall 
replace or repair any product or installation. 
• If the state agency determines the provider is at fault for poor and/or incorrect work during the home 
modification, then the provider is responsible for correcting work at the cost of the provider. 
• Bid must contain warranty information. 
• Before and after drawings are required for bathroom, kitchen and ramps. 
• Bid must be itemized with cost for each major component of the modification. 
• Prohibited from placing residential liens. 
• All home modifications must be approved by the waiver program prior to services being rendered. 
• Home modification requests must be provided in accordance with applicable state and/or local 
building codes. Home modifications must be compliant with applicable building codes. 
• A land survey may be required when exterior modifications approach the property line. 
• Providers of services must maintain receipts for all incurred expenses related to the modification; 
must be in compliance with FSSA and FSSA-specific guidelines and/or policies. 
• Notification to the participant’s care manager and Bureau of Disabilities Services of any 
discrepancies or complaints about the work while it is being completed. Notice must be provided to 
the BDS within 48 hours upon learning of the issues. 
Documentation Standards 
The care manager must provide documentation/explanation of the service within the Request for Approval 
to Authorize Services (RFA) including the following: 
• Property owner of the residence where the requested modification is proposed 
• Property owner’s relationship to the participant  
• What, if any, relationship the property owner has to the waiver program 
• Written agreement of landlord or homeowner for modification, including agreement about items 
purchased during the modification, such as a bathtub, upon participant moving from the property or 
eviction. 
Limitations 
The following limits apply for the Home Modifications service: 
• A lifetime cap of $20,000 is available for Home Modifications – Installation (procedure code and 
modifier S5165 U7 NU); however, the cap on any single project is $15,000. The cap represents a 
cost for basic modification of a participant’s home for accessibility and safety and accommodates 
the participant’s needs for housing modifications.  
• The cost of a home modification includes all materials, equipment, labor and permits to complete 
the project. No parts of a home modification may be billed separately as part of any other service 
category (such as specialized medical equipment).  
• In addition to the $20,000 lifetime cap, $1,000 is allowable annually for the repair, replacement or 
an adjustment to an existing home modification that was funded by an HCBS waiver.

[Audio] Home Modification Assessment services are available for repair and service of home modifications provided through H-C-B-S waivers. However, certain restrictions and guidelines must be followed in order to receive these services. Firstly, requests for service must detail parts cost and labor cost. If the need for maintenance exceeds $1000, the care 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. Additionally, items requested that are not listed in the Allowable Activities section must be reviewed and a decision rendered by the state F-S-S-A director or state agency designee. Requests for modifications at two or more locations may only be approved at the discretion of the F-S-S-A director or designee. Requests for modifications may be denied if the state F-S-S-A director or state agency designee determines the documentation does not support residential stability and/or the service requested. It is important to note that Home Modifications services are limited to additional services not otherwise covered under the Indiana Medicaid State Plan, including EPSDT, but consistent with waiver objectives of avoiding institutionalization. Activities not allowed under Home Modifications include but are not limited to the following: Adaptations or improvements that are not of direct medical or remedial benefit to the participant, such as central heating and air conditioning, routine home maintenance, roof repair, structural repair that is not incidental to the original modification, driveways, decks, patios, publicly owned sidewalks and household furnishings, swimming pools, spas, or hot tubs, outside storage spaces, and 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 on). Modifications that will add non-incidental square footage to the home. Home Modifications services for participants living in foster homes, group homes, assisted living facilities or homes for special services (any licensed residential facility) are not allowed. Additionally, Home Modifications services for participants living in a provider-owned or controlled residence are not allowed. Completion of, or modifications to, new construction or significant remodeling/reconstruction are also excluded, unless there is documented evidence of a significant change in the participant's medical or remedial needs that now require the requested modification.. 

Scene 5

Section 12: Health and Wellness (H&W) and Traumatic Brain Injury (TBI) Waivers 
DDRS HCBS Waivers 
Library Reference Number: PRPR10014 
261 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
• Home Modifications – Maintenance (procedure code and modifier S5165 U7 U8) is limited to 
$1,000 annually for the repair and service of home modifications that have been provided through 
an HCBS waiver. The following apply for these home modification maintenance services: 
– Requests for service must detail parts cost and labor cost. 
– If the need for maintenance exceeds $1,000, the care 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 that are not listed in the Allowable Activities section must be reviewed and decision 
rendered by the state FSSA director or state agency designee. 
• Requests for modifications at two or more locations may only be approved at the discretion of the 
FSSA director or designee. 
• Requests for modifications may be denied if the state FSSA director or state agency designee 
determines the documentation does not support residential stability and/or the service requested. 
The services under Home Modifications are limited to additional services not otherwise covered under the 
Indiana Medicaid State Plan, including Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) 
but consistent with waiver objectives of avoiding institutionalization. 
Activities Not Allowed 
Activities not allowed under Home Modifications include but are not limited to the following: 
• Adaptations or improvements that are not of direct medical or remedial benefit to the participant, 
such as: 
– Central heating and air conditioning 
– Routine home maintenance 
– Roof repair 
– Structural repair that is not incidental to the original modification 
– Driveways, decks, patios, publicly owned sidewalks and household furnishings 
– Swimming pools, spas or hot tubs 
– Outside storage spaces 
– 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 on) 
• Modifications that will add non-incidental square footage to the home 
• Home Modifications services for participants living in foster homes, group homes, assisted living 
facilities or homes for special services (any licensed residential facility)  
(Note: The responsibility for Hme Modifications rests with the facility owner or operator.) 
• Home Modifications services for participants living in a provider-owned or -controlled residence 
(Note: The responsibility for Home Modifications rests with the facility owner or operator.) 
• Completion of, or modifications to, new construction or significant remodeling/reconstruction are 
excluded, unless there is documented evidence of a significant change in the participant’s medical or 
remedial needs that now require the requested modification 
• The services under Home Modifications are limited to additional services not otherwise covered 
under the Indiana Medicaid State Plan, including EPSDT, but consistent with waiver objectives of 
avoiding institutionalization.

[Audio] Our purpose for gathering is to discuss the requirements and criteria for individuals or organizations seeking to provide Home Modification Assessment services under H&W and T-B-I waivers. It is important to note that providers who have any ownership in the organization are not eligible to offer Home Modification services to participants under these waivers. This includes parents of minor child participants, spouses of participants, attorneys-in-fact (or poas), H-C-R-s-, and legal guardians of participants. Furthermore, any Home Modification services provided by the aforementioned individuals, also known as L-R-I-s-, will not be reimbursed under H&W and T-B-I waivers, as outlined in C-2-d and C-2-e of the waivers. In order to become an approved provider of Home Modification services, certain requirements and standards must be met, as stated in the H&W and T-B-I waivers. These qualifications include possessing a valid FSSA-approved license or certification, adhering to relevant building codes and permits, maintaining appropriate liability insurance, and providing documentation of professional qualifications and requirements. Additionally, providers must ensure that they remain in good standing with the 455 I-A-C 2, IC 25-20.2, and IC 25-28.5 standards, and comply with any other applicable standards outlined in the H&W and T-B-I waivers. We hope that the information provided has clarified the guidelines and qualifications for providers of Home Modification Assessment services under H&W and T-B-I waivers.. 

Scene 6

DDRS HCBS Waivers 
Section 12: Health and Wellness (H&W) and Traumatic Brain Injury (TBI) Waivers 
262 
Library Reference Number: PRPR10014 
 
Published: Sept. 9, 2024 
 
Policies and procedures as of July 1, 2024 
 
Version: 11.1 
• Home Modifications services will not be reimbursed when the owner of the organization is any of 
the following: 
– Parent of a minor child participant 
– Spouse of a participant 
– Attorney-in-fact (or POA) of a participant 
– HCR of a participant 
– Legal guardian of a participant 
This service will not be reimbursed when provided by the parent of a minor child participant or the spouse 
of a participant (also known as LRIs) as outlined in C-2-d and C-2-e of the H&W and TBI waivers.  
Provider Qualifications 
Provider qualifications for Home Modifications are presented in Table 20. 
Table 20 – Provider Qualifications for Home Modifications 
Waiver 
Provider 
Licensure/ 
Certification 
Other Standards 
H&W/TBI  FSSA-approved 
Home Modification 
Individual  
Any applicable 
licensure must be 
in place  
FSSA Approved  
455 IAC 2 Becoming an approved provider; 
maintaining approval 
455 IAC 2 Provider qualifications: General 
requirements 
455 IAC 2 Maintenance of records of services 
provided 
455 IAC 2 Liability insurance 
455 IAC 2 Professional qualifications and 
requirements; documentation of 
qualifications 
455 IAC 2 Warranty required 
Compliance with applicable building codes and 
permits 
H&W/TBI  FSSA-approved 
Home Modification 
Agency/ Contractor  
Any applicable 
licensure 
IC 25-20.2 
Home inspector 
IC 25-28.5  
Plumber  
IC 25-4 
Architect  
FSSA approved  
455 IAC 2 Becoming an approved provider; 
maintaining approval  
455 IAC 2 Provider qualifications: General 
requirements 
455 IAC 2 Maintenance of records of services 
provided  
455 IAC 2 Liability insurance  
455 IAC 2 Professional qualifications and 
requirements; documentation of 
qualifications  
455 IAC 2 Warranty required  
Compliance with applicable building codes and 
permits  
H&W/TBI  Plumber  
IC 25-28.5  
FSSA Approved  
455 IAC 2 Becoming an approved provider; 
maintaining approval

[Audio] This meeting is held to discuss the guidelines and requirements for providers of Home Modification Assessment services under the H&W and T-B-I waivers. The first topic of discussion will be the general requirements for provider qualifications, including financial information, liability insurance, and professional qualifications. These qualifications must be documented and providers must also comply with warranty requirements and applicable building codes and permits. We will then move on to the specific qualifications and requirements for becoming an approved provider. These include obtaining a license or certification from the appropriate state agency, receiving approval from the F-S-S-A-, and following relevant building codes and permits. Next, we will discuss the Integrated Health Care Coordination (I-H-C-C-) services available under the H&W and T-B-I waivers. These services aim to improve health status and quality of life, prevent health deterioration, manage chronic conditions in collaboration with physicians, and integrate medical and social services. Activities such as developing and overseeing a healthcare support plan, collaborating with all service providers, and coordinating with social supports are allowed under IHCC. It is crucial to note that Home Modification Assessment services cannot be provided for living arrangements owned by providers, and any services provided by a parent or spouse of a participant will not be reimbursed. Providers must also adhere to specific qualifications and standards outlined in the H&W and T-B-I waivers. In conclusion, it is necessary for providers of Home Modification Assessment services to meet specific qualifications and standards in order to offer these services under the H&W and T-B-I waivers. It is essential for providers to fully understand and comply with these guidelines to ensure the delivery of high-quality and effective services to their clients.. 

Scene 7

Section 12: Health and Wellness (H&W) and Traumatic Brain Injury (TBI) Waivers 
DDRS HCBS Waivers 
Library Reference Number: PRPR10014 
263 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
Waiver 
Provider 
Licensure/ 
Certification 
Other Standards 
455 IAC 2 Provider qualifications: General 
requirements 
455 IAC 2 Financial information  
455 IAC 2 Liability insurance  
455 IAC 2 Professional qualifications and 
requirements; documentation of 
qualifications  
455 IAC 2 Warranty required  
Compliance with applicable building codes and 
permits  
H&W/TBI  Architect  
IC 25-4  
FSSA Approved  
455 IAC 2 Becoming an approved provider; 
maintaining approval.  
455 IAC 2 Provider qualifications: General 
requirements 
455 IAC 2 Financial information  
455 IAC 2 Liability insurance  
455 IAC 2 Professional qualifications and 
requirements; documentation of 
qualifications  
455 IAC 2 Warranty required  
Compliance with applicable building codes and 
permits  
Section 12.19: Integrated Health Care Coordination for 
H&W and TBI Waiver 
The following subsections provide information and requirements for Integrated Health Care Coordination 
(IHCC) services for the H&W and TBI waiver. 
Service Definition 
IHCC is to promote improved health status and quality of life, delay/prevent deterioration of health status, 
manage chronic conditions in collaboration with the physicians, and integrate medical and social services. 
Allowable Activities 
IHCC may include the following activities: 
• Development and oversight of a healthcare support plan that includes coordination of medical care 
and proactive care management of both chronic diseases and complex conditions such as recurring 
falls, depression and dementia (Note: Skilled nursing services are provided within the scope of the 
Indiana State Nurse Practice Act.) 
• Collaboration across all service providers: waiver, Indiana Medicaid State Plan, mental health, 
dental and medical 
• Collaboration across social supports: housing, food, Medicare/Medicaid system navigation, finances 
and transportation 
• Medication review

[Audio] This presentation is about the Home Modification Assessment services offered under the Health and Wellness (H&W) and Traumatic Brain Injury (T-B-I--) waivers. Our discussion will focus on the guidelines and qualifications for providers of Home Modification Assessment services, which include limitations on using the service for accommodations owned by providers and disqualification for services provided by a parent or spouse of a participant. These service standards must be adhered to in order for the care manager to coordinate and collaborate with the participant's integrated healthcare coordination provider, stay updated on the participant's status from the healthcare coordination provider, and work together to address any unmet needs. It is important to note that I-H-C-C services will not duplicate any other waiver services, and that at least one face-to-face visit per month is required. Thank you for your attention to this crucial topic.. 

Scene 8

DDRS HCBS Waivers 
Section 12: Health and Wellness (H&W) and Traumatic Brain Injury (TBI) Waivers 
264 
Library Reference Number: PRPR10014 
 
Published: Sept. 9, 2024 
 
Policies and procedures as of July 1, 2024 
 
Version: 11.1 
• Transitional support from hospital or nursing facility to home/assisted living 
• Advance care planning 
Service Standards 
These service standards must be followed for IHCC: 
• Current Indiana RN license for each nurse. 
• Current Indiana license for each LPN. 
• Indiana license for social worker (LSW) with master’s degree in social work with additional 
documentation of at least two years of experience providing health care coordination.  
• Weekly consultations or reviews 
• Face-to-face visits with the participant; including a minimum of one face-to-face visit per month 
• No duplication of services provided under the Indiana Medicaid State Plan or under any other 
waiver service 
• Services must address needs in the plan of care.  
The care manager is expected to coordinate and collaborate with the participant’s integrated healthcare 
coordination provider; review all updates about the participant from the health care coordination provider 
including interventions and follow up with the participant about changes in medical and social services as 
well as interventions implemented by the health care coordinator provider to ensure the member’s needs are 
being met. The care manager shall communicate information learned in these follow-up meetings with the 
integrated health care coordination provider and shall work together to resolve any unmet needs identified.  
Documentation Standards 
These documentation standards must be followed for IHCC: 
• Evidence of a consultation, including complete date and signature (Note: Consultation can be with 
the participant, informal caregivers, other staff, other professionals, as well as healthcare 
professionals.) 
– Weekly consultations or reviews 
– Minimum of one face-to-face visit with the participant per month. 
• Services required to address needs identified in the plan of care or PCA 
• Written report provided to pertinent parties at least quarterly by the IHCC provider (Note: Pertinent 
parties include the participant, guardian, waiver care manager, all waiver service providers 
including mental health providers, Indiana Medicaid State Plan services and physicians.) 
Limitations 
IHCC services will not duplicate services provided under the Indiana Medicaid State Plan or any other 
waiver service. 
IHCC services are: 
• A minimum of one face-to-face visit per month 
• Not to exceed 16 hours of healthcare coordination per month, including travel time

[Audio] Providers of Home Modification Assessment services under the Health and Wellness (H&W) and Traumatic Brain Injury (T-B-I--) waivers must adhere to specific restrictions and qualifications outlined in Section 12 of the waiver. These include not providing skilled nursing services covered under the Indiana Medicaid State Plan, or any other services already available through the waiver. To be eligible as a provider, one must be approved by the Family and Social Services Administration (F-S-S-A-) as a Home Health Agency, physician practice, Adult Day Facility, or Assisted Living Facility under the H&W and T-B-I programs. Nutritional supplements must be prescribed by a physician, physician assistant, or nurse practitioner and can only be reimbursed through a local Area Agency on Aging (A-A-A--) or approved F-S-S-A provider who maintains receipts and verifies services. Providers may also communicate with the state Medicaid agency at their own discretion. It is important to note that providers cannot use Home Modification Assessment services for their own living arrangements, and services provided by a participant's parent or spouse will not be reimbursed. These restrictions are in place to ensure that participants receive the best quality of care and support.. 

Scene 9

Section 12: Health and Wellness (H&W) and Traumatic Brain Injury (TBI) Waivers 
DDRS HCBS Waivers 
Library Reference Number: PRPR10014 
265 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
Activities Not Allowed 
The following activities are not allowed under IHCC: 
• Skilled nursing services that are available under the Indiana Medicaid State Plan  
• Any other service otherwise provided by the waiver  
Provider Qualifications 
Provider qualifications for IHCC are presented in Table 21. 
Table 21 – Provider Qualifications for Integrated Health Care Coordination 
Waiver 
Provider 
Licensure/ 
Certification 
Other Standards 
H&W/TBI 
Home Health Agency  
IC 25-23-1 LPN 
IC 25.23.6 LSW 
IC 25-23-1 RN  
FSSA approved  
H&W/TBI 
Adult Day Facility 
IC 25-23-1 RN 
IC 25-23-1 LPN 
IC 25.23.6 LSW 
FSSA approved 
H&W/TBI 
Assisted Living Facility 
IC 25-23-1 RN 
IC 25-23-1 LPN 
IC 25.23.6 LSW 
FSSA approved 
H&W/TBI 
FSSA-approved 
physician practice 
IC 25-23-1 RN 
IC 25-23-1 LPN 
IC 25.23.6 LSW 
FSSA approved 
Section 12.20: Nutritional Supplements for H&W and 
TBI Waivers 
The following subsections provide information and requirements for the Nutritional Supplements service 
for H&W and TBI waivers. 
Service Definition 
Nutritional (dietary) supplements include liquid supplements, such as Boost or Ensure, to support people in 
maintaining an individual’s health, so they are able to remain in the community. 
Supplements must be ordered by a physician, physician assistant or nurse practitioner.  
Approved Nutritional Supplement expenditures are reimbursed through the local AAA or an approved 
FSSA provider which maintains all applicable receipts and verifies the delivery of services. Providers can 
directly relate with the state Medicaid agency at the provider’s election.  
Allowable Activities 
The Nutritional Supplements service includes enteral formulae, category 1, such as Boost or Ensure.

[Audio] This discussion aims to outline the guidelines and qualifications necessary for providers who offer Home Modification Assessment services under H&W and T-B-I waivers, specifically related to Nutritional Supplements services. The care manager has the responsibility of completing certain documentation tasks when requesting Nutritional Supplements for a participant. These tasks include documenting the delivery date, number of meals provided, and the care professional or manager involved in the participant's care. Furthermore, personal records must be kept in a prominent location in the participant's file and given to them when they transfer for medical care or move from their residence. There are limitations to the Nutritional Supplements services. A yearly cap of $1200 is available for these services, and they can only cover additional services not already included in Indiana's Medicaid State Plan, such as EPSDT, but still align with the goal of avoiding institutionalization. The meals provided as part of these services cannot constitute a full nutritional regimen. Certain activities are not permitted under Nutritional Supplements services. Services that are already covered by Indiana's Medicaid State Plan will not be reimbursed, and this service will not be reimbursed when provided by the parent of a minor child participant or the spouse of a participant, as described in C-2-d and C-2-e of the H&W and T-B-I waivers. Providers must meet specific qualifications outlined in Table 22 in order to offer Nutritional Supplements services to participants. We appreciate your attention to these guidelines and qualifications for providers of Home Modification Assessment services under H&W and T-B-I waivers.. 

Scene 10

DDRS HCBS Waivers 
Section 12: Health and Wellness (H&W) and Traumatic Brain Injury (TBI) Waivers 
266 
Library Reference Number: PRPR10014 
 
Published: Sept. 9, 2024 
 
Policies and procedures as of July 1, 2024 
 
Version: 11.1 
Service Standards  
Nutritional Supplements services must follow a written service plan addressing specific needs determined 
by the individual’s PCA.  
Documentation Standards 
The care manager must complete these documentation tasks: 
• Document the need for Nutritional Supplements and amount being requested. 
• Identify the amount requesting from the annual cap of $1,200 for Nutritional Supplements services. 
The provider must document the following: 
• Date of delivery 
• How many meals were provided 
• Care professional or care manager that involved the participant 
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 
Limitations 
The following limits apply for Nutritional Supplements services: 
• An annual cap of $1,200 is available for Nutritional Supplements services.  
• The services under Nutritional Supplements are limited to additional services not otherwise covered 
under the Indiana Medicaid State Plan, including EPSDT, but consistent with waiver objectives of 
avoiding institutionalization.  
• The meals provided as part of these services shall not constitute a full nutritional regimen. 
Activities Not Allowed 
The following activities are not allowed under Nutritional Supplements: 
• Services available through the Indiana Medicaid State Plan (a Medicaid State Plan PA denial is 
required before reimbursement is available through the Medicaid waiver for this service)  
• This service will not be reimbursed when provided by the parent of a minor child participant or the 
spouse of a participant (also known as LRIs) as outlined in C-2-d and C-2-e of the H&W and TBI 
waivers.  
Provider Qualifications 
Provider qualifications for the Nutritional Supplements service are presented in Table 22.

[Audio] Our purpose for gathering is to discuss the criteria and qualifications for individuals who want to provide Home Modification Assessment services under the H&W and T-B-I waivers. These requirements are outlined in the DDRS HCBS Waivers and Table 22 Provider Qualifications for Nutritional Supplements. To become an approved provider, it is necessary to maintain proper licensure/certification and adhere to other standards. Furthermore, the Participant-Directed Home Care Service (P-D-H-C-S) within the H&W Waiver has specific definitions and guidelines which must be followed. This service can be carried out by either licensed medical personnel or trained nonmedical personnel and must include skilled or attendant care activities. It is available 24 hours per day, seven days a week, with a maximum of five slots, and must be approved by the F-S-S-A-. In order to be eligible, the participant must have a chronic medical condition and receive Indiana Medicaid State Plan Home Health Services. Lastly, the participant must be willing to take on the risks and responsibilities associated with hiring a caregiver and directing their own care. These guidelines and standards are in place to ensure that individuals receive high-quality care and services.. 

Scene 11

Section 12: Health and Wellness (H&W) and Traumatic Brain Injury (TBI) Waivers 
DDRS HCBS Waivers 
Library Reference Number: PRPR10014 
267 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
Table 22 – Provider Qualifications for Nutritional Supplements 
Waiver 
Provider 
Licensure/ 
Certification 
Other Standards 
H&W/TBI  FSSA-
approved  
Nutritional  
Supplements  
Agency  
Not required  
FSSA approved 
455 IAC 2 Becoming an approved provider; 
maintaining approval.  
455 IAC 2 Provider qualifications: General 
requirements 
455 IAC 2 Transfer of individual’s record upon 
change of provider  
455 IAC 2 Maintenance of records of services 
provided  
455 IAC 2 Liability insurance 
Section 12.21: Participant-Directed Home Care Service 
for H&W Waiver 
The following subsections provide information and requirements for Participant-Directed Home Care 
Service (PDHCS) under the H&W Waiver. 
Service Definition 
The PDHCS is a health-related service under the Health and Wellness (H&W) Waiver that can be 
performed by either licensed medical or trained nonmedical personnel, and is provided for the primary 
purpose of meeting the chronic personal needs of the participant to maintain a level of function that will 
allow for a participant to avoid unnecessary institutionalization. This service can provide skilled or 
attendant care activities or both. In conjunction with the Indiana Medicaid State Plan, PDHCS may be 
provided 24 hours per day, seven days a week. 
Note: The PDHCS has a limit of five slots, and services must be approved by the FSSA. 
Service Standards 
• A participant shall hire either a licensed professional through a home health agency, an independent, 
licensed professional or a nonclinical competency trained unlicensed profession. 
• Home care service requires individual and continuous services when there is no person available 
outside of these services to assume the role of caregiver. 
• PDHCS requires a participant to be diagnosed with a chronic medical condition that may require up 
to 24 hours of continuous care, as evidenced through a physician’s order that can be safely provided 
outside of an institution. The participant must also receive Indiana Medicaid State Plan Home 
Health Services. 
• Home care attendant service is provided according to the participant’s service plan/plan of care 
which documents the participant’s specific health-related need for individual and continuous care. 
• Participant must be willing to accept risks and responsibilities associated with employing the 
caregiver and directing their own care.

[Audio] We are present today to discuss the guidelines and qualifications for providers of Home Modification Assessment services under Health and Wellness (H&W) and Traumatic Brain Injury (T-B-I--) waivers. These waivers are intended to support individuals with disabilities who require assistance in living arrangements and care management. However, there are specific limitations and documentation standards that must be followed by service coordinators and care managers. Firstly, P-D-H-C-S is only offered to individuals in a non-congregate setting and living alone without family or other informal supports willing and able to be trained to care for the participant and assume a portion of the participant’s care. Secondly, P-D-H-C-S is only available to individuals residing in certain postal codes. Thirdly, P-D-H-C-S does not include administration of level II, III, IV, and V medications. Service coordinators and care managers play a crucial role in the success of PDHCS. They must maintain documentation standards such as providing oversight and monitoring of the service plan of the participant, assessing the participant for participation in the PDHCS, completing the participant-directed checklist, assisting the participant in directing care, evaluating whether the P-D-H-C-S is appropriate for meeting their needs, assessing the needs of the participant through a person-centered planning process, establishing an annual cost limit, documenting the medical need for a skilled service and types of skilled care required, documenting the frequency, duration, and types of appropriate skilled activities, having the participant sign a waiver liability form, documenting who is the employer and employee/direct worker and their relationship to the participant, documenting the backup plan for the participant when the direct worker is unavailable, monitoring the enrollment process, collecting all training paperwork containing signatures, and monitoring service delivery every month.. 

Scene 12

DDRS HCBS Waivers 
Section 12: Health and Wellness (H&W) and Traumatic Brain Injury (TBI) Waivers 
268 
Library Reference Number: PRPR10014 
 
Published: Sept. 9, 2024 
 
Policies and procedures as of July 1, 2024 
 
Version: 11.1 
Limitations 
PDHCS has the following limitations: 
• PDHCS is offered to individuals in a non-congregate setting.  
• PDHCS is offered to individuals living alone without family or other informal supports willing and 
able to be trained to care for the participant and assume a portion of the participant’s care.  
• PDHCS is offered to individuals residing in postal codes 46260, 46143, 46202 and 46204 
• PDHCS does not include administration of level II, III, IV and V medications. 
Documentation Standards 
Service coordinators/care managers are an integral part of the success of the PDHCS. The service 
coordinator/care manager must maintain these documentation standards: 
• Provide oversight and monitoring of the service plan of the participant. 
• Assess the participant for participation in the PDHCS and complete the participant-directed 
checklist before the service may be added to the service plan and at the initial, quarterly review, 
annual and reentry assessments. 
• Assist the participant in directing care in evaluating whether the PDHCS is appropriate for meeting 
the participant's needs. 
• Assess the needs of the participant through a person-centered planning process and establish an 
annual cost limit based on the authorized plan of care. For waiver participants, annual cost per 
participant is determined by an algorithm established by the FSSA. The service coordinator/care 
manager will develop a person-centered plan that aligns with all setting rule requirements and meets 
those needs and service requests, and a dollar amount will be assigned to the plan using the FSSA’s 
algorithm. The service coordinator/care manager must document the budget process and review with 
the participant. 
• Document the medical need for a skilled service and types of skilled care the participant may 
require. 
• Document the frequency, duration and types of appropriate skilled activities that will meet the 
participant’s needs and ensure it is accurately documented in the skilled level of care E-screen. 
• Have the participant sign a waiver liability form. 
• Document who is the employer, who is the employee/direct worker and their relationship to the 
participant. 
• Document the backup plan for the participant for when the direct worker is unavailable to deliver 
skilled care. 
• Monitor the enrollment process for the participant and their employee/direct worker. 
• Collect all training paperwork containing signatures for the file. 
• Monitor service delivery every month. The service coordinator/care manager shall coordinate 
service delivery (frequency, activities) with the employee/direct worker and also contact the fiscal 
intermediary agency to verify.

[Audio] We have rewritten and removed mentions of the slide references from the following text: In order to become a paid caregiver, the caregiver applicant must enter into the I-H-C-P agreement. The caregiver authorized to provide home care attendant services to participants must meet the personnel qualifications specified in IC.16-27-1 or successfully complete the following requirements: * If applicable, a competency evaluation program or training and competency evaluation program approved or conducted under section 10.2.2 of the American Association of Respiratory Care (A-A-R-C-) Clinical Practice Guideline and/or * A program that includes cardiopulmonary resuscitation (C-P-R--), basic first aid, and any applicable durable medical equipment (D-M-E--) training The paid caregiver must identify and document participant needs in the provider service plan. Services must be outlined in the provider service plan, and a data record of services must be provided and maintained, including: * Complete date and time of service (in and out) * Specific services or tasks provided * Signature of the paid caregiver providing the service (minimally the last name and first initial) Each paid caregiver providing direct care or supervision of care to the participant must make at least one entry on each day of service. All entries must describe an issue or circumstance offered to the individual. Daily documentation of service delivery is to be signed by the participant. If the participant cannot sign, then the paid caregiver must self-attest and sign in lieu of the participant. The paid caregiver is required to coordinate information about the participant's care, including backup plan, with any and all other providers and care manager rendering services to the participant. Provider coordination shall occur among providers/paid caregivers during shift changes for the participant and at any other time where the participant experiences a healthcare change.. 

Scene 13

Section 12: Health and Wellness (H&W) and Traumatic Brain Injury (TBI) Waivers 
DDRS HCBS Waivers 
Library Reference Number: PRPR10014 
269 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
Activities Not Allowed 
The following activities are not allowed under PDHCS: 
• Participant must be able to direct their own care. 
• This service will not be reimbursed when provided by the parent of a minor child participant or the 
spouse of a participant (also known as LRIs) as outlined in C-2-d and C-2-e of the H&W waiver.  
Provider Standards 
The caregiver applicant must enter into the IHCP agreement to become a paid caregiver. The caregiver 
authorized to provide home care attendant services to participants if the individual:  
• Either meets the personnel qualifications specified in IC.16-27-1 or successfully completed the 
following, as applicable (verified by the fiscal intermediary):  
– If applicable, a competency evaluation program or training and competency evaluation program 
approved or conducted under section 10.2.2 of the American Association of Respiratory Care 
(AARC) Clinical Practice Guideline and/or 
– A program that includes cardiopulmonary resuscitation (CPR), basic first aid and any applicable 
durable medical equipment (DME) training 
– The paid caregiver must identify and document participant need in the provider service plan. 
• Identifies and documents participant need in the provider service plan:  
– Services must be outlined in the provider service plan.  
– Data record of services must be provided and maintained, including: 
➢ Complete date and time of service (in and out) 
➢ Specific services or tasks provided 
➢ Signature of paid caregiver providing the service (minimally the last name and first initial)  
– Each paid caregiver providing direct care or supervision of care to the participant must make at 
least one entry on each day of service. All entries must describe an issue or circumstance offered 
to the individual.  
– Daily documentation of service delivery is to be signed by the participant. If the participant 
cannot sign, then the paid caregiver must self-attest and sign in lieu of the participant. The paid 
caregiver is required to coordinate information about the participant’s care, including backup 
plan, with any and all other providers and care manager rendering services to the participant. 
Provider coordination shall occur among providers/paid caregivers during shift changes for the 
participant and at any other time where the participant experiences a healthcare change. 
Provider Qualifications 
Provider qualifications for the PDHCS are presented in Table 23. 
Table 23 – Provider Qualifications for Participant-Directed Home Care Service 
Waiver 
Provider 
Licensure/ 
Certification 
Other Standards 
H&W 
Aide/Paid 
Caregiver  
Not required 
FSSA approved  
  
H&W 
Home Health 
agency 
IC 16-27-1 
FSSA approved provider

[Audio] Thank you for joining us for this presentation on DDRS HCBS Waivers and the guidelines for Personal Emergency Response System under H&W and T-B-I waivers. This information is important for anyone looking to serve as a provider and ensure that their services are following the necessary standards. We want to remind you that Home Modification Assessment services are not to be used for living arrangements owned by providers. This is to avoid any conflicts of interest and maintain a fair and unbiased approach to the services provided. Furthermore, services provided by a parent or spouse of a participant will not be reimbursed. This is to ensure that the participant receives appropriate care from an external, unbiased source. The Personal Emergency Response System, or pers, is an essential electronic device that enables at-risk participants to receive help in an emergency. It includes a portable help button for increased mobility. The pers system is connected to the participant's phone and is programmed to signal a response center when activated. This center is staffed 24/7 by trained professionals to ensure quick and effective emergency response. Under the pers service, the following activities are allowed: device installation, ongoing monthly maintenance, and electronic services such as a portable help button. However, remote monitoring will not be placed in participant bedrooms or bathrooms for privacy reasons. To ensure quality care, the pers service must follow a written service plan that addresses the specific needs of the individual as determined by their assessment. This is to ensure that the participant receives personalized and appropriate care. In the event that a participant experiences a fall, the care manager is required to be contacted by the pers provider. This is to ensure that the participant receives the necessary follow-up care. Finally, it is the responsibility of the care manager to document any important information regarding the pers service. Thank you for joining us for this presentation on DDRS HCBS Waivers and the guidelines for Personal Emergency Response System under H&W and T-B-I waivers. We hope you found this information useful. Have a great day.. 

Scene 14

DDRS HCBS Waivers 
Section 12: Health and Wellness (H&W) and Traumatic Brain Injury (TBI) Waivers 
270 
Library Reference Number: PRPR10014 
 
Published: Sept. 9, 2024 
 
Policies and procedures as of July 1, 2024 
 
Version: 11.1 
Section 12.22: Personal Emergency Response System 
for H&W and TBI Waivers 
The following subsections provide information and requirements for the Personal Emergency Response 
System (PERS) under the H&W and TBI waivers. 
Service Definition 
PERS is an electronic device that enables certain participants at high risk of institutionalization to secure 
help in an emergency. The participant may also wear a portable help button to allow for mobility. The 
system is connected to the person’s phone and programmed to signal a response center after a button is 
activated. The response center is staffed 24 hours a day, seven days a week by trained professionals. 
Allowable Activities 
The following activities are allowed under the PERS service: 
• Device installation  
• Ongoing monthly maintenance of the device 
• Electronic service that is usually a portal help button; however, it can also be an electronic device 
that includes, but is not limited to GPS or video monitoring service (Note: Remote monitoring will 
not be placed in participant bedrooms or bathrooms.) 
Service Standards 
The PERS service must follow a written service plan addressing specific needs determined by the 
individual’s assessment. 
The care manager is required to contact the waiver participant if contacted by the PERS provider that 
waiver participant experienced a fall. 
Documentation Standards 
The care manager is responsible for the documenting the following: 
• The need for PERS  
• The need for PERS maintenance 
• Whether the person is residing alone or alone for significant parts of the day without a caregiver 
present 
The provider is responsible for documenting the following:  
• Date of installation  
• Expense for installation 
• Monthly rental fee 
• Ongoing monthly maintenance of device 
• Monthly written notification to care managers of any participant who experienced a fall within a 
one-month time frame

 part 20

We are excited to present the next slide in our presentation on Home Modification Assessment services. This slide will outline the guidelines and qualifications for providers of this service, as well as the restrictions and disqualifications for using the service for living arrangements owned by providers and services provided by a parent or spouse of a participant.

Under Section 12 of the DDRS HCBS Waivers, Home Modifications are physical adaptations to the home that are necessary to ensure the health, welfare, and safety of the participant and enable them to function with greater independence in their home. 

When the participant owns a home, home modifications are considered. Rented homes or apartments or family-owned homes are allowed to be modified only when a signed agreement from the property owner is obtained. The signed agreement must be submitted along with all other required documentation. Disputes between different parties may not be within the scope of the Bureau of Disabilities Services to be able to intervene in a resolution.

The participant chooses the certified providers to submit bids for the Home Modifications. If the participant chooses to continue with the Home Modification after receiving the bids, then the lowest bid that meets the minimum requirements shall be chosen. There is a minimum requirement to gather two bids for any expected amount over $5000.

Modifications allowed under the Home Modifications service may include but are not limited to adaptive door openers and locks, bathroom modification, home control units, and kitchen modification. Home safety devices such as door alarms are also allowed.

It’s important to note that services provided by a parent or spouse of a participant will not be reimbursed, and there are specific provider qualifications and standards outlined in the H&W and T-B-I waivers. Providers must comply with all requirements and guidelines outlined in these waivers to be eligible for reimbursement.

In summary, Home Modifications are physical adaptations to the home that are necessary to ensure the health, welfare, and safety of the participant and enable them to function with greater independence in their home. Providers must comply with all requirements and guidelines outlined in the H&W and T-B-I waivers to be eligible for reimbursement, and services provided by a parent or spouse of a participant will not be reimbursed.

avatar

Our objective is to enhance the quality of life for individuals with health and wellness requirements and those with traumatic brain injury. We believe that our guidelines and qualifications will assist in ensuring that our Home Modification Assessment services are offered safely, effectively, and efficiently. Thank you for taking our presentation into account.

We are here to discuss the guidelines and qualifications for providers of Home Modification Assessment services. These guidelines set out specific requirements to ensure that home modification services are safe, effective, and meet the needs of participants. In this presentation, we will be covering the guidelines and qualifications for providers of Home Modification Assessment services, including restrictions on using the service for living arrangements owned by providers and disqualification for services provided by a parent or spouse of a participant. We will also be discussing the documentation standards and limitations that apply to these services, including a lifetime cap of $20000 for home modifications and an annual allowance of $1000 for repairs, replacements, or adjustments to existing home modifications. We hope that this presentation will provide you with a better understanding of the guidelines and qualifications for providers of Home Modification Assessment services. Thank you for your attention.

Home Modification Assessment services are available for repair and service of home modifications provided through H-C-B-S waivers. However, certain restrictions and guidelines must be followed in order to receive these services. Firstly, requests for service must detail parts cost and labor cost. If the need for maintenance exceeds $1000, the care 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. Additionally, items requested that are not listed in the Allowable Activities section must be reviewed and a decision rendered by the state F-S-S-A director or state agency designee. Requests for modifications at two or more locations may only be approved at the discretion of the F-S-S-A director or designee. Requests for modifications may be denied if the state F-S-S-A director or state agency designee determines the documentation does not support residential stability and/or the service requested. It is important to note that Home Modifications services are limited to additional services not otherwise covered under the Indiana Medicaid State Plan, including EPSDT, but consistent with waiver objectives of avoiding institutionalization. Activities not allowed under Home Modifications include but are not limited to the following: Adaptations or improvements that are not of direct medical or remedial benefit to the participant, such as central heating and air conditioning, routine home maintenance, roof repair, structural repair that is not incidental to the original modification, driveways, decks, patios, publicly owned sidewalks and household furnishings, swimming pools, spas, or hot tubs, outside storage spaces, and 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 on). Modifications that will add non-incidental square footage to the home. Home Modifications services for participants living in foster homes, group homes, assisted living facilities or homes for special services (any licensed residential facility) are not allowed. Additionally, Home Modifications services for participants living in a provider-owned or controlled residence are not allowed. Completion of, or modifications to, new construction or significant remodeling/reconstruction are also excluded, unless there is documented evidence of a significant change in the participant's medical or remedial needs that now require the requested modification.

Our purpose for gathering is to discuss the requirements and criteria for individuals or organizations seeking to provide Home Modification Assessment services under H&W and T-B-I waivers. It is important to note that providers who have any ownership in the organization are not eligible to offer Home Modification services to participants under these waivers. This includes parents of minor child participants, spouses of participants, attorneys-in-fact (or poas), H-C-R-s-, and legal guardians of participants.

Furthermore, any Home Modification services provided by the aforementioned individuals, also known as L-R-I-s-, will not be reimbursed under H&W and T-B-I waivers, as outlined in C-2-d and C-2-e of the waivers. In order to become an approved provider of Home Modification services, certain requirements and standards must be met, as stated in the H&W and T-B-I waivers.

These qualifications include possessing a valid FSSA-approved license or certification, adhering to relevant building codes and permits, maintaining appropriate liability insurance, and providing documentation of professional qualifications and requirements. Additionally, providers must ensure that they remain in good standing with the 455 I-A-C 2, IC 25-20.2, and IC 25-28.5 standards, and comply with any other applicable standards outlined in the H&W and T-B-I waivers.

We hope that the information provided has clarified the guidelines and qualifications for providers of Home Modification Assessment services under H&W and T-B-I waivers.

This meeting is held to discuss the guidelines and requirements for providers of Home Modification Assessment services under the H&W and T-B-I waivers. The first topic of discussion will be the general requirements for provider qualifications, including financial information, liability insurance, and professional qualifications. These qualifications must be documented and providers must also comply with warranty requirements and applicable building codes and permits. 
We will then move on to the specific qualifications and requirements for becoming an approved provider. These include obtaining a license or certification from the appropriate state agency, receiving approval from the F-S-S-A-, and following relevant building codes and permits. 
Next, we will discuss the Integrated Health Care Coordination (I-H-C-C-) services available under the H&W and T-B-I waivers. These services aim to improve health status and quality of life, prevent health deterioration, manage chronic conditions in collaboration with physicians, and integrate medical and social services. Activities such as developing and overseeing a healthcare support plan, collaborating with all service providers, and coordinating with social supports are allowed under IHCC. 
It is crucial to note that Home Modification Assessment services cannot be provided for living arrangements owned by providers, and any services provided by a parent or spouse of a participant will not be reimbursed. Providers must also adhere to specific qualifications and standards outlined in the H&W and T-B-I waivers. 
In conclusion, it is necessary for providers of Home Modification Assessment services to meet specific qualifications and standards in order to offer these services under the H&W and T-B-I waivers. It is essential for providers to fully understand and comply with these guidelines to ensure the delivery of high-quality and effective services to their clients.

This presentation is about the Home Modification Assessment services offered under the Health and Wellness (H&W) and Traumatic Brain Injury (T-B-I--) waivers. Our discussion will focus on the guidelines and qualifications for providers of Home Modification Assessment services, which include limitations on using the service for accommodations owned by providers and disqualification for services provided by a parent or spouse of a participant. These service standards must be adhered to in order for the care manager to coordinate and collaborate with the participant's integrated healthcare coordination provider, stay updated on the participant's status from the healthcare coordination provider, and work together to address any unmet needs. It is important to note that I-H-C-C services will not duplicate any other waiver services, and that at least one face-to-face visit per month is required. Thank you for your attention to this crucial topic.

Providers of Home Modification Assessment services under the Health and Wellness (H&W) and Traumatic Brain Injury (T-B-I--) waivers must adhere to specific restrictions and qualifications outlined in Section 12 of the waiver. These include not providing skilled nursing services covered under the Indiana Medicaid State Plan, or any other services already available through the waiver. To be eligible as a provider, one must be approved by the Family and Social Services Administration (F-S-S-A-) as a Home Health Agency, physician practice, Adult Day Facility, or Assisted Living Facility under the H&W and T-B-I programs. Nutritional supplements must be prescribed by a physician, physician assistant, or nurse practitioner and can only be reimbursed through a local Area Agency on Aging (A-A-A--) or approved F-S-S-A provider who maintains receipts and verifies services. Providers may also communicate with the state Medicaid agency at their own discretion. It is important to note that providers cannot use Home Modification Assessment services for their own living arrangements, and services provided by a participant's parent or spouse will not be reimbursed. These restrictions are in place to ensure that participants receive the best quality of care and support.

This discussion aims to outline the guidelines and qualifications necessary for providers who offer Home Modification Assessment services under H&W and T-B-I waivers, specifically related to Nutritional Supplements services. The care manager has the responsibility of completing certain documentation tasks when requesting Nutritional Supplements for a participant. These tasks include documenting the delivery date, number of meals provided, and the care professional or manager involved in the participant's care. Furthermore, personal records must be kept in a prominent location in the participant's file and given to them when they transfer for medical care or move from their residence.

There are limitations to the Nutritional Supplements services. A yearly cap of $1200 is available for these services, and they can only cover additional services not already included in Indiana's Medicaid State Plan, such as EPSDT, but still align with the goal of avoiding institutionalization. The meals provided as part of these services cannot constitute a full nutritional regimen.

Certain activities are not permitted under Nutritional Supplements services. Services that are already covered by Indiana's Medicaid State Plan will not be reimbursed, and this service will not be reimbursed when provided by the parent of a minor child participant or the spouse of a participant, as described in C-2-d and C-2-e of the H&W and T-B-I waivers.

Providers must meet specific qualifications outlined in Table 22 in order to offer Nutritional Supplements services to participants. We appreciate your attention to these guidelines and qualifications for providers of Home Modification Assessment services under H&W and T-B-I waivers.

Our purpose for gathering is to discuss the criteria and qualifications for individuals who want to provide Home Modification Assessment services under the H&W and T-B-I waivers. These requirements are outlined in the DDRS HCBS Waivers and Table 22  Provider Qualifications for Nutritional Supplements. To become an approved provider, it is necessary to maintain proper licensure/certification and adhere to other standards. Furthermore, the Participant-Directed Home Care Service (P-D-H-C-S) within the H&W Waiver has specific definitions and guidelines which must be followed. This service can be carried out by either licensed medical personnel or trained nonmedical personnel and must include skilled or attendant care activities. It is available 24 hours per day, seven days a week, with a maximum of five slots, and must be approved by the F-S-S-A-. In order to be eligible, the participant must have a chronic medical condition and receive Indiana Medicaid State Plan Home Health Services. Lastly, the participant must be willing to take on the risks and responsibilities associated with hiring a caregiver and directing their own care. These guidelines and standards are in place to ensure that individuals receive high-quality care and services.

We are present today to discuss the guidelines and qualifications for providers of Home Modification Assessment services under Health and Wellness (H&W) and Traumatic Brain Injury (T-B-I--) waivers. These waivers are intended to support individuals with disabilities who require assistance in living arrangements and care management. However, there are specific limitations and documentation standards that must be followed by service coordinators and care managers.

Firstly, P-D-H-C-S is only offered to individuals in a non-congregate setting and living alone without family or other informal supports willing and able to be trained to care for the participant and assume a portion of the participant’s care. Secondly, P-D-H-C-S is only available to individuals residing in certain postal codes. Thirdly, P-D-H-C-S does not include administration of level II, III, IV, and V medications.

Service coordinators and care managers play a crucial role in the success of PDHCS. They must maintain documentation standards such as providing oversight and monitoring of the service plan of the participant, assessing the participant for participation in the PDHCS, completing the participant-directed checklist, assisting the participant in directing care, evaluating whether the P-D-H-C-S is appropriate for meeting their needs, assessing the needs of the participant through a person-centered planning process, establishing an annual cost limit, documenting the medical need for a skilled service and types of skilled care required, documenting the frequency, duration, and types of appropriate skilled activities, having the participant sign a waiver liability form, documenting who is the employer and employee/direct worker and their relationship to the participant, documenting the backup plan for the participant when the direct worker is unavailable, monitoring the enrollment process, collecting all training paperwork containing signatures, and monitoring service delivery every month.

We have rewritten and removed mentions of the slide references from the following text:
                                     In order to become a paid caregiver, the caregiver applicant must enter into the I-H-C-P agreement. The caregiver authorized to provide home care attendant services to participants must meet the personnel qualifications specified in IC.16-27-1 or successfully complete the following requirements:
                                     * If applicable, a competency evaluation program or training and competency evaluation program approved or conducted under section 10.2.2 of the American Association of Respiratory Care (A-A-R-C-) Clinical Practice Guideline and/or
                                     * A program that includes cardiopulmonary resuscitation (C-P-R--), basic first aid, and any applicable durable medical equipment (D-M-E--) training

                                     The paid caregiver must identify and document participant needs in the provider service plan. Services must be outlined in the provider service plan, and a data record of services must be provided and maintained, including:

                                     * Complete date and time of service (in and out)
                                     * Specific services or tasks provided
                                     * Signature of the paid caregiver providing the service (minimally the last name and first initial)

                                     Each paid caregiver providing direct care or supervision of care to the participant must make at least one entry on each day of service. All entries must describe an issue or circumstance offered to the individual. Daily documentation of service delivery is to be signed by the participant. If the participant cannot sign, then the paid caregiver must self-attest and sign in lieu of the participant. The paid caregiver is required to coordinate information about the participant's care, including backup plan, with any and all other providers and care manager rendering services to the participant. Provider coordination shall occur among providers/paid caregivers during shift changes for the participant and at any other time where the participant experiences a healthcare change.

Thank you for joining us for this presentation on DDRS HCBS Waivers and the guidelines for Personal Emergency Response System under H&W and T-B-I waivers. This information is important for anyone looking to serve as a provider and ensure that their services are following the necessary standards.

            We want to remind you that Home Modification Assessment services are not to be used for living arrangements owned by providers. This is to avoid any conflicts of interest and maintain a fair and unbiased approach to the services provided. Furthermore, services provided by a parent or spouse of a participant will not be reimbursed. This is to ensure that the participant receives appropriate care from an external, unbiased source.

            The Personal Emergency Response System, or pers, is an essential electronic device that enables at-risk participants to receive help in an emergency. It includes a portable help button for increased mobility.

            The pers system is connected to the participant's phone and is programmed to signal a response center when activated. This center is staffed 24/7 by trained professionals to ensure quick and effective emergency response.

            Under the pers service, the following activities are allowed: device installation, ongoing monthly maintenance, and electronic services such as a portable help button. However, remote monitoring will not be placed in participant bedrooms or bathrooms for privacy reasons.

            To ensure quality care, the pers service must follow a written service plan that addresses the specific needs of the individual as determined by their assessment. This is to ensure that the participant receives personalized and appropriate care.

            In the event that a participant experiences a fall, the care manager is required to be contacted by the pers provider. This is to ensure that the participant receives the necessary follow-up care.

            Finally, it is the responsibility of the care manager to document any important information regarding the pers service.

            Thank you for joining us for this presentation on DDRS HCBS Waivers and the guidelines for Personal Emergency Response System under H&W and T-B-I waivers. We hope you found this information useful. Have a great day.