[Virtual Presenter] Welcome to our presentation on conducting complaint investigations and mortality reviews for B-D-S services. This is a crucial part of our Quality Assurance for H-C-B-S Waiver Program Services. We conduct complaint investigations as necessary to maintain high standards of care and address any concerns or issues that may arise. These investigations may involve site visits, one-on-one interviews, and document review to gather all necessary information. If a problem or violation is found, we may send a corrective action plan (C-A-P--) to the provider to resolve the issue. Our goal is to work with providers to promptly and effectively address any concerns. In cases of mortality, our B-D-S quality vendor conducts a review that includes discussing the events leading to the death, the supports and services in place at the time, and any documentation received. Depending on the review, the case may be presented to our Mortality Review Committee (M-R-C--) for further examination and discussion. The M-R-C--, which consists of qualified professionals, thoroughly evaluates the case and provides recommendations for systemic improvements and provider-specific actions. This allows for continuous improvement and better outcomes for our clients. In certain instances, providers may be required to develop a C-A-P to prevent negative outcomes and improve the quality of care provided. This is our commitment to continually improving the well-being of our clients. Thank you for listening to this overview. Please proceed to the next slide for more details and examples.. 

Scene 1

Section 9: BDS Quality Assurance for HCBS Waiver Program Services  
DDRS HCBS Waivers 
Library Reference Number: PRPR10014 
75 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
circumstances may require the BDS to contact APS, DCS, local law enforcement and/or the 
provider to take immediate measures to assure the individual’s health and welfare.  
• It should be noted that the BDS quality vendor conducts most activities related to complaint 
investigations on an unannounced basis. Some activities, such as interviews with individuals who 
may have information regarding the issue but are not directly employed by the entity the complaint 
is against, sometimes require advanced scheduling to ensure those individuals are available. 
Depending on the nature of the complaint, investigation activities may include: 
– Conducting site visits to the individual’s home and/or day program site 
– Conducting one-on-one interviews with the individual receiving services and/or their staff, 
guardians, family members, and any other people involved in the issue being investigated 
– Requesting and reviewing of documents/information from involved providers 
When complaint allegations are found to be in violation of IAC, the BDS quality vendor sends the provider 
a corrective action plan (CAP) to remedy the situation. In rare cases in which the issue was already 
discovered and corrected by the provider prior to any investigation by the quality vendor, a CAP may not 
be required. In these cases, the quality vendor would verify the implementation of the corrective action the 
provider implemented to ensure that the issue is appropriately resolved. To obtain specific information 
related to the investigation process, providers may refer to the Policy on BQIS Complaints Supported 
Living Services & Supports at in.gov/fssa. 
Currently, complaints can be filed using the online complaint form or through the BDS toll-free telephone 
number at 800-545-7763. 
Section 9.4: Mortality Reviews 
The BDS is responsible for conducting mortality reviews for all deaths of individuals that received the BDS 
services, regardless of service setting. Providers are required to report all deaths through the Incident 
Reporting System accessible from the BDS Incident Reporting page: 
• The BDS quality vendor is responsible for conducting the mortality review process, which begins 
when the BDS Mortality Review Triage Team (MRTT) requests and reviews medical history and 
other related documentation for all deceased individuals. Reviews involve discussion of events prior 
to the death, supports/services in place at the time of death, documentation received, whether 
additional documentation is needed for review, and whether the death should be presented to the 
Mortality Review Committee (MRC) as a focus case for further review and discussion. Any death 
can be brought before the MRC for discussion at the request of the members, the BDS Quality 
Assurance director or other BDS staff that has a concern. 
• The MRC is facilitated by the BDS quality vendor. Committee members include representatives 
from APS, the Indiana Department of Health (IDOH), Indiana Disability Rights, the Office 
of Medicaid Policy and Planning (OMPP), the statewide waiver ombudsman, BDS field service staff 
and community advocates. 
• Based on their discussion, the MRC makes recommendations for systemic improvements, such as 
developing new DDRS policy, revising policy, training, or the development and sharing of critical 
service area fact sheets and posting to the BDS Quality Assurance page. The MRC also makes 
provider-specific recommendations that are included in the closure letter from the MRC. 
• The MRTT and/or the MRC can refer a case to BDS for a mortality investigation to review key 
areas of a provider’s system that appear to have not been in place or to have been ineffective at the 
time of an individual’s death. Providers may be required to develop CAPs to address identified 
issues and to prevent other individuals from experiencing negative outcomes. 
• See the Policy on Mortality Review at in.gov/fssa for further information regarding mortality 
reviews and the MRC.

[Audio] Welcome, attendees. This is the second slide of our presentation, where we will cover the procedures for conducting complaint investigations and mortality reviews for B-D-S services. These procedures can be found in the B-D-S Quality Assurance for H-C-B-S Waiver Program Services section. During a complaint investigation, our team may conduct site visits, one-on-one interviews, and review documents to gather all necessary information. Depending on our findings, a corrective action plan may be issued to the provider. On the other hand, mortality reviews are conducted by our quality vendor and involve a thorough discussion of events leading up to the death, the supports and services in place, and any documentation received. If necessary, the Mortality Review Committee (M-R-C--) will convene to further review and discuss the case. The M-R-C plays a vital role in making recommendations for systemic improvements and provider-specific recommendations based on their findings. These recommendations may include developing corrective action plans to address identified issues and prevent negative outcomes. We appreciate your attention to this crucial aspect of our quality assurance process. Let's proceed to the next slide for more details.. 

Scene 2

DDRS HCBS Waivers 
Section 9: BDS Quality Assurance for HCBS Waiver Program Services 
76 
Library Reference Number: PRPR10014 
 
Published: Sept. 9, 2024 
 
Policies and procedures as of July 1, 2024 
 
Version: 11.1 
Section 9.5: National Core Indicator (NCI) Project 
The DDRS participates in the National Core Indicator (NCI) Project for individuals served by the 
Community Integration & Habilitation Waiver (CIH) and Family Supports Waiver (FSW) and will 
continue gathering data for the Traumatic Brain Injury (TBI) and Health and Wellness (H&W) waivers 
through the NCI survey process previously established by the Division of Aging with an NCI-AD survey 
contractor. This national research project, administered through the Human Services Research Institute and 
the National Association of State Developmental Disabilities Directors (NASDDDS), was developed to 
obtain a standardized set of consumer outcome measures for community-based services. NCI Project 
information is designed to be captured through face-to-face consumer satisfaction interviews. The BDS 
quality vendor or the NCI-AD survey contractor conducts these interviews across the state with individuals 
selected based on representative random samples from each DDRS waiver. Participation in this project 
allows the DDRS to make comparisons with other states providing waiver services across the country. 
Section 9.6: Case Record Reviews 
From October 2014 through September 2022 for the FSW and CIH Waiver, the BDS Quality Assurance 
services and authorized vendors were responsible for conducting case record reviews (CRRs) on files for 
individuals who receive HCBS waiver services to ascertain case manager compliance with 460 IAC 7 and 
the FSW and CIH Waiver. Based on the requirement that the service plan is centered around the 
individual’s needs and preferences using person-centered services that support them and their families in 
living their defined best life, Case record reviews included:  
• Review of the person-centered individualized support plan (PCISP) to ensure it reflects what was 
important to and for the individual in each completed Life Domain 
• Risk assessment (embedded in PCISP) was demonstrated by information included in the appropriate 
Life Domain 
• Identified risk plans were attached to PCISP and had been reviewed/updated during the service plan 
year 
• Nonwaiver services or choice to not receive intermediate care facility for individuals with 
intellectual disabilities (ICF/IID) Medicaid services was documented on the BDS Signature 
Page/Freedom of Choice Section 
• Signed pick lists (provider choice lists) for each service was documented 
• An updated PCISP was completed when an individual’s conditions or circumstances changed 
Reviews were conducted on a monthly basis using a waiver-specific valid random sampling methodology.  
Section 9.7: Quality On-Site Provider Review for FSW 
and CIH Waiver 
To evaluate services, BDS has created the Quality On-Site Provider Review, or QOPR. This process is 
specific to the CIH Waiver and FSW and includes an on-site review and evaluation of the quality of 
services being delivered to individuals receiving waivers. While BDS will continue to review compliance 
with Medicaid rules (such as, qualified provider, employee background checks and training), the state will 
also talk directly to individuals to make sure they are receiving person-centered quality services. Detailed 
information related to the QOPR, including an overview video, individual and organizational indicators, 
and information sheets can be found on the BDS Quality Assurance page at in.gov/fssa/ddrs.

[Audio] Slide number 3 provides an overview of the steps involved in conducting investigations for complaints and mortality in the H-C-B-S waiver program for B-D-S services. These processes are critical for maintaining the quality and safety of our services. Complaint investigations involve a thorough examination, including site visits, one-on-one interviews, and document reviews. If any issues are found, a corrective action plan (C-A-P--) will be issued to the provider. On the other hand, mortality reviews are carried out by the B-D-S quality vendor and focus on the events leading to the death, the support and services provided, and the submitted documentation. Based on their findings, the review team will determine if the case should be presented to the Mortality Review Committee (M-R-C--) for further analysis and discussion. The M-R-C is responsible for making recommendations for systemic improvements and specific actions for the provider based on their review. In some instances, providers may be required to develop C-A-Ps to address any issues identified during the review and prevent future negative outcomes. These procedures are crucial for our quality assurance efforts and ensure that individuals receiving B-D-S services receive the highest level of care. We appreciate your attention to this essential information.. 

Scene 3

Section 9: BDS Quality Assurance for HCBS Waiver Program Services  
DDRS HCBS Waivers 
Library Reference Number: PRPR10014 
77 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
For ease of reference, the Provider Information Sheet contains the following:  
What is the Quality On-Site Provider Review? 
The Bureau of Disabilities Services is using the Quality On-Site Provider Review to ensure the quality 
of the home and community-based (waiver) services individuals receive. These person-centered 
services should empower the individual to live, love, learn, work, play and pursue their dreams.  
What is the Quality On-Site Provider Tool? 
The tool is organized around the Charting the LifeCourse domains and includes indicators which will 
support BDS in determining if individual outcomes are being achieved as well as provider compliance 
with the HCBS Settings Rule. The Quality On-Site Provider Review has two sets of indicators. One set 
is used to assess a provider’s systems to support people to have their best life. The second set of 
indicators is used in conversations with individuals supported by the provider. Each indicator is given a 
rating: disagree, met, strongly agree, not observed.  
What can we expect of the process? 
To assess service delivery, the Quality On-Site Provider Review process will include a two-day, on-
site review conducted by a quality reviewer. They will have conversations with individuals, support 
staff, supervisors, and management. They’ll also review key documents to ensure provider standards 
are being met.  
How will I know the result of the Quality On-Site Provider Review? 
The review will include a wrap-up meeting to discuss the results and an opportunity for the provider to 
request technical assistance and training regarding any of the review. BDS wants to ensure that you 
have the tools you need to be successful. A final report will summarize the review. 
What if I have questions about the Quality On-Site Provider Review? 
You are welcome to contact BDS:  
BDS.Help@fssa.in.gov  
800-545-7763 
Section 9.8: Statewide Waiver Ombudsman for Waiver 
Participants With Intellectual/Developmental 
Disabilities 
Note: See the Statewide Aging Ombudsman section for information on the statewide aging 
ombudsman for waiver individuals who meet the nursing facility level of care (NF LOC).  
The role of the statewide waiver ombudsman is to receive, investigate and attempt to resolve complaints 
and concerns that are made by or on behalf of individuals who have an intellectual/developmental disability 
and who receive HCBS waiver services.  
• Complaints may be submitted to the statewide waiver ombudsman via the toll-free number 
800-622-4484 and option 2 or via email at BDSWaiver.Ombudsman@fssa.in.gov. 
• Types of complaints received include complaints initiated by families and/or individuals involving 
rights or issues of individual choice, and complaints requiring coordination between legal services, 
administrating agency services and provider services. 
• The ombudsman is expected to initiate contact with the complainant as soon as possible after the 
complaint is received. However, precise timelines for the final resolution of each complaint are not 
established. Although it is expected that the ombudsman will diligently and persistently pursue the 
resolution of each complaint determined to require investigation, it is recognized that circumstances 
surrounding each investigation vary.

[Audio] We will discuss procedures for conducting complaint investigations and mortality reviews within the H-C-B-S waiver program for B-D-S services in this section. These procedures are outlined in the B-D-S Quality Assurance section for H-C-B-S waiver program services. We will begin with complaint investigations, which may involve methods such as site visits, one-on-one interviews, and document review. These investigations aim to ensure the quality and safety of services provided by B-D-S providers. If any issues are identified, a corrective action plan (C-A-P--) may be sent to the provider, outlining specific actions to address the issues and prevent future negative outcomes. Moving on to mortality reviews, these are conducted by the B-D-S quality vendor and focus on events that occurred before the individual's death while receiving B-D-S services. The quality vendor will review the supports and services in place and relevant documentation. Based on the review, a decision will be made whether to present the death to the Mortality Review Committee (M-R-C--) for further analysis. The M-R-C is responsible for making recommendations for systemic improvements and provider-specific suggestions. These recommendations aim to enhance the overall quality of B-D-S services and prevent negative outcomes. Providers may be required to develop C-A-Ps to address issues identified during the M-R-C discussions. It is important to note that complaint investigations and mortality reviews are essential components of our quality assurance process. They help us identify and address any issues or areas for improvement in our services. We will now move on to the next section of our presentation.. 

Scene 4

DDRS HCBS Waivers 
Section 9: BDS Quality Assurance for HCBS Waiver Program Services 
78 
Library Reference Number: PRPR10014 
 
Published: Sept. 9, 2024 
 
Policies and procedures as of July 1, 2024 
 
Version: 11.1 
• Time frames for complaint resolution vary in accordance with the required research, in the 
collection of evidence, and in the numbers and availability of persons who must be contacted, 
interviewed or brought together to resolve the complaint. Although the statewide waiver 
ombudsman is considered “independent” by statute, the DDRS director is responsible for oversight 
of the ombudsman. 
• With the consent of the waiver individual, the ombudsman must be provided access to the individual 
records, including records held by the entity providing services to the individual. When it has been 
determined the individual is not capable of giving consent, the statewide waiver ombudsman must 
be provided access to the name, address and telephone number of the individual’s legal 
representative. 
• A provider of waiver services or any employee of a provider of waiver services is immune from 
civil or criminal liability and from actions taken under a professional disciplinary procedure for the 
release or disclosure of records to the statewide waiver ombudsman. 
• A state or local government agency or entity that has records relevant to a complaint or an 
investigation conducted by the ombudsman must also provide the ombudsman with access to the 
records. The statewide waiver ombudsman coordinates their activities among the programs that 
provide legal services for individuals with an intellectual/developmental disability, the 
administrative agency, providers of waiver services and providers of other necessary or appropriate 
services. The ombudsman 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

[Audio] During our presentation, we would like to take a few moments to discuss the procedures for conducting complaint investigations and mortality reviews for B-D-S services. These procedures are a crucial part of our Quality Assurance for H-C-B-S Waiver Program Services, and it is important that you have a clear understanding of them. Complaint investigations can involve site visits, one-on-one interviews, and document reviews. They are conducted to address any concerns or issues raised by clients or their families regarding our services. If necessary, a corrective action plan or C-A-P may be sent to the provider to address any identified issues and prevent negative outcomes. Similarly, mortality reviews are an essential aspect of our quality assurance process. These reviews are conducted by our B-D-S quality vendor and include a thorough discussion of events leading up to the death, the supports and services in place at the time, and any documentation received. Based on this discussion, a decision is made whether the death should be presented to the Mortality Review Committee or M-R-C for further review and discussion. The M-R-C--, consisting of experienced professionals, then makes recommendations for systemic improvements and provider-specific recommendations. This ensures that we are continuously striving to provide the best possible care and support for our clients. To reiterate, these procedures are vital in maintaining the quality of our services. Providers may be required to develop C-A-Ps to address any identified issues, and we are committed to working together to prevent negative outcomes and continuously improve our services. Thank you for your attention and understanding. We will now continue with our presentation.. 

Scene 5

Library Reference Number: PRPR10014 
79 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
Section 10: Service Definitions and 
Requirements for FSW and CIH Waivers 
The Division of Disability & Rehabilitative Services (DDRS) within the Indiana Family and Social 
Services Administration (FSSA) administers the Family Supports Waiver (FSW) and Community 
Integration and Habilitation (CIH) Waiver, as well as the Health and Wellness (H&W) Waiver and 
Traumatic Brain Injury (TBI) Waiver.  
Note: For information specific to the H&W and TBI waivers, see Section 12: Health and 
Wellness (H&W) and Traumatic Brain Injury (TBI) Waivers. Sections 1–9 also 
contain some general information applicable to all four waivers. 
Section 10.1: Service Definition Overview 
This section defines the services currently approved for the Home- and Community-Based Services 
(HCBS) of the Family Supports Waiver (FSW) and Community Integration and Habilitation (CIH) Waiver 
programs administered by the Division of Disability and Rehabilitative Services (DDRS). Each service 
definition includes the following: 
• A description of the service 
• A list of reimbursable (allowable) activities for the service 
• Service standards 
• Documentation standards 
• Limitations 
• A list of activities not allowed  
• Provider qualifications 
• In some cases, additional information or clarifications that are unique to the service 
Section 10.2: FSW and CIH Waiver Services, Codes 
and Rates 
For the FSW and CIH Waiver, Table 3 contains Healthcare Common Procedure Coding System (HCPCS) 
procedure (billing) codes and modifiers, as well as unit rates. 
Note: For procedure codes, modifiers and rates related to the H&W and TBI waivers, see 
Section 12.6: H&W and TBI Waiver Services, Codes and Rates.

[Audio] We will now discuss the procedures for conducting complaint investigations and mortality reviews for B-D-S services. Complaint investigations may involve site visits, one-on-one interviews, and document review. If issues are found, a corrective action plan (C-A-P--) will be sent to the provider. Mortality reviews are conducted by the B-D-S quality vendor and involve discussion of events leading up to the death, services in place at the time, and documentation received. The Mortality Review Committee (M-R-C--) will then determine if the death should be further reviewed and discussed. Based on their discussion, the M-R-C will make recommendations for systemic improvements and provider-specific recommendations. In some cases, providers may be required to develop C-A-Ps to address identified issues and prevent similar outcomes. We will be going over the specific procedures outlined in the B-D-S Quality Assurance for H-C-B-S Waiver Program Services section. On slide 6, there is a table that displays the service definitions and requirements for F-S-W and C-I-H Waivers. This table contains information on codes, rates, and units for various services such as Adult Day Services, Behavior Management, Career Exploration and Planning, Case Management, Community Transition, Day Habilitation, Transitional Case Management Activities, and more.. 

Scene 6

DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
80 
Library Reference Number: PRPR10014 
 
Published: Sept. 9, 2024 
 
Policies and procedures as of July 1, 2024 
 
Version: 11.1 
Table 3 – Medicaid Waiver Services, Codes and Rates for FSW and CIH Waiver 
FSW 
CIH 
INsite 
Code 
Service Description 
HCPCS 
Code 
Modifiers 
Rate 
Unit/ 
Size 
Unit/$ 
Limit 
Yes 
Yes 
ADS1 
Adult Day Services, 
Level 1 
S5101 
U7  U5  U1 
$37.18 
0.50/Day 
2 Units/Day 
Yes 
Yes 
ADS2 
Adult Day Services, 
Level 2 
S5101 
U7  U5  U2 
$43.75 
0.50/Day 
2 Units/Day 
Yes 
Yes 
ADS3 
Adult Day Services, 
Level 3 
S5101 
U7  U5  U3 
$54.74 
0.50/Day 
2 Units/Day 
Yes 
Yes 
AS14 
Adult Day Services, 
1/4 Hour, Level 1 
S5100 
U7  U5  U1 
$2.93 
0.25/Hour 
16 Units/Day 
Yes 
Yes 
AS24 
Adult Day Services, 
1/4 Hour, Level 2 
S5100 
U7  U5  U2 
$3.30 
0.25/Hour 
16 Units/Day 
Yes 
Yes 
AS34 
Adult Day Services, 
1/4 Hour, Level 3 
S5100 
U7  U5  U3 
$4.20 
0.25/Hour 
16 Units/Day 
Yes 
Yes 
BMGO 
Behavior Management, 
Basic 
H0004 
U7  U5  U2 
$18.56 
0.25/Hour 
 
Yes 
Yes 
BG1O 
Behavior Management, 
Level 1 
H0004 
U7  U5  U1 
$18.56 
0.25/Hour 
 
Yes 
Yes 
CEP 
Career Exploration and 
Planning - Individual 
97537 
U7  U5 
$37.06 
1/Hour 
Shall not 
exceed 20 
hours/month 
for six months 
in any 12-
month period 
Yes 
Yes 
CEPG 
Career Exploration and 
Planning - Group 
97537 
U7  U5  U2 
$13.65 
1/Hour 
Shall not 
exceed 20 
hours/month 
for six months 
in any 12-
month period. 
Yes 
Yes 
CMGT 
Case Management 
T2022 
U7  U5 
$189.56 
1/Month 
1 Unit/Month 
No 
Yes 
TRCM 
Transitional Case 
Management Activities 
T2038 
U7  U5  UA 
$180.55 
1/Month 
for up to 
6 months 
based on 
successful 
transition 
to Waiver 
Services 
1 Unit per 
month for up to 
6 Units/ 
Successful 
Transition 
No 
Yes 
CT 
Community Transition 
T2038 
U7  U5 
Individual 
1/Unit 
$2,500 
Lifetime 
Yes 
Yes 
DHI 
Day Habilitation, 
Individual 
T2020 
U7  U5  UF 
$36.88 
1/Hour 
 
Yes 
Yes 
DHGS 
Day Habilitation, Group-
Small (2:1 to 4:1) 
T2020 
U7  U5  U2 UF 
$13.28 
1/Hour 
 
Yes 
Yes 
DHGM 
Day Habilitation, Group-
Medium (5:1 to 10:1) 
T2020 
U7  U5  UA UF 
$6.54 
1/Hour 
 
Yes 
Yes 
DHGL 
Day Habilitation, Group-
Large (11:1 to 16:1) 
T2020 
U7  U5  UB UF 
$4.20 
1/Hour 
 
Yes 
Yes 
DHI 
Day Habilitation, 
Individual 
T2020 
U7  U5  UG 
$36.88 
1/Hour

[Audio] We are currently on slide 7 of our presentation, discussing the procedures for conducting complaint investigations and mortality reviews for our B-D-S services. It is crucial that our providers fully grasp the significance of these processes and understand the potential impact they can have on the individuals we serve. Our complaint investigations involve site visits, one-on-one interviews, and document review, and may result in a corrective action plan (C-A-P--) being issued to the provider. The B-D-S quality vendor handles mortality reviews, which include a discussion of events leading up to the death, the supports and services in place at the time of death, the documentation received, and whether the death should be referred to the Mortality Review Committee (M-R-C--) for further review and discussion. The M-R-C then offers recommendations for systemic improvements and provider-specific actions based on their discussion. Providers may be required to develop C-A-Ps in order to address identified issues and prevent negative outcomes.. 

Scene 7

DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
Library Reference Number: PRPR10014 
81 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
FSW 
CIH 
INsite 
Code 
Service Description 
HCPCS 
Code 
Modifiers 
Rate 
Unit/ 
Size 
Unit/$ 
Limit 
Yes 
Yes 
DHGS 
Day Habilitation, Small 
Group (2:1, 3:1, and 4:1) 
T2020 
U7  U5  U2  UG 
$13.28 
1/Hour 
 
Yes 
Yes 
DHGM 
Day Habilitation, Medium 
Group (5:1 to 10:1) 
T2020 
U7  U5  UA  UG 
$6.54 
1/Hour 
 
Yes 
Yes 
DHGL 
Day Habilitation, Large 
Group (11:1 to 16:1) 
T2020 
U7  U5  UB  UG 
$4.20 
1/Hour 
 
Yes 
Yes 
INSP 
Equipment – 
Assess/Inspect/Train 
T1028 
U7  U5 
$18.53 
0.25/Hour 
 
Yes 
Yes 
EXTS 
Extended Services 
T2025 
U7  U5  UA 
$52.85 
1/Hour 
 
Yes 
Yes 
FBS 
Facility Based Support 
T1020 
U7  U5  UA 
$2.51 
1/Hour 
 
Yes 
Yes 
FCAR 
Family & Caregiver 
Training, Family 
S5111 
U7  U5 
Individual 
1/Unit 
$5,000/Year 
Yes 
Yes 
FCNF 
Family & Caregiver 
Training, Non-Family 
S5116 
U7  U5 
Individual 
1/Unit 
$5,000/Year 
Yes 
Yes 
HMA1/
HMA2 
Home Modification 
Assessment 
T1028 
U7 U5 
$628.00 
Per 
Project 
(Spec/ 
Exam) 
Spec: $409.46 
Exam: $218.54 
Yes 
Yes 
EMOI 
Home Modification, 
Install 
S5165 
U7  U5  NU 
Individual 
1/Unit 
$20,000 
Lifetime 
Yes 
Yes 
EMOM 
Home Modification, 
Maintain 
S5165 
U7  U5  U8 
Individual 
1/Unit 
$1,000/Year 
Yes 
Yes 
IBI1 
Intensive Behavioral 
Intervention, Level 1 
H2020 
U7  U5  U1 
$104.60 
1/Hour 
 
Yes 
Yes 
IBI2 
Intensive Behavioral 
Intervention, Level 2 
H2020 
U7  U5  U2 
$39.53 
1/Hour 
 
Yes 
Yes 
MUTH 
Music Therapy 
H2032 
U7  U5  U1 
$16.81 
0.25/Hour 
 
Yes 
Yes 
OCTH 
Occupational Therapy 
G0152 
U7  U5  UA 
$17.99 
0.25/Hour 
 
Yes 
No 
PAC 
Participant Assistance and 
Care 
T2033 
U7  U5 
$34.39 
1/Hour 
 
Yes 
Yes 
PRSI 
Personal Response 
System, Install 
S5160 
U7  U5 
$54.41 
1/Unit 
1 Unit/POC/ 
service plan 
Yes 
Yes 
PRSM 
Personal Response 
System, Maintain 
S5161 
U7  U5 
$54.41 
1/Unit 
1 Unit/Month 
Yes 
Yes 
PHTH 
Physical Therapy 
G0151 
U7  U5  UA 
$18.12 
0.25/Hour 
 
Yes 
Yes 
PV02 
Prevocational (2:1) 
T2015 
U7  U5  U1  UF 
$10.81 
1/Hour 
 
Yes 
Yes 
PV04 
Prevocational (4:1) 
T2015 
U7  U5  U1  UF 
$10.81 
1/Hour 
 
Yes 
Yes 
PV06 
Prevocational (6:1) 
T2015 
U7  U5  U3  UF 
$5.66 
1/Hour 
 
Yes 
Yes 
PVO8 
Prevocational (8:1) 
T2015 
U7  U5  U3  UF 
$5.66 
1/Hour 
 
Yes 
Yes 
PV10 
Prevocational (10:1) 
T2015 
U7  U5  U3  UF 
$5.66 
1/Hour 
 
Yes 
Yes 
PV12 
Prevocational (12:1) 
T2015 
U7  U5  U8  UF 
$3.73 
1/Hour 
 
Yes 
Yes 
PV14 
Prevocational (14:1) 
T2015 
U7  U5  U8  UF 
$3.73 
1/Hour 
 
Yes 
Yes 
PV16 
Prevocational (16:1) 
T2015 
U7  U5  U8  UF 
$3.73 
1/Hour 
 
Yes 
Yes 
PV02 
Prevocational (2:1)  
T2015 
U7  U5  U2  UG 
$10.81 
1/Hour 
 
Yes 
Yes 
PV04 
Prevocational (4:1) 
T2015 
U7  U5  U2  UG 
$10.81 
1/Hour

[Audio] Welcome everyone to slide number 8 of our presentation on the procedures for conducting complaint investigations and mortality reviews for B-D-S services. In this section, we will be discussing the steps and processes involved in these crucial quality assurance procedures. Firstly, we will go over complaint investigations. When a complaint is made regarding our services, our team conducts a thorough investigation which may include site visits, one-on-one interviews, and a review of relevant documents. Our main goal is to gather all necessary information to determine the validity of the complaint and address any areas that may need improvement. If any issues are found, we will collaborate with the provider to create a corrective action plan (C-A-P--) to address these concerns. Moving on to mortality reviews, we also take these very seriously. Our quality vendor conducts these reviews by examining the events leading up to the death, the supports and services that were in place, and any relevant documentation received. These reviews may also be presented to our Mortality Review Committee (M-R-C--) for further analysis and discussion. The M-R-C plays a vital role in identifying systemic improvements that can be made to prevent negative outcomes in the future. They may also provide specific recommendations for individual providers based on their discussions. In some cases, providers may be required to create C-A-Ps to address any issues identified and prevent further negative outcomes. We understand that these procedures may seem intimidating, but please know that they are in place to ensure the highest quality of care for our clients. We take all complaints and reviews seriously and are committed to continuously improving our services. Thank you for your attention to this important aspect of our quality assurance process.. 

Scene 8

DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
82 
Library Reference Number: PRPR10014 
 
Published: Sept. 9, 2024 
 
Policies and procedures as of July 1, 2024 
 
Version: 11.1 
FSW 
CIH 
INsite 
Code 
Service Description 
HCPCS 
Code 
Modifiers 
Rate 
Unit/ 
Size 
Unit/$ 
Limit 
Yes 
Yes 
PV06 
Prevocational (6:1) 
T2015 
U7  U5  U4  UG 
$5.66 
1/Hour 
 
Yes 
Yes 
PV08 
Prevocational (8:1) 
T2015 
U7  U5  U4  UG 
$5.66 
1/Hour 
 
Yes 
Yes 
PV10 
Prevocational (10:1) 
T2015 
U7  U5  U4  UG 
$5.66 
1/Hour 
 
Yes 
Yes 
PV12 
Prevocational (12:1) 
T2015 
U7  U5  U9  UG 
$3.73 
1/Hour 
 
Yes 
Yes 
PV14 
Prevocational (14:1) 
T2015 
U7  U5  U9  UG 
$3.73 
1/Hour 
 
Yes 
Yes 
PV16 
Prevocational (16:1) 
T2015 
U7  U5  U9  UG 
$3.73 
1/Hour 
 
Yes 
Yes 
PSTF 
Psychological Therapy, 
Family 
90846 
U7  U5 
$17.27 
0.25/Hour 
 
Yes 
Yes 
PSTG 
Psychological Therapy, 
Group 
90853 
U7  U5 
$4.81 
0.25/Hour 
 
Yes 
Yes 
PSTI 
Psychological Therapy, 
Individual 
H0004 
U7  U5  U3 
$15.45 
0.25/Hour 
 
Yes 
Yes 
RETH 
Recreational Therapy 
H2032 
U7  U5  U2 
$16.81 
0.25/Hour 
 
Yes 
No 
RSE 
Remote Supports, 
Equipment/Install 
A9279 
U7  U5  NU 
Individual 
1/Unit 
$500/year  
Yes 
Yes 
RS1 
Remote Supports, 
1 Individual 
A9279 
U7  U5  UA 
$24.26 
1/Hour 
 
Yes 
Yes 
RS2 
Remote Supports, 
2 Individuals 
A9279 
U7  U5  U2 
$12.13 
1/Hour 
 
Yes 
Yes 
RS3 
Remote Supports, 
3 Individuals 
A9279 
U7  U5  U3 
$8.09 
1/Hour 
 
Yes 
Yes 
RS4 
Remote Supports, 
4 Individuals 
A9279 
U7  U5  U4 
$6.06 
1/Hour 
 
No 
Yes 
R&F 
Rent & Food for 
Unrelated Live-In 
Caregiver 
T2025 
U7  U5 
$545.00 
1/Month 
 
No 
Yes 
RH1O 
Residential Habilitation 
Services, Level 1  
(35 or Less Hrs/Week) 
T2016 
U7  U5  UA 
$35.02 
1/Hour 
 
No 
Yes 
RH2O 
Residential Habilitation 
Services, Level 2  
(Over 35 Hrs/Week) 
T2016 
U7  U5 
$30.36 
1/Hour 
 
No 
Yes 
RD1 
RHS Daily Level 1 
(2-Person Setting, 
Algo Level 3) 
T2016  
U7  U5  UN  UA 
$237.77 
1/Day 
1 Unit/Day 
No 
Yes 
RD2 
RHS Daily Level 2 
(2-Person Setting, 
Algo Level 4) 
T2016  
U7  U5  UN  UB 
$331.74 
1/Day 
1 Unit/Day 
No 
Yes 
RD3 
RHS Daily Level 3 
(2-Person Setting, Algo 
Level 5) 
T2016  
U7  U5  UN  UC 
$357.86 
1/Day 
1 Unit/Day 
No 
Yes 
RD4 
RHS Daily Level 4 
(3-Person Setting, Algo 
Level 3) 
T2016  
U7  U5  UP  UA 
$233.90 
1/Day 
1 Unit/Day 
No 
Yes 
RD5 
RHS Daily Level 5 
(3-Person Setting, Algo 
Level 4) 
T2016  
U7  U5  UP  UB 
$303.31 
1/Day 
1 Unit/Day

[Audio] We are now on slide 9 out of 14 in our presentation about conducting complaint investigations and mortality reviews for B-D-S services. In this section, we will discuss the Quality Assurance process for the H-C-B-S Waiver Program Services. First, we will cover complaint investigations. These investigations may include site visits, one-on-one interviews, and document reviews. Their purpose is to ensure that providers are meeting the standards set by B-D-S--. If any issues are found, a corrective action plan may be sent to the provider to address and prevent similar issues in the future. Moving on to mortality reviews, these are conducted by the B-D-S quality vendor. During these reviews, the events leading up to the individual's death will be discussed, as well as the supports and services that were in place at the time. The documentation received will also be reviewed to determine if further review and discussion is needed by the Mortality Review Committee (M-R-C--). The M-R-C is responsible for making recommendations for overall improvements and provider-specific recommendations based on their discussion. This is a crucial aspect of our Quality Assurance process, as it ensures that we learn from past experiences and make necessary improvements to prevent negative outcomes in the future. In some cases, providers may be required to develop corrective action plans to address any identified issues and prevent similar issues in the future. This is another important step in holding our providers accountable for delivering high-quality services to our clients. Thank you for paying attention to this section on complaint investigations and mortality reviews for B-D-S services. We hope this has provided you with a better understanding of our Quality Assurance process and how we strive to achieve the best outcomes for our clients. Please continue to the next slide for more information. Thank you.. 

Scene 9

DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
Library Reference Number: PRPR10014 
83 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
FSW 
CIH 
INsite 
Code 
Service Description 
HCPCS 
Code 
Modifiers 
Rate 
Unit/ 
Size 
Unit/$ 
Limit 
No 
Yes 
RD6 
RHS Daily Level 6 
(3-Person Setting, Algo 
Level 5) 
T2016  
U7  U5  UP  UC 
$332.84 
1/Day 
1 Unit/Day 
No 
Yes 
RD7 
RHS Daily Level 7 
(4-Person Setting, Algo 
Level 3) 
T2016  
U7  U5  UQ  UA 
$220.86 
1/Day 
1 Unit/Day 
No 
Yes 
RD8 
RHS Daily Level 8 
(4-Person Setting, Algo 
Level 4) 
T2016  
U7  U5  UQ  UB 
$280.27 
1/Day 
1 Unit/Day 
No 
Yes 
RD9 
RHS Daily Level 9 
(4-Person Setting, Algo 
Level 5) 
T2016  
U7  U5  UQ  UC 
$298.60 
1/Day 
1 Unit/Day 
Yes 
Yes 
RNUR 
Respite Nursing Care, RN 
T1005 
U7  U5  TD 
$17.10 
0.25/Hour 
 
Yes 
Yes 
RNUR 
Respite Nursing Care, 
LPN 
T1005 
U7  U5  TE 
$13.69 
0.25/Hour 
 
Yes 
Yes 
RSPO 
Respite Care Services 
S5151 
U7  U5  
$43.38 
1/Hour 
 
Yes 
Yes 
ATCH 
Specialized Medical 
Equip/Supply, Install 
T2029 
U7  U5  NU 
Individual 
1/Unit 
$15,000 
Lifetime 
Yes 
Yes 
ATCM 
Specialized Medical 
Equip/Supply, Maintain 
T2029 
U7  U5  U8 
Individual 
1/Unit 
$1,000/Year 
Yes 
Yes 
SPTH 
Speech/Language Therapy 
92507 
U7  U5  UA 
$18.12 
0.25/Hour 
 
No 
Yes 
AF01 
Structured Family 
Caregiving, Level 1 
T2033 
U7  U5  U1 
$77.54 
1/Day 
1 Unit/Day 
No 
Yes 
AF02 
Structured Family 
Caregiving, Level 2 
T2033 
U7  U5  U2 
$99.71 
1/Day 
1 Unit/Day 
No 
Yes 
AF03 
Structured Family 
Caregiving, Level 3 
T2033 
U7  U5  U3 
$133.44 
1/Day 
1 Unit/Day 
Yes 
Yes 
TRNO 
Transportation, Level 1 
T2002 
U7  U5 
$15.05 
1/Trip 
2 Trips/Day, 
$7,530/Year 
Yes 
Yes 
TRN2 
Transportation, Level 2 
T2002 
U7  U5 U2 
$26.52 
1/Trip 
2 Trips/Day, 
$8,255/Year 
Yes 
Yes 
TRN3 
Transportation, Level 3 
T2002 
U7  U5  U3 
$47.88 
1/Trip 
2 Trips/Day, 
$8,980/Year 
Yes 
Yes 
VMOD 
Vehicle Modification, 
Install 
T2039 
U7  U5 
Individual 
1/Unit 
$15,000 for one 
vehicle every 
10 years 
Yes 
Yes 
VMOM 
Vehicle Modification, 
Maintain 
T2039 
U7  U5  U8 
Individual 
1/Unit 
$1,000/Year 
No 
Yes 
WEL1 
Wellness Coordination 
Tier 1 
T2022 
U7  U5  U1 
$118.66 
1/Month 
1 Unit/Month 
No 
Yes 
WEL2 
Wellness Coordination 
Tier 2 
T2022 
U7  U5  U2 
$163.02 
1/Month 
1 Unit/Month 
No 
Yes 
WEL3 
Wellness Coordination 
Tier 3 
T2022 
U7  U5  U3 
$251.74 
1/Month 
1 Unit/Month 
Yes 
Yes 
WPA 
Workplace Assistance 
T1020 
U7  U5 
$38.36 
1/Hour

[Audio] In our presentation on B-D-S services, we have reached slide 10 out of 14, where we will focus on the steps involved in conducting complaint investigations and mortality reviews. These processes are vital for ensuring the quality of services provided and have implications for service providers. As part of a complaint investigation, we may conduct site visits, one-on-one interviews, and review documents to gather information and validate the complaint. Upon completion of the investigation, a corrective action plan (C-A-P--) may be issued to the provider to address any areas of improvement. Our trusted B-D-S quality vendor also conducts mortality reviews, which involve a thorough examination of the events leading up to the death, the services and supports in place, and the documentation received. The Mortality Review Committee (M-R-C--) may then review the case and make recommendations for systemic improvements and provider-specific actions to prevent similar negative outcomes in the future. It is crucial for providers to take these reviews seriously and implement any recommendations promptly. Failure to do so may result in the need for a C-A-P to address identified issues and prevent future negative outcomes. We appreciate your attention to this important topic and will now move on to the next slide.. 

Scene 10

DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
84 
Library Reference Number: PRPR10014 
 
Published: Sept. 9, 2024 
 
Policies and procedures as of July 1, 2024 
 
Version: 11.1 
Section 10.3: Adult Day Services for FSW and CIH 
Waiver 
The following subsections provide information and requirements for Adult Day Services (ADS) for the 
FSW and CIH Waiver. 
Service Definition 
ADS are community-based group programs designed to support individuals as specified through the 
person-centered individualized support plan (PCISP). These programs encompass both the health and social 
service needs to ensure the optimal functioning of the individual. Meals and/or nutritious snacks are 
required. The meals provided as part of these services do not constitute a full noninstitutional, nutritional 
regimen (that is, three meals per day). The meals need not constitute the full daily nutritional regimen (that 
is, three meals per day).  
However, each meal must meet one-third of the daily Recommended Dietary Allowance. These services 
must be provided in a noninstitutional, community-based setting in one of three available levels of service: 
basic, enhanced or intensive. 
Individuals attend ADS on a planned basis. A maximum of 12 hours per day shall be allowable. 
A half-day unit is defined as one unit of three hours to a maximum of five hours per day. Two units is more 
than five hours to a maximum of eight hours per day. A maximum of two half-day units per day is allowed. 
A quarter-hour unit is defined as 15 minutes. It is billable only if fewer than three hours or more than eight 
hours of ADS have been provided on the same day. A maximum of 16 quarter-hour units per day are 
allowed. 
Additional Information: 
• 
ADS described in this section are available under the FSW and the CIH Waiver.  
• 
For information about ADS available under the H&W Waiver and TBI Waiver, see 
Section 12.7: Adult Day Services for H&W and TBI Waivers. 
Reimbursable Activities 
ADS may be used in conjunction with Transportation services. 
• Basic ADS (Level 1) includes: 
– Person-centered monitoring and/or support for 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 
– Health assessment and intermittent monitoring of health status 
– Monitoring medication or medication administration 
– Appropriate structure and support for those with mild cognitive impairment 
– Minimum staff ratio: One staff for each eight individuals 
• Enhanced ADS (Level 2) includes the Level 1 service requirements and the following additional 
services: 
– Hands-on assistance with two or more ADLs or hands-on assistance with bathing or other 
personal care 
– Health assessment with regular monitoring or intervention with health status

[Audio] During our presentation, we will now discuss slide number 11 out of 14, which outlines the procedures for conducting complaint investigations and mortality reviews for B-D-S services. These procedures are detailed in the B-D-S Quality Assurance for H-C-B-S Waiver Program Services section. Complaint investigations are a crucial aspect of maintaining the highest standards of quality and care in our services. They involve various steps such as site visits, one-on-one interviews, and document reviews. If necessary, a corrective action plan (C-A-P--) may be sent to the service provider as a result of these investigations. Mortality reviews are also a significant part of our quality assurance efforts. These reviews are conducted by the B-D-S quality vendor and involve a thorough discussion of the events leading up to the death, the supports and services in place at the time, and any relevant documentation received. The review team may also determine whether the death should be presented to the Mortality Review Committee (M-R-C--) for further review and discussion. The M-R-C plays a critical role in identifying systemic issues and making recommendations for improvements. This includes suggestions for both the entire system and individual service providers. In some cases, providers may need to develop C-A-Ps to address any identified issues and prevent adverse outcomes in the future. These procedures are essential to our commitment to providing high-quality services and ensuring the well-being of our clients. By conducting thorough complaint investigations and mortality reviews, we can continuously improve and enhance our services to better meet the needs of our clients and promote positive outcomes.. 

Scene 11

DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
Library Reference Number: PRPR10014 
85 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
– Dispensing or supervising the dispensing of medication  
– Psychological needs assessed and addressed, including counseling as needed for individuals and 
caregivers 
– Therapeutic structure, support and intervention for those with mild to moderate cognitive 
impairments 
– Minimum staff ratio: One staff for each six individuals  
• Intensive ADS (Level 3) includes the Level 1 and Level 2 service requirements and the following 
additional services: 
– Hands-on assistance or supervision 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 
Service Standards 
ADS must follow a written plan of care addressing specific needs determined by the individual’s Adult Day 
Service Level of Service Evaluation Form. The case manager completes this form in the INsite case 
management system and gives it to the provider. 
Documentation Standards 
The following are required documentation for ADS: 
• Services must be outlined in the PCISP 
• Evidence that level of service provided is required by the individual 
• Attendance record documenting the date of service and the number of units of service delivered that 
day 
• Completed Adult Day Service Level of Service Evaluation Form 
– The case manager should give the completed Adult Day Service Level of Service Evaluation 
Form to the provider 
As applicable, monthly/quarterly reports must be uploaded to the document library of the state’s case 
management system by the chosen service provider on or before the 15th day of the following month. 
Limitations 
Therapies provided through ADS will not duplicate therapies provided under any other service. 
Activities Not Allowed 
Any activity that is not described under Reimbursable Activities is not included in ADS. 
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).

[Audio] We are now on slide number 12 of our presentation. This section will cover the procedures for conducting complaint investigations and mortality reviews for B-D-S services, as outlined in the Quality Assurance for H-C-B-S Waiver Program Services section. Please note that complaint investigations may involve site visits, one-on-one interviews, and document reviews. If a complaint is substantiated, a corrective action plan will be sent to the provider. On the other hand, mortality reviews are conducted by the B-D-S quality vendor and involve a thorough examination of the events leading to the individual's death, the supports and services in place at the time, and any relevant documentation. The results of the mortality review are then presented to the Mortality Review Committee for further review and discussion. This committee makes recommendations for overall improvements and specific changes for individual providers based on their findings. Providers may be required to develop corrective action plans to address any identified issues and prevent negative outcomes. Let's move on to the next slide.. 

Scene 12

DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
86 
Library Reference Number: PRPR10014 
 
Published: Sept. 9, 2024 
 
Policies and procedures as of July 1, 2024 
 
Version: 11.1 
Provider Qualifications 
ADS providers must meet the following criteria: 
• Enrolled as an active Medicaid provider 
• Be FSSA/DDRS-approved 
• Must comply with Indiana Administrative Code, 460 IAC 6, including but not limited to: 
– 460 IAC 6-10-5 Documentation of Criminal Histories 
– 460 IAC 6-12-1 and 460 IAC 6-12-2 Insurance 
– 460 IAC 6-11-1 to 460 IAC 6-11-3 Financial Status of Providers 
– 460 IAC 6-5-2 Adult Day Services Provider Qualifications 
– 460 IAC 6-14-5 Requirements for Direct Care Staff  
– 460 IAC 6-14-4 Training 
– 460 IAC 6-34-1 through 460 IAC 34-3 Transportation Services 
• Must comply with any applicable FSSA/BDS service standards, guidelines, policies and/or manuals, 
including FSSA/DDRS BDS policies, written agreements and this module accessible from the 
IHCP Bulletins, Banner Pages and Reference Modules page at in.gov/medicaid/providers 
• Obtain/maintain accreditation (specific to Indiana programs) by at least one of the following 
organizations: 
– The Commission on Accreditation of Rehabilitation Facilities (CARF) or its successor 
– The Council on Quality and Leadership in Supports for People with Disabilities (CQL) or its 
successor 
– The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) or its successor 
– The National Committee for Quality Assurance or its successor 
– The ISO-9001 human services quality assurance (QA) system 
– An independent national accreditation organization approved by the secretary 
– The Council on Accreditation or its successor 
Section 10.4: Behavioral Support Services for FSW and 
CIH Waiver 
The following subsections provide information and requirements for Behavioral Support Services for the 
FSW and CIH Waiver. 
Service Definition 
Behavioral supports are an array of services designed to support individuals who are experiencing or are 
likely to experience challenges accessing, and actively participating in the community as a result of 
behavioral, social or emotional challenges. 
Behavioral Support Services are intended to empower individuals and families (by leveraging their 
strengths and unique abilities) to achieve self-determination, interdependence, productivity, integration and 
inclusion in all facets of community life, across all environments, across the lifespan. Behavioral supports 
should be individually designed to offer choice while creating social opportunities to generate integration, 
collaboration and inclusion in the community.  
Behavioral Support Services encourage individuals to live their best life while exploring their community 
with social experiences that may include work and employment opportunities. Behavioral Support Services 
emphasize learning hands-on in the community and providing opportunities for individuals to gain 
experience in community-based settings. Behavioral Support Services may offer improved training and

[Audio] Slide number 13 of our presentation provides information on the procedures for conducting complaint investigations and mortality reviews for B-D-S services. These procedures are detailed in the B-D-S Quality Assurance for H-C-B-S Waiver Program Services section. During a complaint investigation, various steps are taken, such as site visits, one-on-one interviews, and document reviews. These investigations aim to ensure the quality and safety of our services. If any issues are found, a corrective action plan (C-A-P--) may be sent to the provider to address and prevent similar incidents from occurring in the future. In contrast, mortality reviews are conducted by our B-D-S quality vendor. These reviews involve discussing the events leading up to the individual's death, the supports and services they had in place, and reviewing documentation to determine if the death should be brought to our Mortality Review Committee (M-R-C--) for further discussion. The M-R-C is a crucial part of our quality assurance process, as they make recommendations for systemic improvements and provider-specific recommendations. This helps us continuously improve our services and ensure the best outcomes for our participants. In some cases, providers may be required to develop C-A-Ps to address any identified issues from the mortality review. This is done to prevent negative outcomes and maintain the highest level of quality for our participants. Thank you for taking the time to learn about the processes involved in complaint investigations and mortality reviews for B-D-S services. Please refer to the next slide for additional information.. 

Scene 13

DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
Library Reference Number: PRPR10014 
87 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
expectations around competitive integrated employment designed for positive outcomes that will promote 
healthy and fulfilling everyday life.  
Additional Information: 
• 
Behavioral Support Services described in this section are available under the FSW and 
CIH Waiver. 
• 
For information related to the similarly named but unique service, Behavior 
Management/Behavior Program and Counseling, available only under the TBI Waiver, 
see Section 12.11: Behavior Management/Behavior Program and Counseling for TBI 
Waiver. 
Reimbursable Activities 
Reimbursable activities of Behavioral Support Services include: 
• Completing the functional behavioral assessment: this includes observation, environmental 
assessment, record reviews, interviews, data collection, complete psychosocial and biomedical 
history to identify targeted behaviors, the function of those behaviors, and to hypothesize the 
underlying need for new learning. Based on the principles of person-centered thinking and positive 
behavioral support, the assessment process should inform the recommendations for development of 
the behavior support plan (BSP). 
• Developing a comprehensive behavioral support plan and subsequent revisions: this includes 
devising proactive and reactive strategies designed to support the individual. Any restrictive 
techniques employed as part of the behavioral support plan must be approved by a human rights 
committee (HRC), be time-limited and regularly reviewed for elimination or reduction of the 
restrictive techniques to ensure appropriate reduction in these interventions over time. Either a 
Level 1 or Level 2 clinician can develop the behavioral support plan (BSP), but any behavioral 
support plans developed by a Level 2 clinician (behavior consultant) must be submitted for review 
and written approval by a Level 1 clinician (licensed psychologist) prior to implementation for the 
development to be a reimbursable activity. All other reimbursable activities can be performed by 
either a Level 1 or Level 2 clinician. 
• Obtaining consensus of the Individualized Support Team (IST) that the behavioral support plan is 
feasible for implementation and uses the least restrictive methods possible. 
• Supporting the individual in learning new, positive behaviors as outlined in the behavioral support 
plan. This may include coping strategies, improving interpersonal relationships or other positive 
strategies to reduce targeted behaviors and increase quality of life. 
• Training staff, family members, housemates or other IST members on the implementation of the 
behavioral support plan. 
• Consulting with team members to achieve the outcomes of assessment and behavioral support 
planning. 
• Concurrent service delivery of Behavioral Support Services with other approved Medicaid services 
is allowable under the following conditions: 
– The service being provided concurrently with Behavioral Support Services is not similar in 
nature, does not have a similar purpose, and does not promote similar outcomes to Behavioral 
Support Services. 
– The need for the concurrent service is clearly documented in the behavioral support plan, and 
outlines the individualized assessed need, and how the Behavioral Support Services will support 
or contribute to the specified need.

[Audio] In summary, the procedures for conducting complaint investigations and mortality reviews for B-D-S services are outlined in the B-D-S Quality Assurance for H-C-B-S Waiver Program Services section. These investigations utilize various methods, such as site visits, one-on-one interviews, and document reviews. If any issues are discovered, a corrective action plan (C-A-P--) will be sent to the provider for implementation. Mortality reviews, on the other hand, are conducted by the B-D-S quality vendor and involve a thorough discussion of events leading up to the death, the supports and services in place at the time of death, and the documentation received. The Mortality Review Committee (M-R-C--) may also be consulted to make recommendations for systemic improvements and provider-specific changes. It should be noted that providers may be required to develop C-A-Ps in response to identified issues in order to prevent negative outcomes in the future. We recognize the importance of these reviews and investigations in ensuring the quality and safety of our services. Thank you for your attention during this presentation. We hope you now have a better understanding of the complaint investigation and mortality review procedures for B-D-S services. Thank you.. 

Scene 14

DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
88 
Library Reference Number: PRPR10014 
 
Published: Sept. 9, 2024 
 
Policies and procedures as of July 1, 2024 
 
Version: 11.1 
Service Standards 
Behavioral Support Services must be reflected in the PCISP: 
• Services must address needs identified in the person-centered planning process and be outlined in 
the PCISP. 
• The behavior supports specialist will observe the individual in their own milieu and develop a 
specific plan to address identified issues.  
• The behavior supports specialist must ensure that Residential Habilitation and Support (RHS) direct 
service staff are aware of and are active individuals in the development and implementation of the 
behavioral support plan. The behavior plan will meet the requirements stated in the DDRS 
Behavioral Support Plan Policy (2011) at in.gov/fssa/ddrs. 
• The behavior supports provider will comply with all specific standards in 460 IAC 6. 
• Any behavior supports techniques that limit the individual’s human or civil rights must be approved 
by the IST and the provider’s HRC. No aversive techniques may be used. Chemical restraints and 
medications prescribed for use as needed (PRN) meant to retrain the individual shall be used with 
caution. The use of these medications must be approved by the IST and the appropriate HRC. 
• The efficacy of the plan must be reviewed not less than quarterly and adjusted as necessary. 
• The behavior specialist will provide a written report to pertinent parties at least quarterly. Pertinent 
parties include the individual, guardian, BDS service coordinator, waiver case manager, all service 
providers, and other involved entities. 
The PCISP must identify the Behavioral Support Services needed by the individual to pursue their desired 
outcomes as identified during the person-centered planning process. The need for service continuation is to 
be evaluated annually by the Individualized Support Team (IST) and reflected in the PCISP. Each outcome 
within the PCISP has at least one associated proposed strategy/action step designed to address potential 
barriers or maintenance needs in relation to the desired outcomes and the support and services needed to 
facilitate the outcomes. The proposed strategy/action step also identifies all paid and unpaid responsible 
parties and includes the names of each responsible party including the provider, the service, and the staffing 
positions within the agency that are responsible for the strategy/action step. The individual may be the 
responsible party for a strategy/action step initiative if they so determine. In addition, each proposed 
strategy/activity has a specific time frame identified, including a minimum time frame for review. The 
service authorization identifies the name of the waiver-funded service, the name of the individual-chosen 
provider of that service, the cost of the service per unit, the number of units of service, and the start and end 
dates for each waiver service identified on the service authorization.  
Documentation must include any progress toward outcomes in addition to any changes or modifications 
within the PCISP.  
While the behavior support plan (BSP) is an integral part of the PCISP, the dates of the BSP are not 
required to be the same as the annual PCISP. However, the BSP must have been updated within the 
individual’s plan year. 
Documentation Standards 
Documentation shall include:  
• Services outlined in the PCISP  
• A functional behavior assessment  
• A behavioral support plan (BSP), which must be attached to the PCISP

 part 7

Welcome, attendees. This is the second slide of our presentation, where we will cover the procedures for conducting complaint investigations and mortality reviews for B-D-S services. These procedures can be found in the B-D-S Quality Assurance for H-C-B-S Waiver Program Services section. During a complaint investigation, our team may conduct site visits, one-on-one interviews, and review documents to gather all necessary information. Depending on our findings, a corrective action plan may be issued to the provider. On the other hand, mortality reviews are conducted by our quality vendor and involve a thorough discussion of events leading up to the death, the supports and services in place, and any documentation received. If necessary, the Mortality Review Committee (M-R-C--) will convene to further review and discuss the case. The M-R-C plays a vital role in making recommendations for systemic improvements and provider-specific recommendations based on their findings. These recommendations may include developing corrective action plans to address identified issues and prevent negative outcomes. We appreciate your attention to this crucial aspect of our quality assurance process. Let's proceed to the next slide for more details.

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Slide number 3 provides an overview of the steps involved in conducting investigations for complaints and mortality in the H-C-B-S waiver program for B-D-S services. These processes are critical for maintaining the quality and safety of our services. Complaint investigations involve a thorough examination, including site visits, one-on-one interviews, and document reviews. If any issues are found, a corrective action plan (C-A-P--) will be issued to the provider. On the other hand, mortality reviews are carried out by the B-D-S quality vendor and focus on the events leading to the death, the support and services provided, and the submitted documentation. Based on their findings, the review team will determine if the case should be presented to the Mortality Review Committee (M-R-C--) for further analysis and discussion. The M-R-C is responsible for making recommendations for systemic improvements and specific actions for the provider based on their review. In some instances, providers may be required to develop C-A-Ps to address any issues identified during the review and prevent future negative outcomes. These procedures are crucial for our quality assurance efforts and ensure that individuals receiving B-D-S services receive the highest level of care. We appreciate your attention to this essential information.

We will discuss procedures for conducting complaint investigations and mortality reviews within the H-C-B-S waiver program for B-D-S services in this section. These procedures are outlined in the B-D-S Quality Assurance section for H-C-B-S waiver program services. We will begin with complaint investigations, which may involve methods such as site visits, one-on-one interviews, and document review. These investigations aim to ensure the quality and safety of services provided by B-D-S providers. If any issues are identified, a corrective action plan (C-A-P--) may be sent to the provider, outlining specific actions to address the issues and prevent future negative outcomes. Moving on to mortality reviews, these are conducted by the B-D-S quality vendor and focus on events that occurred before the individual's death while receiving B-D-S services. The quality vendor will review the supports and services in place and relevant documentation. Based on the review, a decision will be made whether to present the death to the Mortality Review Committee (M-R-C--) for further analysis. The M-R-C is responsible for making recommendations for systemic improvements and provider-specific suggestions. These recommendations aim to enhance the overall quality of B-D-S services and prevent negative outcomes. Providers may be required to develop C-A-Ps to address issues identified during the M-R-C discussions. It is important to note that complaint investigations and mortality reviews are essential components of our quality assurance process. They help us identify and address any issues or areas for improvement in our services. We will now move on to the next section of our presentation.

During our presentation, we would like to take a few moments to discuss the procedures for conducting complaint investigations and mortality reviews for B-D-S services. These procedures are a crucial part of our Quality Assurance for H-C-B-S Waiver Program Services, and it is important that you have a clear understanding of them. Complaint investigations can involve site visits, one-on-one interviews, and document reviews. They are conducted to address any concerns or issues raised by clients or their families regarding our services. If necessary, a corrective action plan or C-A-P may be sent to the provider to address any identified issues and prevent negative outcomes. Similarly, mortality reviews are an essential aspect of our quality assurance process. These reviews are conducted by our B-D-S quality vendor and include a thorough discussion of events leading up to the death, the supports and services in place at the time, and any documentation received. Based on this discussion, a decision is made whether the death should be presented to the Mortality Review Committee or M-R-C for further review and discussion. The M-R-C--, consisting of experienced professionals, then makes recommendations for systemic improvements and provider-specific recommendations. This ensures that we are continuously striving to provide the best possible care and support for our clients. To reiterate, these procedures are vital in maintaining the quality of our services. Providers may be required to develop C-A-Ps to address any identified issues, and we are committed to working together to prevent negative outcomes and continuously improve our services. Thank you for your attention and understanding. We will now continue with our presentation.

We will now discuss the procedures for conducting complaint investigations and mortality reviews for B-D-S services. Complaint investigations may involve site visits, one-on-one interviews, and document review. If issues are found, a corrective action plan (C-A-P--) will be sent to the provider. Mortality reviews are conducted by the B-D-S quality vendor and involve discussion of events leading up to the death, services in place at the time, and documentation received. The Mortality Review Committee (M-R-C--) will then determine if the death should be further reviewed and discussed. Based on their discussion, the M-R-C will make recommendations for systemic improvements and provider-specific recommendations. In some cases, providers may be required to develop C-A-Ps to address identified issues and prevent similar outcomes. We will be going over the specific procedures outlined in the B-D-S Quality Assurance for H-C-B-S Waiver Program Services section. On slide 6, there is a table that displays the service definitions and requirements for F-S-W and C-I-H Waivers. This table contains information on codes, rates, and units for various services such as Adult Day Services, Behavior Management, Career Exploration and Planning, Case Management, Community Transition, Day Habilitation, Transitional Case Management Activities, and more.

We are currently on slide 7 of our presentation, discussing the procedures for conducting complaint investigations and mortality reviews for our B-D-S services. It is crucial that our providers fully grasp the significance of these processes and understand the potential impact they can have on the individuals we serve. Our complaint investigations involve site visits, one-on-one interviews, and document review, and may result in a corrective action plan (C-A-P--) being issued to the provider. The B-D-S quality vendor handles mortality reviews, which include a discussion of events leading up to the death, the supports and services in place at the time of death, the documentation received, and whether the death should be referred to the Mortality Review Committee (M-R-C--) for further review and discussion. The M-R-C then offers recommendations for systemic improvements and provider-specific actions based on their discussion. Providers may be required to develop C-A-Ps in order to address identified issues and prevent negative outcomes.

Welcome everyone to slide number 8 of our presentation on the procedures for conducting complaint investigations and mortality reviews for B-D-S services. In this section, we will be discussing the steps and processes involved in these crucial quality assurance procedures. Firstly, we will go over complaint investigations. When a complaint is made regarding our services, our team conducts a thorough investigation which may include site visits, one-on-one interviews, and a review of relevant documents. Our main goal is to gather all necessary information to determine the validity of the complaint and address any areas that may need improvement. If any issues are found, we will collaborate with the provider to create a corrective action plan (C-A-P--) to address these concerns. Moving on to mortality reviews, we also take these very seriously. Our quality vendor conducts these reviews by examining the events leading up to the death, the supports and services that were in place, and any relevant documentation received. These reviews may also be presented to our Mortality Review Committee (M-R-C--) for further analysis and discussion. The M-R-C plays a vital role in identifying systemic improvements that can be made to prevent negative outcomes in the future. They may also provide specific recommendations for individual providers based on their discussions. In some cases, providers may be required to create C-A-Ps to address any issues identified and prevent further negative outcomes. We understand that these procedures may seem intimidating, but please know that they are in place to ensure the highest quality of care for our clients. We take all complaints and reviews seriously and are committed to continuously improving our services. Thank you for your attention to this important aspect of our quality assurance process.

We are now on slide 9 out of 14 in our presentation about conducting complaint investigations and mortality reviews for B-D-S services. In this section, we will discuss the Quality Assurance process for the H-C-B-S Waiver Program Services. First, we will cover complaint investigations. These investigations may include site visits, one-on-one interviews, and document reviews. Their purpose is to ensure that providers are meeting the standards set by B-D-S--. If any issues are found, a corrective action plan may be sent to the provider to address and prevent similar issues in the future. Moving on to mortality reviews, these are conducted by the B-D-S quality vendor. During these reviews, the events leading up to the individual's death will be discussed, as well as the supports and services that were in place at the time. The documentation received will also be reviewed to determine if further review and discussion is needed by the Mortality Review Committee (M-R-C--). The M-R-C is responsible for making recommendations for overall improvements and provider-specific recommendations based on their discussion. This is a crucial aspect of our Quality Assurance process, as it ensures that we learn from past experiences and make necessary improvements to prevent negative outcomes in the future. In some cases, providers may be required to develop corrective action plans to address any identified issues and prevent similar issues in the future. This is another important step in holding our providers accountable for delivering high-quality services to our clients. Thank you for paying attention to this section on complaint investigations and mortality reviews for B-D-S services. We hope this has provided you with a better understanding of our Quality Assurance process and how we strive to achieve the best outcomes for our clients. Please continue to the next slide for more information. Thank you.

In our presentation on B-D-S services, we have reached slide 10 out of 14, where we will focus on the steps involved in conducting complaint investigations and mortality reviews. These processes are vital for ensuring the quality of services provided and have implications for service providers. As part of a complaint investigation, we may conduct site visits, one-on-one interviews, and review documents to gather information and validate the complaint. Upon completion of the investigation, a corrective action plan (C-A-P--) may be issued to the provider to address any areas of improvement. Our trusted B-D-S quality vendor also conducts mortality reviews, which involve a thorough examination of the events leading up to the death, the services and supports in place, and the documentation received. The Mortality Review Committee (M-R-C--) may then review the case and make recommendations for systemic improvements and provider-specific actions to prevent similar negative outcomes in the future. It is crucial for providers to take these reviews seriously and implement any recommendations promptly. Failure to do so may result in the need for a C-A-P to address identified issues and prevent future negative outcomes. We appreciate your attention to this important topic and will now move on to the next slide.

During our presentation, we will now discuss slide number 11 out of 14, which outlines the procedures for conducting complaint investigations and mortality reviews for B-D-S services. These procedures are detailed in the B-D-S Quality Assurance for H-C-B-S Waiver Program Services section. Complaint investigations are a crucial aspect of maintaining the highest standards of quality and care in our services. They involve various steps such as site visits, one-on-one interviews, and document reviews. If necessary, a corrective action plan (C-A-P--) may be sent to the service provider as a result of these investigations. Mortality reviews are also a significant part of our quality assurance efforts. These reviews are conducted by the B-D-S quality vendor and involve a thorough discussion of the events leading up to the death, the supports and services in place at the time, and any relevant documentation received. The review team may also determine whether the death should be presented to the Mortality Review Committee (M-R-C--) for further review and discussion. The M-R-C plays a critical role in identifying systemic issues and making recommendations for improvements. This includes suggestions for both the entire system and individual service providers. In some cases, providers may need to develop C-A-Ps to address any identified issues and prevent adverse outcomes in the future. These procedures are essential to our commitment to providing high-quality services and ensuring the well-being of our clients. By conducting thorough complaint investigations and mortality reviews, we can continuously improve and enhance our services to better meet the needs of our clients and promote positive outcomes.

We are now on slide number 12 of our presentation. This section will cover the procedures for conducting complaint investigations and mortality reviews for B-D-S services, as outlined in the Quality Assurance for H-C-B-S Waiver Program Services section. Please note that complaint investigations may involve site visits, one-on-one interviews, and document reviews. If a complaint is substantiated, a corrective action plan will be sent to the provider. On the other hand, mortality reviews are conducted by the B-D-S quality vendor and involve a thorough examination of the events leading to the individual's death, the supports and services in place at the time, and any relevant documentation. The results of the mortality review are then presented to the Mortality Review Committee for further review and discussion. This committee makes recommendations for overall improvements and specific changes for individual providers based on their findings. Providers may be required to develop corrective action plans to address any identified issues and prevent negative outcomes. Let's move on to the next slide.

Slide number 13 of our presentation provides information on the procedures for conducting complaint investigations and mortality reviews for B-D-S services. These procedures are detailed in the B-D-S Quality Assurance for H-C-B-S Waiver Program Services section. During a complaint investigation, various steps are taken, such as site visits, one-on-one interviews, and document reviews. These investigations aim to ensure the quality and safety of our services. If any issues are found, a corrective action plan (C-A-P--) may be sent to the provider to address and prevent similar incidents from occurring in the future. In contrast, mortality reviews are conducted by our B-D-S quality vendor. These reviews involve discussing the events leading up to the individual's death, the supports and services they had in place, and reviewing documentation to determine if the death should be brought to our Mortality Review Committee (M-R-C--) for further discussion. The M-R-C is a crucial part of our quality assurance process, as they make recommendations for systemic improvements and provider-specific recommendations. This helps us continuously improve our services and ensure the best outcomes for our participants. In some cases, providers may be required to develop C-A-Ps to address any identified issues from the mortality review. This is done to prevent negative outcomes and maintain the highest level of quality for our participants. Thank you for taking the time to learn about the processes involved in complaint investigations and mortality reviews for B-D-S services. Please refer to the next slide for additional information.

In summary, the procedures for conducting complaint investigations and mortality reviews for B-D-S services are outlined in the B-D-S Quality Assurance for H-C-B-S Waiver Program Services section. These investigations utilize various methods, such as site visits, one-on-one interviews, and document reviews. If any issues are discovered, a corrective action plan (C-A-P--) will be sent to the provider for implementation. Mortality reviews, on the other hand, are conducted by the B-D-S quality vendor and involve a thorough discussion of events leading up to the death, the supports and services in place at the time of death, and the documentation received. The Mortality Review Committee (M-R-C--) may also be consulted to make recommendations for systemic improvements and provider-specific changes. It should be noted that providers may be required to develop C-A-Ps in response to identified issues in order to prevent negative outcomes in the future. We recognize the importance of these reviews and investigations in ensuring the quality and safety of our services. Thank you for your attention during this presentation. We hope you now have a better understanding of the complaint investigation and mortality review procedures for B-D-S services. Thank you.