[Virtual Presenter] We recommend thoroughly reviewing the DDRS HCBS Waivers to ensure compliance with service definitions and requirements for F-S-W and C-I-H Waivers. These waivers include important information such as the name of the provider, the date range of services, the primary type of service, and the notation of the ratio for service delivery. Providers should also provide a brief summary of progress towards P-C-I-S-P outcomes, challenges hindering progress, and a positive event that occurred during the quarter that contributed to the individual's good life. All data elements must be made available to auditors, quality monitors, case managers, and any other government entity upon request. For Group Services, further guidance related to day habilitation, including group services, is available on the Current D-D-R-S Policies page at in.gov/fssa/ddrs and at the direct link for Day Habilitation: Service Definition and Standards. This document outlines limitations on group sizes, such as the 1:1 Individual, 2:1 to 4:1 Small Group, 5:1 to 10:1 Medium Group, and 11:1 to 16:1 Large Group (applies only to a facility setting). Providers should note that Day Habilitation services reimbursement does not include reimbursement for the cost of the activities in which the individual is participating when they receive skills training, such as the cost to attend a community event or a camp. The document also lists activities that are not allowed under Day Habilitation, such as services that are available under the Rehabilitation Act of 1973 or PL 94-142, skills training for any activity that is not identified as directly related to an individual's habilitation outcome, activities that do not foster the acquisition and retention of skills, activities that duplicate or replace supports provided through residential habilitation and support (R-H-S--) services, services furnished to a minor by parents, stepparents or legal guardian, and services furnished to an individual by the individual’s spouse. We urge all providers to thoroughly review the DDRS HCBS Waivers and ensure that all data elements, including the name of the provider, the date range of services, the primary type of service, the notation of the ratio for service delivery, the percent of time in community, the percent of time in a facility, the brief summary of progress towards P-C-I-S-P outcomes, challenges hindering progress towards P-C-I-S-P outcomes, if applicable, and a positive event that occurred during the quarter that contributed to the individual’s good life, are made available to auditors, quality monitors, case managers, and any other government entity upon request.. 

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DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
Library Reference Number: PRPR10014 
103 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
• Name of provider  
• Date range of services  
• Service rendered Primary type of service: Community or Facility  
•  Notation of the ratio for service delivery  
• Percent of time in community  
• Percent of time in a facility  
• Brief summary of progress towards PCISP outcomes  
• Challenges hindering progress towards PCISP outcomes, if applicable  
• A positive event that occurred during the quarter that contributed to the individual’s good life  
Upon request, all data elements must be made available to auditors, quality monitors, case managers and 
any other government entity. The documentation may reside in multiple locations but must be clearly and 
easily linked to the individual or the standard will not be met. 
For Group Services 
Further guidance related to day habilitation, including group services, is posted on the Current DDRS 
Policies page at in.gov/fssa/ddrs and at the direct link for Day Habilitation: Service Definition and 
Standards. 
Limitations 
The following are limitations on group sizes: 
• 1:1 Individual 
• 2:1 to 4:1 Small Group 
• 5:1 to 10:1 Medium Group 
• 11:1 to 16:1 Large Group (applies only to a facility setting) 
Day Habilitation services reimbursement does not include reimbursement for the cost of the activities in 
which the individual is participating when they receive skills training, such as the cost to attend a 
community event or a camp. 
Activities Not Allowed 
The following activities are not allowed under Day Habilitation:  
• Services that are available under the Rehabilitation Act of 1973 or PL 94-142 
• Skills training for any activity that is not identified as directly related to an individual’s habilitation 
outcome 
• Activities that do not foster the acquisition and retention of skills 
• Activities that duplicate or replace supports provided through residential habilitation and support 
(RHS) services.  
• Services furnished to a minor by parents, stepparents or legal guardian 
• Services furnished to an individual by the individual’s spouse

[Audio] We recommend that you review the service definitions and requirements for F-S-W and C-I-H Waivers in the DDRS HCBS Waivers Section 10. This document contains important information such as the provider's name, date range of services, primary type of service, and ratio for service delivery. Additionally, it requires a brief summary of progress towards P-C-I-S-P outcomes, challenges hindering progress, and a positive event that occurred during the quarter that contributed to the individual's good life. All data elements must be made available to auditors, quality monitors, case managers, and any other government entity upon request. For Group Services, further guidance related to day habilitation is available on the Current D-D-R-S Policies page at in.gov/fssa/ddrs and at the direct link for Day Habilitation: Service Definition and Standards. This document outlines limitations on group sizes for day habilitation services, such as the 1:1 Individual, 2:1 to 4:1 Small Group, 5:1 to 10:1 Medium Group, and 11:1 to 16:1 Large Group (applies only to a facility setting). Data elements must be made available to auditors, quality monitors, case managers, and any other government entity upon request. Providers of Day Habilitation must meet the following criteria: enrolled as an active Medicaid provider, FSSA DDRS-approved, comply with Indiana Administrative Code, 460 I-A-C 6, including but not limited to: documentation of criminal histories, insurance, financial status of providers, requirements for direct care staff, health care coordination services provider qualifications, transportation services provider qualifications. Comply with any applicable B-D-S service standards, guidelines, policies and/or manuals, including FSSA DDRS policies and this module, accessible from the I-H-C-P Bulletins, Banner Pages and Reference Modules page at in.gov/medicaid/providers. Obtain or maintain accreditation (specific to Indiana programs) by at least one of the following organizations: The Commission on Accreditation of Rehabilitation Facilities (C-A-R-F-), or its successor, The Council on Quality and Leadership In Supports for People with Disabilities, or its successor, The Joint Commission on Accreditation of Healthcare Organizations (J-C-A-H-O), or its successor, The National Committee for Quality Assurance, or its successor, The ISO-9001 human services quality assurance (Q-A---) system, or an independent national accreditation organization approved by the F-S-S-A Secretary. The following subsections provide information and requirements for Extended Services for the F-S-W and C-I-H Waiver. Service Definition: Extended Services are ongoing employment support services that enable an individual to maintain integrated competitive employment in a community. 

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DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
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Library Reference Number: PRPR10014 
 
Published: Sept. 9, 2024 
 
Policies and procedures as of July 1, 2024 
 
Version: 11.1 
Provider Qualifications 
Providers of Day Habilitation must meet the following criteria: 
• Enrolled as an active Medicaid provider 
• Be FSSA DDRS-approved 
• Comply with Indiana Administrative Code, 460 IAC 6, including but not limited to: 
– 460 IAC 6-10-5 Documentation of Criminal Histories 
– 460 IAC 6-12-1 and 460 IAC 6-12-2 Insurance 
– 460 IAC 6-11-1 to 460 IAC 6-11-3 Financial Status of Providers 
– 460 IAC 6-14-5 Requirements for Direct Care Staff 
– 460 IAC 6-14-4 Staff Training and 460 IAC 6-14-4 Training 
– 460 IAC 6-5-14 Health Care Coordination Services Provider Qualifications 
– 460 IAC 6-5-30 Transportation Services Provider Qualifications 
• Comply with any applicable BDS service standards, guidelines, policies and/or manuals, including 
FSSA DDRS policies and this module, accessible from the IHCP Bulletins, Banner Pages and 
Reference Modules page at in.gov/medicaid/providers 
• Must obtain/maintain accreditation (specific to Indiana programs) by at least one of the following 
organizations: 
– The Commission on Accreditation of Rehabilitation Facilities (CARF), or its successor 
– The Council on Quality and Leadership In Supports for People with Disabilities, or its successor 
– The Joint Commission on Accreditation of Healthcare Organizations (JCAHO), or its successor 
– The National Committee for Quality Assurance, or its successor 
– The ISO-9001 human services quality assurance (QA) system 
– An independent national accreditation organization approved by the FSSA Secretary 
Section 10.9: Extended Services for FSW and CIH 
Waiver 
The following subsections provide information and requirements for Extended Services for the FSW and 
CIH Waiver. 
Service Definition  
• Extended Services are ongoing employment support services that enable an individual to maintain 
integrated competitive employment in a community setting. Individuals must be employed in a 
community-based, competitive job that pays at or above minimum wage to access this service. 
• The initial job placement, training and stabilization may be provided through Indiana Vocational 
Rehabilitation (VR). Extended Services provide the additional work-related supports needed by the 
individual to continue to be as independent as possible in community employment. If an employed 
individual has obtained community-based competitive employment and stabilization without VR 
services, the individual is still eligible to receive Extended Services, as long as the individual meets 
the qualifications (see the Provider Qualifications section). 
• Ongoing employment support services are identified in the individuals’ PCISP and must be related 
to the individuals’ limitations in functional areas (for example, self-care, understanding and use of 
language, learning, mobility, self-direction, capacity for independent living, economic self-
sufficiency), as necessary to maintain employment.

[Audio] We are here today to discuss the importance of understanding the service definitions and requirements for F-S-W and C-I-H Waivers. This document is crucial in ensuring compliance with the service definitions and requirements for F-S-W and C-I-H Waivers. The document includes vital information such as the name of the provider, date range of services, primary type of service, and the notation of the ratio for service delivery. For Group Services, we have additional guidance available on the Current D-D-R-S Policies page at in.gov/fssa/ddrs and at the direct link for Day Habilitation: Service Definition and Standards. This document outlines the limitations on group sizes, such as the 1:1 Individual, 2:1 to 4:1 Small Group, 5:1 to 10:1 Medium Group, and 11:1 to 16:1 Large Group (applies only to a facility setting). It is important to understand that day habilitation services reimbursement does not include reimbursement for the cost of the activities in which the individual is participating when they receive skills training, such as the cost to attend a community event or a camp. The document also lists activities that are not allowed under Day Habilitation, such as services that are available under the Rehabilitation Act of 1973 or PL 94-142, skills training for any activity that is not identified as directly related to an individual's habilitation outcome, activities that do not foster the acquisition and retention of skills, activities that duplicate or replace supports provided through residential habilitation and support (R-H-S--) services, services furnished to a minor by parents, stepparents or legal guardian, and services furnished to an individual by the individual’s spouse. All data elements must be made available to auditors, quality monitors, case managers, and any other government entity upon request. In conclusion, we strongly recommend understanding the service definitions and requirements for F-S-W and C-I-H Waivers to ensure compliance with the service definitions and requirements for F-S-W and C-I-H Waivers. It is important to understand the limitations on group sizes and the reimbursable activities for Day Habilitation services. Thank you for your attention to this matter.. 

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DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
Library Reference Number: PRPR10014 
105 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
Documentation is maintained in the file of each individual receiving this service that the service is not 
available under a program funded under Section 110 of the Rehabilitation Act of 1973 or the IDEA (20 
USC 1401 et seq.). Federal financial participation is not claimed for incentive payments, subsidies or 
unrelated vocational training expenses such as the following: 
• Incentive payments made to an employer to encourage or subsidize the employer's participation in 
Supported Employment; or 
• Payments that are passed through to users of Supported Employment services. 
Additional Information 
• 
Individuals may also use workplace assistance during any hours of competitive 
integrated employment in conjunction with their use of Extended Services. 
Extended Services are not time-limited.  
• 
Community settings are defined as nonresidential, integrated settings that are in the 
community. Services may not be rendered within the same buildings alongside other 
nonintegrated individuals.  
• 
Competitive integrated employment is defined as full or part-time work at minimum 
wage or higher, with wages and benefits similar to those without disabilities 
performing the same work, and fully integrated with coworkers without disabilities.  
• 
Individuals may be self-employed, working from their own homes, and still receive 
Extended Services when the work is competitive and could also be performed in an 
integrated environment by and among persons without intellectual/developmental 
disabilities. 
Reimbursable Activities 
Reimbursable activities include the following: 
• Ensuring that natural supports at the worksite are secured through interaction with supervisors and 
staff (A tangible outcome of this activity would be a decrease in the number of hours of Extended 
Services an individual accessed over time.)  
• Training for the individual and/or the individual’s employer, supervisor or coworkers, to increase 
the individual’s inclusion at the worksite  
• Regular observation or support of the individual to reinforce and stabilize the job placement  
• Job-specific or job-related safety training  
• Job-specific or job-related self-advocacy skills training  
• Reinforcement of work-related personal care and social skills 
• Training on use of public transportation and/or acquisition of appropriate transportation 
• Facilitating, but not funding, driver’s education training  
• Coaching and training on job-related tasks, such as computer skills or other job-specific tasks 
• Travel by the provider to the worksite as part of the delivery of this service 
Individual (one-on-one) services can be billed in 15-minute increments.  
For Extended Services provided in a group setting, reimbursement equals the unit rate divided by the 
number of individuals served.  
With the exception of 1:1 on-the-job coaching, support and observation, the potential exists for all 
components of the Extended Services service definition to be applicable to either a waiver individual or to a

[Audio] We recommend that important information such as the name of the provider, the date range of services, the primary type of service, and the notation of the ratio for service delivery be reviewed. It is also important to include a brief summary of progress towards P-C-I-S-P outcomes, challenges hindering progress, and a positive event that occurred during the quarter that contributed to the individual's good life. All data elements must be made available to auditors, quality monitors, case managers, and any other government entity upon request. For Group Services, further guidance related to day habilitation, including group services, is available on the Current D-D-R-S Policies page at in.gov/fssa/ddrs and at the direct link for Day Habilitation: Service Definition and Standards. This document outlines limitations on group sizes, such as the 1:1 Individual, 2:1 to 4:1 Small Group, 5:1 to 10:1 Medium Group, and 11:1 to 16:1 Large Group (applies only to a facility setting). Day Habilitation services reimbursement does not include reimbursement for the cost of the activities in which the individual is participating when they receive skills training, such as the cost to attend a community event or a camp. The document also lists activities that are not allowed under Day Habilitation, such as services that are available under the Rehabilitation Act of 1973 or PL 94-142, skills training for any activity that is not identified as directly related to an individual's habilitation outcome, activities that do not foster the acquisition and retention of skills, activities that duplicate or replace supports provided through residential habilitation and support (R-H-S--) services, services furnished to a minor by parents, stepparents or legal guardian, and services furnished to an individual by the individual’s spouse. Extended services are provided in integrated community settings where persons without disabilities are also employed. Reimbursement will only be made for the employment support services required by the individual receiving services as a result of their disability. Extended services do not include sheltered work or other similar types of vocational services furnished in specialized facilities or volunteer endeavors. An individual's P-C-I-S-P should be constructed in a manner that reflects individual informed choice and goals relating to employment and ensures provision of services in the most integrated setting possible. The extended services supports should be designed to support employment outcomes that lead to further independence and are consistent with the individual’s goals. Individual informed choices and goals related to employment and the justification/need for extended services must be outlined in the PCISP. In addition to compliance with documentation requirements outlined in 460 I-A-C 6, the following data elements are required for each service rendered: Name of individual served, I-H-C-P Member ID of the individual, Name of provider, Identified employment need, Service rendered, Expected outcome, Date of service including the year, Time frame of service (include a.m. or p.m.), Notation of the primary location of service delivery, A summary of services rendered to include the specific reimbursable activities that were performed and the outcomes realized from those activities, and A description of any issue or circumstance concerning the individual including, but not limited to, significant medical or behavioral incidents or any other situation that may be uncommon for the individual.. 

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Policies and procedures as of July 1, 2024 
 
Version: 11.1 
group of individuals. However, specific examples of activities that might be rendered in a group setting 
would include instructing a group of individuals on professional appearance requirements for various types 
of employment, reinforcement of work-related personal care or social skills, knowing how to get up in time 
to get ready for and commute to work. Groups could receive job-specific or job-related safety training, self-
advocacy training, or training on the use of public transportation. A group could receive training on 
computer skills or other job-specific tasks when group individuals have similar training needs.  
Service Standards 
Extended services are provided in integrated community settings where persons without disabilities are also 
employed. Reimbursement will only be made for the employment support services required by the 
individual receiving services as a result of their disability. 
Extended services do not include sheltered work or other similar types of vocational services furnished in 
specialized facilities or volunteer endeavors. 
An individual’s PCISP should be constructed in a manner that reflects individual informed choice and goals 
relating to employment and ensures provision of services in the most integrated setting possible. The 
extended services supports should be designed to support employment outcomes that lead to further 
independence and are consistent with the individual’s goals.  
Documentation Standards 
Individual informed choices and goals related to employment and the justification/need for extended 
services must be outlined in the PCISP.  
In addition to compliance with documentation requirements outlined in 460 IAC 6, the following data 
elements are required for each service rendered: 
• Name of individual served 
• IHCP Member ID of the individual 
• Name of provider 
• Identified employment need 
• Service rendered 
• Expected outcome 
• Date of service including the year 
• Time frame of service (include a.m. or p.m.) 
• Notation of the primary location of service delivery 
• A summary of services rendered to include the specific reimbursable activities that were performed 
and the outcomes realized from those activities 
• A description of any issue or circumstance concerning the individual including, but not limited to, 
significant medical or behavioral incidents or any other situation that may be uncommon for the 
individual 
• Signature that includes at least the last name and first initial of the staff person making the entry 
(Electronic signatures are permissible when in compliance with the Uniform Electronic 
Transactions Act [IC 26-2-8]) 
Upon request, all data elements must be made available to auditors, quality monitors, case managers and 
any other government entity. The documentation may reside in multiple locations but must be clearly and 
easily linked to the individual or the standard will not be met.

[Audio] We recommend that you understand the policies and procedures for F-S-W and C-I-H Waivers. This information includes the name of the provider, the date range of services, the primary type of service, and the ratio for service delivery. Additionally, it requires a brief summary of progress towards P-C-I-S-P outcomes, challenges hindering progress, and a positive event that occurred during the quarter that contributed to the individual's good life. All data elements must be available to auditors, quality monitors, case managers, and any other government entity upon request. For Group Services, we suggest consulting the Current D-D-R-S Policies page at in.gov/fssa/ddrs and the direct link for Day Habilitation: Service Definition and Standards. This document outlines the limitations on group sizes, such as the 1:1 Individual, 2:1 to 4:1 Small Group, 5:1 to 10:1 Medium Group, and 11:1 to 16:1 Large Group (applies only to a facility setting). Activities that are not allowed under Day Habilitation include services that are available under the Rehabilitation Act of 1973 or PL 94-142, skills training for any activity that is not identified as directly related to an individual's habilitation outcome, activities that do not foster the acquisition and retention of skills, activities that duplicate or replace supports provided through residential habilitation and support (R-H-S--) services, services furnished to a minor by parents, stepparents or legal guardian, and services furnished to an individual by the individual’s spouse. As applicable, you must submit monthly/quarterly reports 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 on Group services may only be rendered at the discretion of the I-S-T and in group sizes no greater than four individuals to one staff. You must also provide appropriate documentation, as outlined under Documentation Standards for Extended Services, demonstrating that the ratio for each claimed time frame of services did not exceed the maximum allowable ratio determined by the I-S-T for each group individual, and identify other group individuals, by using the individuals’ Health Insurance Portability and Accountability Act (H-I-P-A-A) naming convention. Activities Not Allowed Reimbursement is not available under Extended Services for the following activities: Any non-community-based setting where the majority (51% or more) of the individuals have an intellectual or developmental disability, Sheltered work observation or participation, Volunteer endeavors, Any. 

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DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
Library Reference Number: PRPR10014 
107 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
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 
Group services may only be rendered at the discretion of the IST and in group sizes no greater than four 
individuals to one staff. In addition, the provider must be able to provide appropriate documentation, as 
outlined under Documentation Standards for Extended Services, demonstrating that the ratio for each 
claimed time frame of services did not exceed the maximum allowable ratio determined by the IST for each 
group individual, and provide documentation identifying other group individuals, by using the individuals’ 
Health Insurance Portability and Accountability Act (HIPAA) naming convention. 
Activities Not Allowed 
Reimbursement is not available under Extended Services for the following activities: 
• Any non-community-based setting where the majority (51% or more) of the individuals have an 
intellectual or developmental disability 
• Sheltered work observation or participation 
• Volunteer endeavors 
• Any service that is otherwise available under the Rehabilitation Act of 1973 or Public Law 94-142 
• Public relations 
• Incentive payments made to an employer to subsidize the employer’s participation in Extended 
Services 
• Payment for vocational training that is not directly related to the individual’s Extended Service 
needs outlined in the PCISP 
• Extended Services do not include payment for supervisory activities rendered as a normal part of the 
business setting. 
• Extended Services provided to a minor by a parents, step-parents, legal guardian or spouse 
• The provision of transportation to an individual is not a reimbursable activity within Extended 
Services. 
• Waiver funding for the provision of vocational services delivered in facility-based or sheltered work 
settings, where individuals are supervised for the primary purpose of producing goods or performing 
services 
• Group supports delivered to individuals who are using different support options (For example, one 
individual in the group is using Extended Services and another individual in the same group setting 
is using Day Habilitation.) 
Note: Supported Employment services continue to be available under the Rehabilitation Act 
of 1973 through the Vocational Rehabilitation (VR) program within the DDRS 
Bureau of Rehabilitation Services (BRS). 
Provider Qualifications 
Providers must meet the following criteria: 
• Enrolled as an active Medicaid provider 
• Be FSSA DDRS-approved

[Audio] We will discuss the importance of understanding the service definitions and requirements for F-S-W and C-I-H Waivers. Providers must comply with Indiana Administrative Code 460 IAC 6 and any applicable B-D-S service standards, guidelines, policies and/or manuals. We will also discuss the requirement for providers to obtain and maintain Indiana accreditation by at least one of the four organizations: The Commission on Accreditation of Rehabilitation Facilities (C-A-R-F-), the Council on Quality and Leadership in Supports for People with Disabilities, the Joint Commission on Accreditation of Healthcare Organizations (J-C-A-H-O), the National Commission on Quality Assurance, or an independent national accreditation organization approved by the secretary. To be eligible to perform this service, a provider must meet the standards as a community rehabilitation provider as outlined in Indiana Code 12-12-1-4.1 Section 10.10: Facility-Based Support for F-S-W and C-I-H Waiver. These services are structured, comprehensive, non-residential programs that provide health, social, recreational and therapeutic activities, as well as educational and life skill opportunities as described in the PCISP. Facility-Based Support services must be provided in a congregate setting in groups not to exceed 16:1.. 

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Version: 11.1 
• Comply with Indiana Administrative Code 460 IAC 6, including but not limited to: 
– 460 IAC 6-12-1 and 460 IAC 6-12-2 Insurance 
– 460 IAC 6-10-5 Documentation of Criminal Histories 
– 460 IAC 6-11-1 to 460 IAC 6-11-3 Financial Status of Providers 
– 460 IAC 6-14-5 Requirements for Direct Care Staff 
– 460 IAC 6-14-4 Staff Training and 460 IAC 6-14-4 Training 
• Comply with any applicable BDS service standards, guidelines, policies and/or manuals, including 
FSSA DDRS policies and this module, accessible from the IHCP Provider Reference Modules page 
at in.gov/medicaid/providers 
• Must obtain/maintain Indiana accreditation by at least one of the following organizations: 
– The Commission on Accreditation of Rehabilitation Facilities (CARF), or its successor 
– The Council on Quality and Leadership in Supports for People with Disabilities, or its successor 
– The Joint Commission on Accreditation of Healthcare Organizations (JCAHO), or its successor 
– The National Commission on Quality Assurance, or its successor 
– An independent national accreditation organization approved by the secretary 
• To be eligible to perform this service, a provider must meet the standards as a community 
rehabilitation provider as outlined in Indiana Code 12-12-1-4.1 
Section 10.10: Facility-Based Support for FSW and CIH 
Waiver 
The following subsections provide information and requirements for Facility-Based Support Services for 
the FSW and CIH Waiver. 
Service Definition 
Facility-Based Support services are structured, comprehensive, non-residential programs that provide 
health, social, recreational and therapeutic activities, as well as educational and life skill opportunities as 
described in the PCISP. Individuals attend on a planned basis. 
These services must be provided in a congregate setting in groups not to exceed 16:1. 
Facility settings are defined as nonresidential, nonintegrated settings that take place within the same 
buildings for the duration of the service rather than being out in the community. 
Reimbursable Activities 
Reimbursable activities include the following: 
• Monitoring and/or supervision of ADLs defined as dressing, grooming, eating, walking and toileting 
with hands-on assistance provided as needed 
• Appropriate structure, support and intervention 
• Minimum staff ratio: 1 staff for each 16 individuals  
• Medication administration 
• Optional or non-work-related educational and life skill opportunities (such as how to use 
computers/computer programs/internet, set an alarm clock, write a check, fill out a bank deposit 
slip, plant and care for vegetable/flower garden, and so on) may be offered and pursued

[Audio] We recommend that you thoroughly review the DDRS HCBS Waivers and the Current D-D-R-S Policies for Group Services, which contain vital information such as the provider's name, the date range of services, the main type of service, and the notation of the ratio for service delivery. Additionally, these documents require a brief summary of the progress made towards P-C-I-S-P outcomes, any obstacles that may have hindered progress, and a positive event that occurred during the quarter that positively impacted the individual's life. It is essential to make all data elements available to auditors and quality monitors.. 

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DDRS HCBS Waivers 
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Library Reference Number: PRPR10014 
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Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
Service Standards 
The following service standards apply to Facility-Based Support: 
• Facility-Based Support services must be reflected in the PCISP. 
• Facility-Based Support services must follow a written plan of care addressing specific needs as 
identified in the PCISP. 
Documentation Standards 
Documentation standards for Facility-Based Support services include the following: 
• Services outlined in the PCISP 
• In addition to compliance with documentation requirements outlined in 460 IAC 6, the following 
data elements are required for each service rendered: 
– Name of individual served 
– IHCP Member ID (also known as RID) of the individual 
– Name of provider 
– Service rendered 
– Time frame of service (include a.m. or p.m.) 
– Date of service including the year 
– Notation of the primary location of service delivery 
– A brief activity summary of service rendered 
– In addition to the brief activity summary of service rendered, a description by direct care staff of 
any issue or circumstance concerning the individual including, but not limited to, significant 
medical or behavioral incidents or any other situation that may be uncommon for the individual 
– Signature that includes at least the last name and first initial of the direct care staff person 
making the entry (Electronic signatures are permissible when in compliance with the Uniform 
Electronic Transactions Act [IC 26-2-8]) 
Upon request, all data elements must be made available to auditors, quality monitors, case managers and 
any other government entity. The documentation may reside in multiple locations but must be clearly and 
easily linked to the individual, or the standard will not be met. 
As applicable, monthly/quarterly reports must be uploaded to the document library of the state’s case 
management system by the chosen service provider on or before the 15th day of the following month. 
For Group Services 
Providers must be able to indicate, in concise format, that the ratio for each claimed time frame of the 
service did not exceed (group or individual) the maximum allowable ratio for individuals utilizing waiver 
funding. 
Limitations 
The following are limitations on Facility-Based Support: 
• These services must be provided in a congregate, protective setting in groups not to exceed 16:1 
(individuals: staff). 
• Habilitation services reimbursement does not include reimbursement for the cost of the activities in 
which the individual in a group is participating when they receive skills training, such as the cost to 
attend a community event.

[Audio] We emphasize the importance of carefully examining the DDRS HCBS Waivers Section 10 for all eligible providers. This section outlines the service definitions and requirements for Facility Supported Waiver (F-S-W--) and Comprehensive Individualized Supportive Habilitation (C-I-H--) Waiver. It is crucial for providers to understand the restrictions on group sizes, the prohibited activities under Day Habilitation, and the qualifications necessary to be eligible for Facility Supported Waiver (F-S-W--) and Comprehensive Individualized Supportive Habilitation (C-I-H--) Waiver.. 

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Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
110 
Library Reference Number: PRPR10014 
 
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 Facility-Based Support: 
• Any activity that is not described in reimbursable activities is not included in this service 
• Services furnished to a minor by parents, stepparents or legal guardian 
• Services furnished to an individual by the individual’s spouse 
• Prevocational Services 
• Service provided by the parent of a minor child participant or the spouse of a participant (also 
known as LRIs) 
Provider Qualifications 
Providers must meet the following criteria: 
• Enrolled as an active Medicaid provider 
• Be FSSA DDRS-approved 
• Comply with Indiana Administrative Code, 460 IAC 6, including but not limited to: 
– 460 IAC 6-10-5 Documentation of Criminal Histories 
– 460 IAC 6-12-1 and 460 IAC 6-12-2 Insurance 
– 460 IAC 6-11-1 to 460 IAC 6-11-3 Financial Status of Providers 
– 460 IAC 6-14-5 Requirements for Direct Care Staff 
– 460 IAC 6-14-4 Staff Training and 460 IAC 6-14-4 Training 
– 460 IAC 6-5-14 Health Care Coordination Services Provider Qualifications 
– 460 IAC 6-5-30 Transportation Services Provider Qualifications 
• Comply with any applicable BDS service standards, guidelines, policies and/or manuals, including 
FSSA DDRS policies and this module, accessible from the IHCP Bulletins, Banner Pages and 
Reference Modules page at in.gov/medicaid/providers 
Section 10.11: Family and Caregiver Training for FSW 
and CIH Waiver 
The following subsections provide information and requirements for Family and Caregiver Training 
services for the FSW and CIH Waiver. 
Service Definition 
Family and Caregiver Training services provides education and support directly to the family caregiver of 
an individual in order to increase the confidence and stamina of the caregivers to support the individual. 
Education and training activities are based on the family/caregiver’s unique needs and must be specifically 
identified in the PCISP. 
The services under Family and Caregiver Training 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.

[Audio] We recommend that all stakeholders carefully review the DDRS HCBS Waivers Section 10 to ensure compliance with the service definitions and requirements for F-S-W and C-I-H Waivers. This document includes critical information such as the name of the provider, the date range of services, the primary type of service, and the notation of the ratio for service delivery. Additionally, it requires a brief summary of progress towards P-C-I-S-P outcomes, challenges hindering progress, and a positive event that occurred during the quarter that contributed to the individual's good life. All data elements must be made available to auditors, quality monitors, case managers, and any other government entity upon request. For Group Services, further guidance related to day habilitation, including group services, is available on the Current D-D-R-S Policies page at in.gov/fssa/ddrs and at the direct link for Day Habilitation: Service Definition and Standards. This document outlines limitations on group sizes, such as the 1:1 Individual, 2:1 to 4:1 Small Group, 5:1 to 10:1 Medium Group, and 11:1 to 16:1 Large Group (applies only to a facility setting). Day Habilitation services reimbursement does not include reimbursement for the cost of the activities in which the individual is participating when they receive skills training, such as the cost to attend a community event or a camp. The document also lists activities that are not allowed under Day Habilitation, such as services that are available under the Rehabilitation Act of 1973 or PL 94-142, skills training for any activity that is not identified as directly related to an individual's habilitation outcome, activities that do not foster the acquisition and retention of skills, activities that duplicate or replace supports provided through residential habilitation and support (R-H-S--) services, services furnished to a minor by parents, stepparents or legal guardian, and services furnished to an individual by the individual’s spouse.. 

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DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
Library Reference Number: PRPR10014 
111 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
Additional Information: 
• 
Family and Caregiver Training services cannot be used to provide behavioral programs 
or supports, or other direct services covered under other available Indiana Medicaid 
State Plan or waiver services.  
Reimbursable Activities  
Reimbursable activities include the following: 
• Educational materials or training programs, workshops, and conferences for caregivers that are 
directly related to the caregiver’s role in supporting the individual in areas specified in the PCISP 
that relate to: 
– Understanding the disability of the individual 
– Achieving greater competence and confidence in providing supports 
– Developing and accessing community other resources and supports 
– Developing or enhancing key parenting strategies 
– Developing advocacy skills 
– Supporting the individual in developing self-advocacy skills 
• Education, training or counseling must be aimed at assisting caregivers who support the individual 
to understand and address individual needs as specified in the PCISP. 
Service Standards 
The following service standards apply to Family and Caregiver Training: 
• Family and Caregiver Training services must be included in the PCISP. 
• The PCISP shall be based on the person-centered planning process for that individual. 
Documentation Standards 
Documentation standards for family and caregiver training services include the following: 
• Services outlined in the PCISP 
• Receipt of payment for activity 
• Proof of participation in activity if payment is made directly to individual/family 
• Documentation in compliance with 460 IAC 6 Supported Living Services and Supports 
requirements 
As applicable, monthly/quarterly reports must be uploaded to the document library of the state’s case 
management system by the chosen service provider on or before the 15th day of the following month. 
Limitations 
Reimbursement for this service is limited to no more than $5,000 per year.

[Audio] We would like to emphasize the importance of reviewing DDRS HCBS Waivers Section 10 to ensure compliance with the service definitions and requirements for Family Support and Waiver (F-S-W--) and Community Integration and Habilitation (C-I-H--) Waivers. This document includes crucial information such as the provider's name, date range of services, primary type of service, and notation of the ratio for service delivery. It is essential that all data elements are made available to auditors, quality monitors, case managers, and any other government entity upon request. For Group Services, further guidance related to day habilitation, including group services, is available on the Current D-D-R-S Policies page at in.gov/fssa/ddrs and at the direct link for Day Habilitation: Service Definition and Standards. This document outlines limitations on group sizes, such as the 1:1 Individual, 2:1 to 4:1 Small Group, 5:1 to 10:1 Medium Group, and 11:1 to 16:1 Large Group (applies only to a facility setting). Day Habilitation services reimbursement does not include reimbursement for the cost of the activities in which the individual is participating when they receive skills training, such as the cost to attend a community event or a camp. The document also lists activities that are not allowed under Day Habilitation, such as services that are available under the Rehabilitation Act of 1973 or PL 94-142, skills training for any activity that is not identified as directly related to an individual's habilitation outcome, activities that do not foster the acquisition and retention of skills, activities that duplicate or replace supports provided through residential habilitation and support (R-H-S--) services, services furnished to a minor by parents, stepparents or legal guardian, and services furnished to an individual by the individual’s spouse. It's important to note that DDRS HCBS Waivers Section 10 includes specific activities that are not allowed under Family and Caregiver Training (F-S-T--) and Community Integration and Habilitation (C-I-H--) Waivers. These activities include educational materials or training programs, workshops, and conferences that are not related to the caregiver’s ability to support the individual, education and training provided to train providers, training provided to caregivers who receive training reimbursement within their Medicaid or state line item reimbursement rates, cost of travel, meals and overnight lodging while attending the training program, workshop or conference, service provided by the parent of a minor child participant or the spouse of a participant, and cost of travel, meals and overnight lodging while attending the training program, workshop or conference. Provider qualifications are crucial for F-S-W and C-I-H Waivers. Providers must meet the following criteria: be enrolled as an active Medicaid provider, be FSSA DDRS-approved, comply with Indiana Administrative Code 460 I-A-C 6, including but not limited to documentation of criminal histories, insurance, financial status of providers, family and caregiver training services provider qualifications, and requirements for provision of services. Additionally, providers must comply with any applicable B-D-S service standards, guidelines, policies and/or manuals, including FSSA DDRS policies and this module, accessible from the I-H-C-P Provider Reference Modules page at in.gov/medicaid/providers. DDRS HCBS Waivers Section 10.12 provides information and requirements for Home Modification Assessment services for the F-S-W and C-I-H Waiver. This service will be used to objectively determine the specifications for a home modification that is safe, appropriate and feasible to ensure accurate bids and workmanship. All participants must receive a Home Modification Assessment 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. In conclusion, it's essential to review DDRS HCBS Waivers Section 10 to ensure compliance with the service definitions and requirements for Family Support and Waiver (F-S-W--) and Community Integration. 

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DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
112 
Library Reference Number: PRPR10014 
 
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 Family and Caregiver Training: 
• Educational materials or training programs, workshops, and conferences that are not related to the 
caregiver’s ability to support the individual 
• Education and training provided to train providers, even when those providers will subsequently 
train caregivers 
• Training provided to caregivers who receive training reimbursement within their Medicaid or state 
line item reimbursement rates 
• Cost of travel, meals and overnight lodging while attending the training program, workshop or 
conference 
• Service provided by the parent of a minor child participant or the spouse of a participant (also 
known as LRIs) 
Provider Qualifications 
Providers must meet the following criteria: 
• Enrolled as an active Medicaid provider 
• Be FSSA DDRS-approved 
• Comply with Indiana Administrative Code 460 IAC 6, including but not limited to: 
– 460 IAC 6-10-5 Documentation of Criminal Histories 
– 460 IAC 6-12-1 and 460 IAC 6-12-2 Insurance 
– 460 IAC 6-11-1 to 460 IAC 6-11-3 Financial Status of Providers 
– 460 IAC 6-5-13 Family and Caregiver Training Services Provider Qualifications, and 
460 IAC 6-23-1 Requirements for Provision of Services 
– 460 IAC 6-14-4 Staff Training and 460 IAC 6-14-4 Training 
• Comply with any applicable BDS service standards, guidelines, policies and/or manuals, including 
FSSA DDRS policies and this module, accessible from the IHCP Provider Reference Modules page 
at in.gov/medicaid/providers 
Section 10.12: Home Modification Assessment for the 
FSW and CIH Waiver 
The following subsections provide information and requirements for Home Modification Assessment 
services for the FSW and CIH Waiver. 
Service Definition 
Home modification assessment will be used to objectively determine the specifications for a home 
modification that is safe, appropriate and feasible to ensure accurate bids and workmanship. All 
participants must receive a Home Modification Assessment 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 Home Modification Assessment will assess the home for physical adaptations to the home, which, 
as indicated by individual’s service plan, are necessary to ensure the health, welfare and safety of the

[Audio] The importance of reviewing the DDRS HCBS Waivers Section 10 to ensure compliance with the service definitions and requirements for F-S-W and C-I-H Waivers will be discussed. This document contains essential information such as the provider's name, service date range, primary type of service, and the service delivery ratio. It also requires a summary of progress towards P-C-I-S-P outcomes, any challenges faced, and any positive occurrences contributing to the individual's well-being during the quarter. All data elements must be readily available to auditors, quality monitors, case managers, and other government entities upon request. For Group Services, additional guidance on day habilitation can be found on the Current D-D-R-S Policies page at in.gov/fssa/ddrs and the direct link for Day Habilitation: Service Definition and Standards. This document outlines restrictions on group sizes, including a 1:1 individual ratio, 2:1 to 4:1 small group ratio, 5:1 to 10:1 medium group ratio, and 11:1 to 16:1 large group ratio (only applicable to facility settings). However, reimbursement for day habilitation services does not cover the cost of activities in which the individual receives skills training, such as attending a community event or a camp. Additionally, certain activities are not allowed under Day Habilitation, such as activities available under the Rehabilitation Act of 1973 or PL 94-142, skills training not directly related to the individual's habilitation outcome, activities that do not promote skill acquisition and retention, duplicating or replacing supports provided through residential habilitation and support (R-H-S--) services, services provided by parents, step-parents, or legal guardians to minors, and services provided by an individual's spouse. Section 10 of the DDRS HCBS Waivers ensures that F-S-W and C-I-H Waivers provide individualized and enabling services to promote independence and prevent institutionalization. The assessor's responsibilities include writing specifications, examining feasibility, and evaluating the post-project results.. 

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DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
Library Reference Number: PRPR10014 
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Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
individual and enable the individual to function with greater independence in the home and without which 
the individual would require institutionalization.  
The assessor will be responsible for writing the specifications, review of feasibility and the post-project 
inspection specifications to the case manager and individual for the bidding process and be paid first 
installment for completion of home specifications. After the project is complete, the assessor, participant 
and case manager will each be present on an agreed-upon date and time to inspect the work and sign off 
indicating the work was completed per the agreed-upon bid, and the assessor will be paid the final 
installment of the home modification work. In the event the participant, provider, assessor and/or the case 
manager become aware of discrepancies or complaints about the work being completed, the provider shall 
stop work immediately and contact the case manager and Bureau of Disabilities Services (BDS) for further 
instruction.  
The BDS also has the ability to request additional assessment visits to help resolve a disagreement between 
the home modification provider and the participant. This payment is not included in the actual home 
modification cost category and shall not be subtracted from the participant’s lifetime cap for home 
modifications. The case management provider entity will be responsible for maintaining related records 
that can be accessed by the state.  
Reimbursable Activities 
Reimbursable activities include the following: 
• Evaluation of the current environment, including the identification of barriers, underneath the home, 
electrical and plumbing, which may prevent the completion of desired modifications 
• Reimbursement for nonfeasible assessments 
• Drafting of specifications 
• Preparation/submission of specifications 
• Examination of the modification (inspection/approve) 
• Contact county code enforcement  
Service Standards 
The following service standards apply to Home Modification Assessments: 
• Need for home modification must be indicated in the participant’s plan of care  
• Modification must address the participant’s level-of-service needs. 
• Proposed specifications for modification must conform to the requirements and limitations of the 
current approved service definition for home modification services. 
• Assessment should be conducted by an approved, qualified individual who is independent of the 
entity providing the home modifications. 
• Contact appropriate authority regarding potential code violations.  
Documentation Standards 
Documentation standards for Home Modification Assessments include the following: 
• The need for Home Modification must be indicated in the participant’s plan of care. 
• Modification must address the participant’s level-of-service needs

[Audio] I am pleased to share the DDRS HCBS Waivers Section 10 with everyone. This section outlines the service definitions and requirements for F-S-W and C-I-H Waivers, which are crucial for compliance. The document includes important details such as the provider's name, service date range, primary type of service, and service delivery ratio. It also requires a brief summary of progress towards P-C-I-S-P outcomes, challenges faced, and a positive event that contributed to the individual's well-being during the quarter. All data elements must be readily accessible to auditors, quality monitors, case managers, and any other government entity upon request.. 

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DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
114 
Library Reference Number: PRPR10014 
 
Published: Sept. 9, 2024 
 
Policies and procedures as of July 1, 2024 
 
Version: 11.1 
• Any discrepancy noted by the provider, case manager and/or participant shall be detailed in the final 
inspection and addressed by the assessor.  
Limitations 
An annual cap of $628 is available for Home Modification Assessment services, unless the BDS requests 
an additional assessment to help mediate disagreements between the home modification provider and the 
participant.  
Activities Not Allowed 
The following activities are not allowed under Home Modification Assessment services: 
• Home Modification Assessment services shall not be performed by the same provider that performs 
the subsequent Home Modifications. 
• Home Modification Assessment services will not be reimbursed when the owner of the organization 
is a parent of a minor child participant, the spouse of a participant, the attorney-in-fact (POA) of a 
participant, the health care representative (HCR) of a participant or the legal guardian of a 
participant. 
• 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.  
Provider Qualifications 
Providers of Home Modification Assessment services must meet the following criteria: 
• Enrolled as an active Medicaid provider  
• Must 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 6-5-27 Specialized Medical Equipment and Supplies Supports Provider Qualifications  
• Must comply with any applicable BDS service standards, guidelines, policies and/or manuals, 
including FSSA DDRS policies and this module, accessible from the IHCP Provider Reference 
Modules page at in.gov/medicaid/providers 
• Where licensure is required, providers rendering waiver-funded services must obtain and maintain 
Indiana-specific licensure. In addition to the licensure standard, either a Certified Aging-In-Place 
Specialist (CAPS Certification – National Association of Home Builders) or an Executive 
Certificate in Home Modifications (University of Southern California) is required.

[Audio] We will now discuss the importance of reviewing Section 10 of the DDRS HCBS Waivers to ensure compliance with the service definitions and requirements for F-S-W and C-I-H waivers. This document includes crucial details such as the provider's name, date range of services, primary type of service, and service delivery ratio notation. All data elements must be made available to auditors, quality monitors, case managers, and government entities upon request. Moving on to group services, we would like to offer further guidance on day habilitation, including group services. This information can be found on the Current D-D-R-S Policies page at in.gov/fssa/ddrs, under the direct link for Day Habilitation: Service Definition and Standards. This document outlines limitations on group sizes, such as the 1:1 Individual, 2:1 to 4:1 Small Group, 5:1 to 10:1 Medium Group, and 11:1 to 16:1 Large Group (applicable only to a facility setting). It is important to note that reimbursement for day habilitation services does not cover the expenses of activities in which the individual participates, such as attending a community event or a camp. The document also specifies the prohibited activities under day habilitation, including those already covered by the Rehabilitation Act of 1973 or PL 94-142, skills training for activities unrelated to an individual's habilitation outcome, activities that do not develop or maintain skills, and activities that duplicate or replace support provided through residential habilitation and support services. Furthermore, day habilitation services are not eligible for reimbursement if provided by family members or spouses. We encourage a thorough review of this information to ensure compliance with regulations and promote the individual's well-being. Thank you for your attention to this matter. This concludes our presentation on DDRS HCBS Waivers Section 10. We hope this information has been helpful in understanding the requirements and regulations for these waivers.. 

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DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
Library Reference Number: PRPR10014 
115 
Published: Sept. 9, 2024 
Policies and procedures as of July 1, 2024 
Version: 11.1 
Section 10.13: Home Modifications for FSW and CIH Waiver 
The following subsections provide information and requirements for Home Modifications services for the 
FSW and CIH Waiver. 
Service Definition 
Home Modifications are those physical adaptations to the home, required by the individual’s PCISP, which 
are necessary to ensure the health, welfare and safety of the individual, which enable the individual to 
function with greater independence in the home. 
DDRS’ waiver services staff must approve all Home Modifications prior to service being rendered. 
Additional Information: 
• 
The Home Modifications service described in this section is available under the FSW 
and CIH Waiver.  
• 
For information about the Home Modifications service available under the H&W and 
TBI Waivers, see Section 12.18: Home Modifications for H&W and TBI Waivers. 
• 
The costs for Home Modifications are outside the $26,482 cap of the FSW.  
• 
Photographs of the proposed areas to be modified must be provided. 
• 
The home modification policy appears in Section 11: RFA Policies and Section 11.1: 
Home Modification Policy. Policy updates are in process. 
 
As a reminder, HCBS waiver funding covers only basic modifications determined to be 
medically necessary for the waiver individual and is not available for items that 
exceed basic medical need. Requests to upgrade products or to use materials 
exceeding the individual’s basic need will not be approved. For example, if a 
bathroom modification is necessary but the individual or family requests tiled flooring 
when basic vinyl flooring could be installed, the individual or family must decide 
whether to access waiver funds for completion of the basic modification or to assume 
financial responsibility for the entire modification inclusive of desired upgrades. 
 
Due to the state’s responsibility to ensure each modification is the most cost effective 
or conservative means to meet the individual’s needs for accessibility within the home, 
it is not acceptable to submit bids attempting to combine waiver funding for basic 
modifications with private funding to cover the higher costs of the desired upgrades.  
Reimbursable Activities 
Reimbursable activities include the following: 
• Installation of ramps and grab bars 
• Widening doorways 
• Modifying existing bathroom facilities 
• Installation of specialized electric and plumbing systems necessary to accommodate the medical 
equipment and supplies that are necessary for the welfare of the individual, including anti-scald 
devices 
• Maintenance and repair of the items and modifications installed during the initial request 
For the FSW, Home Modifications are outside the $26,482 cap.

[Audio] It is recommended that a review of the DDRS HCBS Waivers Section 10 be conducted to ensure compliance with service definitions and requirements for F-S-W and C-I-H Waivers. This review is important as the document includes crucial information such as provider name, service date range, primary type of service, and service delivery ratio. Additionally, the review requires a brief summary of progress towards P-C-I-S-P outcomes, challenges hindering progress, and any positive events that have contributed to the individual's well-being. All data elements must be readily available to auditors, quality monitors, case managers, and other government entities upon request. For Group Services, further guidance on day habilitation can be found on the Current D-D-R-S Policies page at in.gov/fssa/ddrs and at the direct link for Day Habilitation: Service Definition and Standards. This document outlines limitations on group sizes, including 1:1 Individual, 2:1 to 4:1 Small Group, 5:1 to 10:1 Medium Group, and 11:1 to 16:1 Large Group (applicable only to facility settings). It is important to note that day habilitation services do not cover the cost of activities that the individual participates in while receiving skills training, such as attending a community event or camp. The document also specifies activities that are not allowed under day habilitation, such as those covered by the Rehabilitation Act of 1973 or PL 94-142, skills training for activities not directly related to an individual's habilitation outcome, activities that do not promote skill acquisition and retention, activities that duplicate or replace supports provided through residential habilitation and support (R-H-S--) services, services provided to minors by parents, stepparents, or legal guardians, and services provided to an individual by their spouse. The following service standards apply to Home Modifications: all equipment and supplies must directly benefit the individual's health or remediation, and all items must meet applicable manufacturing, design, and installation standards. Additionally, all participants must receive a Home Modification Assessment.. 

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DDRS HCBS Waivers 
Section 10: Service Definitions and Requirements for FSW and CIH Waivers 
116 
Library Reference Number: PRPR10014 
 
Published: Sept. 9, 2024 
 
Policies and procedures as of July 1, 2024 
 
Version: 11.1 
Service Standards 
The following service standards apply to Home Modifications: 
• Equipment and supplies must be for the direct medical or remedial benefit of the individual. All 
items shall meet applicable standards of manufacture, design and installation. 
• All participants must receive a Home Modification Assessment 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. Home Modifications will be used to 
objectively determine the specifications for a home modification that is safe, appropriate and 
feasible to ensure accurate bids and workmanship. (See Section 10.12: Home Modification 
Assessment for the FSW and CIH Waiver.) 
• To ensure that home modifications meet the needs of the individual and abide by established 
federal, state, local and FSSA standards, as well as Americans with Disabilities Act (ADA) 
requirements, approved home modifications will reimburse for necessary: 
– Assessment of the individual’s specific needs, conducted by an approved, qualified individual 
who is independent of the entity providing the Home Modifications 
– Independent inspections during the modification process and at completion of the modifications, 
prior to authorization for reimbursement, based on the complexities of the requested 
modifications 
• Equipment and supplies shall be reflected in the PCISP. 
• Equipment and supplies must address needs identified in the PCISP. 
Documentation Standards 
Documentation standards for Home Modifications include the following: 
• Documentation of the identified direct medical benefit for the individual 
• Documented prior authorization (PA) denial from Medicaid, if applicable 
• Receipts for purchases 
• Identified need in PCISP 
• Documentation in compliance with 460 IAC 6, Supported Living Services and Supports 
requirements 
Limitations 
The following limitations apply to Home Modifications: 
• Reimbursement for Home Modification services has a lifetime cap of $20,000 per waiver  
• Service and repair up to $1,000 per year, outside this cap, is permitted for maintenance and repair of 
prior modifications that were funded by a waiver service 
• If the lifetime cap is fully used, and a need is identified, the case manager will work with other 
available funding streams and community agencies to fulfill the need

 part 9

We recommend that you review the service definitions and requirements for F-S-W and C-I-H Waivers in the DDRS HCBS Waivers Section 10. This document contains important information such as the provider's name, date range of services, primary type of service, and ratio for service delivery. Additionally, it requires a brief summary of progress towards P-C-I-S-P outcomes, challenges hindering progress, and a positive event that occurred during the quarter that contributed to the individual's good life. All data elements must be made available to auditors, quality monitors, case managers, and any other government entity upon request.
                                    
                                    For Group Services, further guidance related to day habilitation is available on the Current D-D-R-S Policies page at in.gov/fssa/ddrs and at the direct link for Day Habilitation: Service Definition and Standards. This document outlines limitations on group sizes for day habilitation services, such as the 1:1 Individual, 2:1 to 4:1 Small Group, 5:1 to 10:1 Medium Group, and 11:1 to 16:1 Large Group (applies only to a facility setting). Data elements must be made available to auditors, quality monitors, case managers, and any other government entity upon request.
                                    
                                    Providers of Day Habilitation must meet the following criteria: enrolled as an active Medicaid provider, FSSA DDRS-approved, comply with Indiana Administrative Code, 460 I-A-C 6, including but not limited to: documentation of criminal histories, insurance, financial status of providers, requirements for direct care staff, health care coordination services provider qualifications, transportation services provider qualifications. Comply with any applicable B-D-S service standards, guidelines, policies and/or manuals, including FSSA DDRS policies and this module, accessible from the I-H-C-P Bulletins, Banner Pages and Reference Modules page at in.gov/medicaid/providers. Obtain or maintain accreditation (specific to Indiana programs) by at least one of the following organizations: The Commission on Accreditation of Rehabilitation Facilities (C-A-R-F-), or its successor, The Council on Quality and Leadership In Supports for People with Disabilities, or its successor, The Joint Commission on Accreditation of Healthcare Organizations (J-C-A-H-O), or its successor, The National Committee for Quality Assurance, or its successor, The ISO-9001 human services quality assurance (Q-A---) system, or an independent national accreditation organization approved by the F-S-S-A Secretary.
                                    
                                    The following subsections provide information and requirements for Extended Services for the F-S-W and C-I-H Waiver. Service Definition: Extended Services are ongoing employment support services that enable an individual to maintain integrated competitive employment in a community

avatar

We are here today to discuss the importance of understanding the service definitions and requirements for F-S-W and C-I-H Waivers. This document is crucial in ensuring compliance with the service definitions and requirements for F-S-W and C-I-H Waivers. The document includes vital information such as the name of the provider, date range of services, primary type of service, and the notation of the ratio for service delivery. 
For Group Services, we have additional guidance available on the Current D-D-R-S Policies page at in.gov/fssa/ddrs and at the direct link for Day Habilitation: Service Definition and Standards. This document outlines the limitations on group sizes, such as the 1:1 Individual, 2:1 to 4:1 Small Group, 5:1 to 10:1 Medium Group, and 11:1 to 16:1 Large Group (applies only to a facility setting). 
It is important to understand that day habilitation services reimbursement does not include reimbursement for the cost of the activities in which the individual is participating when they receive skills training, such as the cost to attend a community event or a camp. The document also lists activities that are not allowed under Day Habilitation, such as services that are available under the Rehabilitation Act of 1973 or PL 94-142, skills training for any activity that is not identified as directly related to an individual's habilitation outcome, activities that do not foster the acquisition and retention of skills, activities that duplicate or replace supports provided through residential habilitation and support (R-H-S--) services, services furnished to a minor by parents, stepparents or legal guardian, and services furnished to an individual by the individual’s spouse. 
All data elements must be made available to auditors, quality monitors, case managers, and any other government entity upon request. In conclusion, we strongly recommend understanding the service definitions and requirements for F-S-W and C-I-H Waivers to ensure compliance with the service definitions and requirements for F-S-W and C-I-H Waivers. It is important to understand the limitations on group sizes and the reimbursable activities for Day Habilitation services. Thank you for your attention to this matter.

We recommend that important information such as the name of the provider, the date range of services, the primary type of service, and the notation of the ratio for service delivery be reviewed. It is also important to include a brief summary of progress towards P-C-I-S-P outcomes, challenges hindering progress, and a positive event that occurred during the quarter that contributed to the individual's good life. All data elements must be made available to auditors, quality monitors, case managers, and any other government entity upon request.
                                    
                                    For Group Services, further guidance related to day habilitation, including group services, is available on the Current D-D-R-S Policies page at in.gov/fssa/ddrs and at the direct link for Day Habilitation: Service Definition and Standards. This document outlines limitations on group sizes, such as the 1:1 Individual, 2:1 to 4:1 Small Group, 5:1 to 10:1 Medium Group, and 11:1 to 16:1 Large Group (applies only to a facility setting). Day Habilitation services reimbursement does not include reimbursement for the cost of the activities in which the individual is participating when they receive skills training, such as the cost to attend a community event or a camp. The document also lists activities that are not allowed under Day Habilitation, such as services that are available under the Rehabilitation Act of 1973 or PL 94-142, skills training for any activity that is not identified as directly related to an individual's habilitation outcome, activities that do not foster the acquisition and retention of skills, activities that duplicate or replace supports provided through residential habilitation and support (R-H-S--) services, services furnished to a minor by parents, stepparents or legal guardian, and services furnished to an individual by the individual’s spouse. Extended services are provided in integrated community settings where persons without disabilities are also employed. Reimbursement will only be made for the employment support services required by the individual receiving services as a result of their disability. Extended services do not include sheltered work or other similar types of vocational services furnished in specialized facilities or volunteer endeavors. An individual's P-C-I-S-P should be constructed in a manner that reflects individual informed choice and goals relating to employment and ensures provision of services in the most integrated setting possible. The extended services supports should be designed to support employment outcomes that lead to further independence and are consistent with the individual’s goals. Individual informed choices and goals related to employment and the justification/need for extended services must be outlined in the PCISP. In addition to compliance with documentation requirements outlined in 460 I-A-C 6, the following data elements are required for each service rendered: Name of individual served, I-H-C-P Member ID of the individual, Name of provider, Identified employment need, Service rendered, Expected outcome, Date of service including the year, Time frame of service (include a.m. or p.m.), Notation of the primary location of service delivery, A summary of services rendered to include the specific reimbursable activities that were performed and the outcomes realized from those activities, and A description of any issue or circumstance concerning the individual including, but not limited to, significant medical or behavioral incidents or any other situation that may be uncommon for the individual.

We recommend that you understand the policies and procedures for F-S-W and C-I-H Waivers. This information includes the name of the provider, the date range of services, the primary type of service, and the ratio for service delivery. Additionally, it requires a brief summary of progress towards P-C-I-S-P outcomes, challenges hindering progress, and a positive event that occurred during the quarter that contributed to the individual's good life. All data elements must be available to auditors, quality monitors, case managers, and any other government entity upon request.
                                    
                                    For Group Services, we suggest consulting the Current D-D-R-S Policies page at in.gov/fssa/ddrs and the direct link for Day Habilitation: Service Definition and Standards. This document outlines the limitations on group sizes, such as the 1:1 Individual, 2:1 to 4:1 Small Group, 5:1 to 10:1 Medium Group, and 11:1 to 16:1 Large Group (applies only to a facility setting). Activities that are not allowed under Day Habilitation include services that are available under the Rehabilitation Act of 1973 or PL 94-142, skills training for any activity that is not identified as directly related to an individual's habilitation outcome, activities that do not foster the acquisition and retention of skills, activities that duplicate or replace supports provided through residential habilitation and support (R-H-S--) services, services furnished to a minor by parents, stepparents or legal guardian, and services furnished to an individual by the individual’s spouse.
                                    
                                    As applicable, you must submit monthly/quarterly reports 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 on Group services may only be rendered at the discretion of the I-S-T and in group sizes no greater than four individuals to one staff. You must also provide appropriate documentation, as outlined under Documentation Standards for Extended Services, demonstrating that the ratio for each claimed time frame of services did not exceed the maximum allowable ratio determined by the I-S-T for each group individual, and identify other group individuals, by using the individuals’ Health Insurance Portability and Accountability Act (H-I-P-A-A) naming convention.
                                    
                                    Activities Not Allowed Reimbursement is not available under Extended Services for the following activities: Any non-community-based setting where the majority (51% or more) of the individuals have an intellectual or developmental disability, Sheltered work observation or participation, Volunteer endeavors, Any

We will discuss the importance of understanding the service definitions and requirements for F-S-W and C-I-H Waivers. Providers must comply with Indiana Administrative Code 460 IAC 6 and any applicable B-D-S service standards, guidelines, policies and/or manuals. We will also discuss the requirement for providers to obtain and maintain Indiana accreditation by at least one of the four organizations: The Commission on Accreditation of Rehabilitation Facilities (C-A-R-F-), the Council on Quality and Leadership in Supports for People with Disabilities, the Joint Commission on Accreditation of Healthcare Organizations (J-C-A-H-O), the National Commission on Quality Assurance, or an independent national accreditation organization approved by the secretary. To be eligible to perform this service, a provider must meet the standards as a community rehabilitation provider as outlined in Indiana Code 12-12-1-4.1 Section 10.10: Facility-Based Support for F-S-W and C-I-H Waiver. These services are structured, comprehensive, non-residential programs that provide health, social, recreational and therapeutic activities, as well as educational and life skill opportunities as described in the PCISP. Facility-Based Support services must be provided in a congregate setting in groups not to exceed 16:1.

We recommend that you thoroughly review the DDRS HCBS Waivers and the Current D-D-R-S Policies for Group Services, which contain vital information such as the provider's name, the date range of services, the main type of service, and the notation of the ratio for service delivery. Additionally, these documents require a brief summary of the progress made towards P-C-I-S-P outcomes, any obstacles that may have hindered progress, and a positive event that occurred during the quarter that positively impacted the individual's life. It is essential to make all data elements available to auditors and quality monitors.

We emphasize the importance of carefully examining the DDRS HCBS Waivers Section 10 for all eligible providers. This section outlines the service definitions and requirements for Facility Supported Waiver (F-S-W--) and Comprehensive Individualized Supportive Habilitation (C-I-H--) Waiver. It is crucial for providers to understand the restrictions on group sizes, the prohibited activities under Day Habilitation, and the qualifications necessary to be eligible for Facility Supported Waiver (F-S-W--) and Comprehensive Individualized Supportive Habilitation (C-I-H--) Waiver.

We recommend that all stakeholders carefully review the DDRS HCBS Waivers Section 10 to ensure compliance with the service definitions and requirements for F-S-W and C-I-H Waivers. This document includes critical information such as the name of the provider, the date range of services, the primary type of service, and the notation of the ratio for service delivery. Additionally, it requires a brief summary of progress towards P-C-I-S-P outcomes, challenges hindering progress, and a positive event that occurred during the quarter that contributed to the individual's good life. All data elements must be made available to auditors, quality monitors, case managers, and any other government entity upon request. For Group Services, further guidance related to day habilitation, including group services, is available on the Current D-D-R-S Policies page at in.gov/fssa/ddrs and at the direct link for Day Habilitation: Service Definition and Standards. This document outlines limitations on group sizes, such as the 1:1 Individual, 2:1 to 4:1 Small Group, 5:1 to 10:1 Medium Group, and 11:1 to 16:1 Large Group (applies only to a facility setting). Day Habilitation services reimbursement does not include reimbursement for the cost of the activities in which the individual is participating when they receive skills training, such as the cost to attend a community event or a camp. The document also lists activities that are not allowed under Day Habilitation, such as services that are available under the Rehabilitation Act of 1973 or PL 94-142, skills training for any activity that is not identified as directly related to an individual's habilitation outcome, activities that do not foster the acquisition and retention of skills, activities that duplicate or replace supports provided through residential habilitation and support (R-H-S--) services, services furnished to a minor by parents, stepparents or legal guardian, and services furnished to an individual by the individual’s spouse.

We would like to emphasize the importance of reviewing DDRS HCBS Waivers Section 10 to ensure compliance with the service definitions and requirements for Family Support and Waiver (F-S-W--) and Community Integration and Habilitation (C-I-H--) Waivers. This document includes crucial information such as the provider's name, date range of services, primary type of service, and notation of the ratio for service delivery. It is essential that all data elements are made available to auditors, quality monitors, case managers, and any other government entity upon request.

For Group Services, further guidance related to day habilitation, including group services, is available on the Current D-D-R-S Policies page at in.gov/fssa/ddrs and at the direct link for Day Habilitation: Service Definition and Standards. This document outlines limitations on group sizes, such as the 1:1 Individual, 2:1 to 4:1 Small Group, 5:1 to 10:1 Medium Group, and 11:1 to 16:1 Large Group (applies only to a facility setting). Day Habilitation services reimbursement does not include reimbursement for the cost of the activities in which the individual is participating when they receive skills training, such as the cost to attend a community event or a camp. The document also lists activities that are not allowed under Day Habilitation, such as services that are available under the Rehabilitation Act of 1973 or PL 94-142, skills training for any activity that is not identified as directly related to an individual's habilitation outcome, activities that do not foster the acquisition and retention of skills, activities that duplicate or replace supports provided through residential habilitation and support (R-H-S--) services, services furnished to a minor by parents, stepparents or legal guardian, and services furnished to an individual by the individual’s spouse.

It's important to note that DDRS HCBS Waivers Section 10 includes specific activities that are not allowed under Family and Caregiver Training (F-S-T--) and Community Integration and Habilitation (C-I-H--) Waivers. These activities include educational materials or training programs, workshops, and conferences that are not related to the caregiver’s ability to support the individual, education and training provided to train providers, training provided to caregivers who receive training reimbursement within their Medicaid or state line item reimbursement rates, cost of travel, meals and overnight lodging while attending the training program, workshop or conference, service provided by the parent of a minor child participant or the spouse of a participant, and cost of travel, meals and overnight lodging while attending the training program, workshop or conference.

Provider qualifications are crucial for F-S-W and C-I-H Waivers. Providers must meet the following criteria: be enrolled as an active Medicaid provider, be FSSA DDRS-approved, comply with Indiana Administrative Code 460 I-A-C 6, including but not limited to documentation of criminal histories, insurance, financial status of providers, family and caregiver training services provider qualifications, and requirements for provision of services. Additionally, providers must comply with any applicable B-D-S service standards, guidelines, policies and/or manuals, including FSSA DDRS policies and this module, accessible from the I-H-C-P Provider Reference Modules page at in.gov/medicaid/providers.

DDRS HCBS Waivers Section 10.12 provides information and requirements for Home Modification Assessment services for the F-S-W and C-I-H Waiver. This service will be used to objectively determine the specifications for a home modification that is safe, appropriate and feasible to ensure accurate bids and workmanship. All participants must receive a Home Modification Assessment 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.

In conclusion, it's essential to review DDRS HCBS Waivers Section 10 to ensure compliance with the service definitions and requirements for Family Support and Waiver (F-S-W--) and Community Integration

The importance of reviewing the DDRS HCBS Waivers Section 10 to ensure compliance with the service definitions and requirements for F-S-W and C-I-H Waivers will be discussed. This document contains essential information such as the provider's name, service date range, primary type of service, and the service delivery ratio. It also requires a summary of progress towards P-C-I-S-P outcomes, any challenges faced, and any positive occurrences contributing to the individual's well-being during the quarter. All data elements must be readily available to auditors, quality monitors, case managers, and other government entities upon request.

For Group Services, additional guidance on day habilitation can be found on the Current D-D-R-S Policies page at in.gov/fssa/ddrs and the direct link for Day Habilitation: Service Definition and Standards. This document outlines restrictions on group sizes, including a 1:1 individual ratio, 2:1 to 4:1 small group ratio, 5:1 to 10:1 medium group ratio, and 11:1 to 16:1 large group ratio (only applicable to facility settings). However, reimbursement for day habilitation services does not cover the cost of activities in which the individual receives skills training, such as attending a community event or a camp. Additionally, certain activities are not allowed under Day Habilitation, such as activities available under the Rehabilitation Act of 1973 or PL 94-142, skills training not directly related to the individual's habilitation outcome, activities that do not promote skill acquisition and retention, duplicating or replacing supports provided through residential habilitation and support (R-H-S--) services, services provided by parents, step-parents, or legal guardians to minors, and services provided by an individual's spouse.

Section 10 of the DDRS HCBS Waivers ensures that F-S-W and C-I-H Waivers provide individualized and enabling services to promote independence and prevent institutionalization. The assessor's responsibilities include writing specifications, examining feasibility, and evaluating the post-project results.

I am pleased to share the DDRS HCBS Waivers Section 10 with everyone. This section outlines the service definitions and requirements for F-S-W and C-I-H Waivers, which are crucial for compliance. The document includes important details such as the provider's name, service date range, primary type of service, and service delivery ratio. It also requires a brief summary of progress towards P-C-I-S-P outcomes, challenges faced, and a positive event that contributed to the individual's well-being during the quarter. All data elements must be readily accessible to auditors, quality monitors, case managers, and any other government entity upon request.

We will now discuss the importance of reviewing Section 10 of the DDRS HCBS Waivers to ensure compliance with the service definitions and requirements for F-S-W and C-I-H waivers. This document includes crucial details such as the provider's name, date range of services, primary type of service, and service delivery ratio notation. All data elements must be made available to auditors, quality monitors, case managers, and government entities upon request. Moving on to group services, we would like to offer further guidance on day habilitation, including group services. This information can be found on the Current D-D-R-S Policies page at in.gov/fssa/ddrs, under the direct link for Day Habilitation: Service Definition and Standards. This document outlines limitations on group sizes, such as the 1:1 Individual, 2:1 to 4:1 Small Group, 5:1 to 10:1 Medium Group, and 11:1 to 16:1 Large Group (applicable only to a facility setting). It is important to note that reimbursement for day habilitation services does not cover the expenses of activities in which the individual participates, such as attending a community event or a camp. The document also specifies the prohibited activities under day habilitation, including those already covered by the Rehabilitation Act of 1973 or PL 94-142, skills training for activities unrelated to an individual's habilitation outcome, activities that do not develop or maintain skills, and activities that duplicate or replace support provided through residential habilitation and support services. Furthermore, day habilitation services are not eligible for reimbursement if provided by family members or spouses. We encourage a thorough review of this information to ensure compliance with regulations and promote the individual's well-being. Thank you for your attention to this matter. This concludes our presentation on DDRS HCBS Waivers Section 10. We hope this information has been helpful in understanding the requirements and regulations for these waivers.

It is recommended that a review of the DDRS HCBS Waivers Section 10 be conducted to ensure compliance with service definitions and requirements for F-S-W and C-I-H Waivers. This review is important as the document includes crucial information such as provider name, service date range, primary type of service, and service delivery ratio. Additionally, the review requires a brief summary of progress towards P-C-I-S-P outcomes, challenges hindering progress, and any positive events that have contributed to the individual's well-being. All data elements must be readily available to auditors, quality monitors, case managers, and other government entities upon request. For Group Services, further guidance on day habilitation can be found on the Current D-D-R-S Policies page at in.gov/fssa/ddrs and at the direct link for Day Habilitation: Service Definition and Standards. This document outlines limitations on group sizes, including 1:1 Individual, 2:1 to 4:1 Small Group, 5:1 to 10:1 Medium Group, and 11:1 to 16:1 Large Group (applicable only to facility settings). It is important to note that day habilitation services do not cover the cost of activities that the individual participates in while receiving skills training, such as attending a community event or camp. The document also specifies activities that are not allowed under day habilitation, such as those covered by the Rehabilitation Act of 1973 or PL 94-142, skills training for activities not directly related to an individual's habilitation outcome, activities that do not promote skill acquisition and retention, activities that duplicate or replace supports provided through residential habilitation and support (R-H-S--) services, services provided to minors by parents, stepparents, or legal guardians, and services provided to an individual by their spouse. The following service standards apply to Home Modifications: all equipment and supplies must directly benefit the individual's health or remediation, and all items must meet applicable manufacturing, design, and installation standards. Additionally, all participants must receive a Home Modification Assessment.