[Virtual Presenter] This presentation will cover the definitions and requirements for the DDRS HCBS FSW and C-I-H waivers. It is essential to have a thorough understanding of this information in order to properly and effectively complete home modifications. We will discuss the specific criteria and limitations for home modifications, including disallowed activities, provider qualifications, and necessary licenses and certifications. Firstly, we will review the activities that are not permitted under home modifications. These include general utility adaptations such as carpeting, roof repair, and central air conditioning. These adaptations must directly benefit the individual's medical or remedial needs in order to be considered acceptable. Additionally, modifications that increase the home's total square footage or are not part of the person's P-C-I-S-P are not allowed. It is important to note that any adaptations must be approved using the Request for Approval to Authorize Services form. Furthermore, adaptations to housing owned by the service provider are not allowed, unless the individual receives residential habilitation and support services in their own home. This ensures that there is no conflict of interest and that services are provided ethically. The use of waiver funds for life safety code modifications or accessibility modifications to housing owned by providers is also not allowed. Finally, waivers cannot be used for living arrangements owned or leased by waiver service providers, or provided by the parent of a minor child participant or the spouse of a participant. These are known as L-R-Is and are not considered appropriate providers for home modifications. Moving on to provider qualifications, in order to be eligible to provide home modifications under these waivers, providers must be an active Medicaid provider and have approval from FSSA DDRS. They must also comply with the rules and regulations outlined in the Indiana Administrative Code, 460 I-A-C 6. This includes documentation of criminal histories, insurance, financial status, and environmental modification supports. Providers must also adhere to any applicable B-D-S service standards, guidelines, policies, and/or manuals, as well as FSSA DDRS policies and this module. This concludes our overview of home modifications under the DDRS HCBS FSW and C-I-H waivers.. 

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Version: 11.1 
Activities Not Allowed 
The following activities are not allowed under Home Modifications: 
• Adaptations to the home that are of general utility 
• Adaptations that are not of direct medical or remedial benefit to the individual (such as carpeting, 
roof repair or central air conditioning) 
• Adaptations that add to the total square footage of the home 
• Adaptations that are not included in the PCISP 
• Adaptations that have not been approved on a Request for Approval to Authorize Services form 
• Adaptations to housing owned by the service provider (Note: Home Modifications as a service 
under the waiver may not be furnished to participants who receive Residential Habilitation and 
Support services except when such services are furnished in the participant’s own home.) 
• Compensation for the costs of life safety code modifications and other accessibility modifications 
made with participant waiver funds to housing owned by providers 
• Service used for living arrangements that are owned or leased by providers of waiver 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 Insurance 
– 460 IAC 6-11 Financial Status of Providers 
– 460 IAC 6-5-11 Environmental Modification Supports 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 Provider Reference Modules page 
at in.gov/medicaid/providers 
• Where licensure or certification is required, providers rendering waiver funded services must 
obtain/maintain Indiana-specific licensure/certification. Examples include but are not limited to: 
– Home Inspector IC 25-20.2 
– Plumber IC 25-28.5 
– Physical Therapist IC 25-27-1 
– Occupational Therapist IC 25-23.5 
– Speech/Language Therapist IC 25-35.6 
– Architect IC 25-4-1

[Audio] On this slide, we will discuss the specific criteria and limitations for Home Modifications under the DDRS HCBS Waivers, specifically focusing on Intensive Behavioral Intervention (I-B-I--) services. Section 10 of the waivers outlines the service definitions and requirements for F-S-W and C-I-H Waivers, with a focus on I-B-I services. These services are intended for individuals with challenging behavioral issues that may put them at risk of being placed in a more restrictive residential setting. The goal of I-B-I services is to develop effective behavior management strategies and teach individuals, families, and caregivers how to respond to and manage intense and challenging behaviors. The need for I-B-I services is determined through a functional and behavioral needs assessment, and they are specified in the Personal Care and Integrated Supports Plan (P-C-I-S-P). When it comes to I-B-I services, there are certain requirements that must be met, including a detailed functional and behavioral assessment, reinforcement, specific and ongoing objective measurement of progress, and family training and involvement for skill generalization and communication promotion. Additionally, there is a focus on acquiring, generalizing, and maintaining new behaviors across various environments and individuals. Caregivers, I-B-I direct care staff, and other waiver service providers must also receive training. To ensure success, I-B-I also includes breaking down targeted skills into small and attainable steps for behavior change, utilizing systematic instruction and consistent structure, and providing one-on-one structured therapy. The treatment approach is tailored to the specific needs of the individual. Skills training must include measurable goals and objectives, with specific targets that may include acquiring, generalizing, and maintaining new behaviors across various environments and individuals.. 

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Version: 11.1 
Section 10.14: Intensive Behavioral Intervention for 
FSW and CIH Waiver 
The following subsections provide information and requirements for Intensive Behavioral Intervention 
(IBI) services for the FSW and CIH Waiver. 
Service Definition 
IBI services focus on developing effective behavior management strategies for individuals whose 
challenging behavioral issues put them at risk of placement in a more restrictive residential setting. IBI 
services teach the individual, families and other caregivers how to respond to and deal with intense and 
challenging behaviors. IBI services are designed to reduce an individual’s behaviors and improve 
independence and inclusion in the community. The need for IBI services is determined by a functional, 
behavioral needs assessment of the individual. IBI services are specified in the PCISP. 
• IBI must include: 
– A detailed functional/behavioral assessment 
– Reinforcement  
– Specific and ongoing objective measurement of progress  
– Family training and involvement so that skills can be generalized and communication promoted 
– Emphasis on the acquisition, generalization and maintenance of new behaviors across other 
environments and with other people 
– Training of caregivers, IBI direct care staff and providers of other waiver services 
– Breaking down targeted skills into small, manageable and attainable steps for behavior change  
– Utilizing systematic instruction, comprehensible structure and high consistency in all areas of 
programming 
– Provision for one-on-one structured therapy 
– Treatment approach tailored to address the specific needs of the individual 
• Skills training under IBI must include: 
– Measurable goals and objectives (specific targets may include appropriate social interaction, 
communication skills and/or language skills) 
– Heavy emphasis on skills that are prerequisites to language (attention, cooperation, imitation) 
Additional Information: 
• 
If individuals under age 21 choose to use IBI-type services they should access 
equivalent service such as applied behavior analysis (ABA) under EPSDT. 
Reimbursable Activities 
Reimbursable activities include the following: 
• Preparation of an IBI support plan in accordance with the DDRS Behavioral Support Plan Policy 
(2011) at in.gov/fssa/ddrs 
• Application of a combination of the following empirically based, multimodal and multidisciplinary 
comprehensive treatment approaches: 
– Intensive Teaching Trials (ITT), also called Discrete Trial Training, is a highly specific and 
structured teaching approach that uses empirically validated behavior change procedures. This 
type of learning is instructor-driven and may use error-correction procedures or reinforcement to 
maintain motivation and attention to task. ITT consists of the following:  
➢ Antecedent: A directive or request for the individual to perform an action

[Audio] This presentation will discuss the definitions and requirements for F-S-W and C-I-H waivers under the DDRS HCBS program. These waivers allow individuals with intellectual and developmental disabilities to receive customized home modifications. We will examine the criteria and limitations for these modifications, including disallowed activities, provider qualifications, and necessary licenses and certifications. A crucial factor to consider when implementing these modifications is the individual's behavior and response to them. Therapists must understand the individual's behavior in order to provide effective modifications. Additionally, we must also consider the consequences of these modifications, including the therapist's reaction and the impact on the individual's progress and well-being. To support the individual's learning and progress, we use a natural environment training approach, which focuses on learner-directed, motivating, and reinforcing training. This is in contrast to the more controlled reinforcement used in intensive trial training. Our interventions are based on behavior analysis research and have been proven effective for individuals with intellectual and developmental disabilities. These interventions may include precision teaching, direct instruction, and pivotal response training. We also use errorless teaching and other prompting procedures to support learning and progress. By understanding these methods and techniques, we can ensure successful home modifications for individuals with intellectual and developmental disabilities.. 

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DDRS HCBS Waivers 
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Policies and procedures as of July 1, 2024 
Version: 11.1 
➢ Behavior: A response from the individual, including anything from successful performance, 
non-compliance, to no response 
➢ Consequence: A reaction from the therapist, including a range of responses from strong 
positive reinforcement, faint praise or a negative (not aversive) reaction 
➢ A pause to separate trials from each other (inter-trial interval) 
– Natural Environment Training (NET) is learner-directed training in which the learner engages in 
activities that are naturally motivating and reinforcing to the learner, rather than the more 
contrived reinforcement employed in ITT.  
– Interventions that are supported by research in behavior analysis and that have been found to be 
effective in the treatment of individual with intellectual/developmental disabilities, which may 
include but are not limited to: 
➢ Precision teaching: A type of programmed instruction that focuses heavily on frequency as its 
main datum. It is a precise and systematic method of evaluating instructional tactics. The 
program emphasizes learner fluency and data analysis is regularly reviewed to determine 
fluency and learning. 
➢ Direct instruction: A general term for the explicit teaching of a skill set. The learner is usually 
provided with some element of frontal instruction of a concept or skill lesson, followed by 
specific instruction on identified skills. Learner progress is regularly assessed, and data 
analyzed. 
➢ Pivotal response training: This training identifies certain behaviors that are “pivotal” (that is, 
critical for learning other behaviors). The therapist focuses on these behaviors to change other 
behaviors that depend on them.  
– Errorless teaching or other prompting procedures that have been found to support successful 
intervention. These procedures focus on the prevention of errors or incorrect responses while 
also monitoring when to fade the prompts to allow the learner to demonstrate ongoing and 
successful completion of the desired activity. 
– Additional methods that occur and are empirically based.  
• Specific and ongoing objective measurement of progress, with success closely monitored via 
detailed data collection. 
Service Standards 
The following service standards apply to Intensive Behavioral Intervention: 
• An appropriate range of hours per week is generally between 20–30 hours of direct service. It is 
recommended that IBI services be delivered a minimum of 20 hours per week. When fewer than 20 
hours per week will be delivered, justification must be submitted explaining why the IST feels a 
number fewer than the recommended minimum is acceptable. 
• A detailed IBI support plan is required. 
• At least quarterly, the IST must meet to review the IBI, consider the need for change, develop a new 
plan or set new goals. 
• IBI services must be reflected in the PCISP. 
• Services must address needs identified in the person-centered planning process and be outlined in 
the PCISP. 
• Services must be detailed in the IBI support plan. 
• Services are usually direct and one-to-one, with the exception of time spent in training the 
caregivers and the family, performing ongoing data collection and analysis, and revising goals and 
plans.

[Audio] This is slide number 4 out of 14 in our presentation on DDRS HCBS Waivers. This section will discuss the service definitions and requirements for F-S-W and C-I-H Waivers. These waivers outline specific criteria and limitations for Home Modifications, including prohibited activities, necessary provider qualifications, and required licenses/certifications. One important aspect of these waivers is the need for regular reporting to relevant parties. The I-B-I case supervisor will provide a written and visual report to pertinent parties at least once a month. These parties include the individual, I-B-I director, guardian, B-D-S service coordinator, waiver case manager, and all service providers and other involved entities. The I-B-I director will also provide a written and visual report to pertinent parties at least quarterly. These parties include the individual, I-B-I case supervisor, guardian, B-D-S service coordinator, waiver case manager, and all service providers and other entities. It should be noted that the services offered under the I-B-I waiver are limited to additional services not covered under the Indiana Medicaid State Plan, such as EPSDT, but align with the waiver objectives of preventing institutionalization. In terms of documentation standards, there are specific requirements for Intensive Behavioral Intervention services. This includes following the services outlined in the P-C-I-S-P and documenting in accordance with 460 I-A-C 6. Similar to regular reporting, the I-B-I case supervisor and director are responsible for providing these reports to relevant parties on a monthly and quarterly basis, respectively. Additionally, these reports must be uploaded to the document library of the state's case management system by the selected service provider on or before the 15th day of the following month. Lastly, there are limitations to be aware of. If an individual under the age of 21 chooses to receive services under these waivers, they must adhere to the aforementioned reporting and documentation requirements. Please proceed to the next slide for further information.. 

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Version: 11.1 
• The IBI case supervisor will provide a narrative and graphical report to pertinent parties at least 
monthly. Pertinent parties include the individual, IBI director, guardian, BDS service coordinator, 
waiver case manager, all service providers and other entities. 
• The IBI director will provide a narrative and graphical report to pertinent parties at least quarterly. 
Pertinent parties include the individual, IBI case supervisor, guardian, BDS service coordinator, 
waiver case manager, all service providers and other entities. 
• The services under IBI are limited to additional services not otherwise covered under the Indiana 
Medicaid State Plan, including EPSDT, but consistent with waiver objectives of avoiding 
institutionalization. 
Documentation Standards 
Documentation standards for Intensive Behavioral Intervention services include the following: 
• Services outlined in the PCISP  
• Documentation in compliance with 460 IAC 6  
• The IBI case supervisor will provide a narrative and graphical report to pertinent parties at least 
monthly. Pertinent parties include the individual, IBI director, guardian, BDS service coordinator, 
waiver case manager, all service providers and other entities.  
• The IBI director will provide a narrative and graphical report to pertinent parties at least quarterly. 
Pertinent parties include the individual, IBI case supervisor, guardian, BDS service coordinator, 
waiver case manager, all service providers and other entities. 
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 
If individuals under age 21 choose to use IBI-type services, they should access equivalent services, such as 
applied behavioral analysis (ABA), under Early and Periodic Screening, Diagnosis and Treatment 
(EPSDT). 
See Activities Not Allowed. 
Activities Not Allowed 
The following activities are not allowed under Intensive Behavioral Intervention: 
• Aversive techniques as referenced within 460 IAC 6 
• Interventions that may reinforce negative behavior, such as Gentle Teaching 
• Group activities 
• Services furnished to a minor by parents, stepparents or legal guardian 
• Services furnished to an individual by the individual’s spouse  
• Therapy services furnished to the individual within the educational/school setting or as a component 
of the individual’s school day

[Audio] Slide number five out of fourteen in our presentation on DDRS HCBS Waivers discusses the service definitions and requirements for F-S-W and C-I-H Waivers. Specifically, we will be focusing on the qualifications and necessary licenses and certifications for providers. Providers offering waiver-funded services must meet certain criteria, including being an active Medicaid provider and being approved by FSSA DDRS. They must also adhere to Indiana Administrative Code 460 I-A-C 6, which outlines regulations regarding criminal histories, insurance, financial status, and staff training. Additionally, providers must follow all applicable B-D-S service standards, guidelines, policies, and manuals, including those provided by FSSA DDRS and this module. These can be accessed on the I-H-C-P Provider Reference Modules page at in.gov/medicaid/providers. If a provider offers services requiring licensure or certification, they must obtain and maintain Indiana-specific licensure or certification. For instance, an I-B-I director must be a licensed psychologist or psychiatrist, while an I-B-I case supervisor must be a Board Certified Behavior Analyst or Board-Certified Assistant Behavior Analyst. Moving on to section 10.15, we will now discuss Music Therapy for F-S-W and C-I-H Waivers. This therapy utilizes music in the treatment of a person's disability, targeting both physiological and psychosocial aspects. The goal is to improve nonmusical skills and behaviors through therapeutic methods. It is important to note that the ultimate focus of Music Therapy must be on therapeutic benefits, rather than the acquisition of musical skills. Thank you for taking the time to listen to this information on provider qualifications and music therapy services for F-S-W and C-I-H Waivers. For more detailed information on these topics, please refer to the provided resources.. 

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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 
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 
• 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/certification is required, providers rendering waiver funded services must 
obtain/maintain Indiana-specific licensure/certification: 
– For IBI director: Psychologist licensed under IC 25-33, or psychiatrist licensed under IC-25-22.5 
– For IBI case supervisor: IBI case supervisor must be Board Certified Behavior Analyst (BCBA)-
certified or Board-Certified Assistant Behavior Analyst (BCaBA)-certified 
Section 10.15: Music Therapy for FSW and CIH Waiver 
The following subsections provide information and requirements for Music Therapy services for the FSW 
and CIH Waiver. 
Service Definition 
Music Therapy services are services provided for the systematic application of music in the treatment of the 
physiological and psychosocial aspects of an individual’s disability and focus on the acquisition of 
nonmusical skills and behaviors. 
Additional Information: 
• 
The focus of the Music Therapy service must be therapeutic in nature rather than on 
the acquisition of musical skills obtained as the result of music lessons, such as piano 
lessons, guitar lessons and so forth. 
Reimbursable Activities 
Reimbursable activities include the following: 
• Therapy to improve: 
– Self-image and body awareness 
– Fine and gross motor skills 
– Auditory perception 
• Therapy to increase: 
– Communication skills 
– Ability to use energy purposefully

[Audio] Section 6 of this presentation focuses on the DDRS HCBS Waivers and the service definitions and requirements for F-S-W and C-I-H Waivers. These waivers were created to support individuals with disabilities and promote their independence and self-direction. One key aspect of these waivers is the need for individuals to actively participate in therapy sessions and demonstrate attending behavior. The waivers also cover therapy to prevent or reduce disruptive behaviors and to improve emotional expression and creativity. Music therapy is a service provided by a music therapist or through demonstration techniques to other service personnel or family members. It can be offered individually or in a group, with a maximum group size of four individuals per music therapist. The unit rate for this service is divided by the number of individuals in the group. Service standards must be followed when providing music therapy under these waivers, including reflecting it in the individual's PCISP, maintaining appropriate documentation, and complying with state requirements. All attendance records, therapist logs, and charts must be kept and any required reports must be uploaded to the state's case management system.. 

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Policies and procedures as of July 1, 2024 
 
Version: 11.1 
– Interaction with peers and others 
– Attending behavior 
– Independence and self-direction 
• Therapy to prevent or reduce the likelihood of certain behaviors that interrupt or interfere with an 
individual’s daily life  
• Therapy to enhance emotional expression and adjustment 
• Therapy to stimulate creativity and imagination. The music therapist may provide services directly, 
or may demonstrate techniques to other service personnel or family members 
• Planning, reporting and write-up when in association with the actual one-on-one direct care/therapy 
service delivery with the waiver individual 
• Individual Music Therapy 
• Group services in group sizes no greater than four individuals to one music therapist (unit rate 
divided by number of individuals) 
Service Standards 
The following service standards apply to Music Therapy: 
• Music Therapy services should be reflected in the PCISP of the individual. 
• Services must address needs identified in the person-centered planning process and be outlined in 
the PCISP. Services must complement other services the individual receives and enhance increasing 
health and safety for the individual. 
Documentation Standards 
Documentation standards for Music Therapy services include the following: 
• Documentation of appropriate assessment by a qualified therapist 
• Services outlined in PCISP 
• Appropriate credentials for service provider 
• Attendance record and therapist logs and/or chart detailing services provided, dates, and times 
• 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 
The services under Music Therapy are limited to additional services not otherwise covered under the 
Indiana Medicaid State Plan, including EPSDT, but consistent with waiver objectives of avoiding 
institutionalization. 
One hour of billed therapy service must include a minimum of 45 minutes of direct individual care/therapy, 
with the balance of the hour spent in related-patient services. To determine if the 45/15-minute rule is met, 
the BDS looks to ensure that units were billed accurately and supported with documentation and that the 
number of direct units billed exceeds the number of indirect units reflecting a general ratio of 75% direct 
units billed to 25% indirect units billed. The 75/25 ratio determination may occur through each encounter 
or over a period of time.

[Audio] Hello, this is slide seven of our presentation on DDRS HCBS waivers. This section will focus on the service definitions and requirements for F-S-W and C-I-H waivers. We will outline specific criteria and limitations for services, including disallowed activities, provider qualifications, and necessary licenses and certifications. Let's begin with the activities that are not allowed under Music Therapy. These include any services that are reimbursable through the Indiana Medicaid State Plan, therapy services provided within an educational or school setting, and specialized equipment which should be purchased under the Specialized Medical Equipment and Supplies service. Additionally, music therapy services are not allowed in nursing facilities, and group sizes must not exceed four individuals per music therapist or the maximum allowable size determined by the I-S-T for each individual group. Moving on to provider qualifications, all providers must meet certain criteria. This includes being enrolled as an active Medicaid provider and being FSSA DDRS-approved. Furthermore, providers must comply with Indiana Administrative Code, including documentation of criminal histories, insurance, and financial status. Specifically for music therapy services, providers must also comply with B-D-S service standards and be certified by a Certification Board for Music Therapists, accredited by a National Commission for Certifying Agencies. It is important for providers to also be aware of any applicable policies and guidelines, including those from FSSA DDRS and the I-H-C-P-, which can be accessed from the I-H-C-P Provider Reference Modules page at in.gov/medicaid/providers. Thank you for your attention to this section on service definitions and requirements for F-S-W and C-I-H waivers. We hope this has provided a clear understanding of the criteria and limitations for Home Modifications, including disallowed activities and necessary qualifications for providers. Please continue to follow along as we dive further into the details of these waivers in the rest of our presentation.. 

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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 
Activities Not Allowed 
The following activities are not allowed under Music Therapy: 
• Any services that are reimbursable through the Indiana Medicaid State Plan 
• Therapy services furnished to the individual within the educational/school setting or as a component 
of the individual’s school day 
• Specialized equipment (Specialized equipment needed for the provision of music therapy services 
should be purchased under the Specialized Medical Equipment and Supplies service; see Section 
11.2: Specialized Medical Equipment and Supplies.) 
• Activities delivered in a nursing facility 
• Group sizes greater than four individuals to one music therapist or group sizes exceeding the 
maximum allowable group size determined by the IST for each group individual 
• 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 6-5-15 Music Therapy 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 Provider Reference Modules page 
at in.gov/medicaid/providers 
• Certified Music Therapist by a Certification Board for Music Therapists, that is Accredited by a 
National Commission for Certifying Agencies 
• Where licensure/certification is required, providers rendering waiver funded services must 
obtain/maintain Indiana-specific licensure/certification 
Section 10.16: Occupational Therapy for FSW and CIH 
Waiver 
The following subsections provide information and requirements for Occupational Therapy services for the 
FSW and CIH Waiver. 
Service Definition 
Occupational Therapy services are services provided by a licensed/certified occupational therapist. 
These services cannot be provided as a substitute for services offered under the Indiana Medicaid State 
Plan.

[Audio] This is slide number 8 out of 14 in our presentation on 'Def. and Req. for F-S-W and C-I-H Waivers outlining the specific criteria and limitations for Home Modifications, including disallowed activities, provider qualifications, and necessary licenses/certifications.' In this slide, we will discuss the service definitions and requirements for DDRS HCBS Waivers, specifically related to Occupational Therapy. Section 10 of the DDRS HCBS Waivers covers the services that can be reimbursed under these waivers. These services include evaluation, training, and direct therapeutic intervention for gross and fine motor function, self-care, sensory and perceptual motor function, as well as screening and assessments. Design, fabrication, training, and assistance with adaptive aids and devices are also covered. Consultation and demonstration of techniques with other service providers and family members are also included. It is important to note that at least 45 minutes of every hour billed for therapy must consist of direct patient care, while the remaining 15 minutes may be spent in related patient services. Moving on, let's discuss the service standards for Occupational Therapy. It is required that individual Occupational Therapy services be documented in the Person-Centered Individualized Support Plan (P-C-I-S-P), regardless of the funding source. The need for these services must also be supported by an appropriate assessment and authorized in the PCISP. Additionally, documentation of this service being requested on Indiana Medicaid State Plan must be included in the PCISP. When it comes to documentation standards, a qualified therapist must conduct the appropriate assessment. Services provided under both the Indiana Medicaid State Plan and the waiver must be outlined in the PCISP, and the service provider must have the necessary credentials for providing Occupational Therapy. Adequate documentation, including attendance records, therapist logs, and charts with dates and times of services provided, must be kept in compliance with 460 IAC 6 Supported Living Services and Supports requirements. Monthly/quarterly reports must also be submitted, as applicable. Thank you for your attention during this slide of our presentation.. 

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Policies and procedures as of July 1, 2024 
 
Version: 11.1 
Reimbursable Activities 
Reimbursable activities include the following: 
• Evaluation and training services in the areas of gross and fine motor function, self-care, and sensory 
and perceptual motor function 
• Screening 
• Assessments 
• Planning, reporting and write-up when in association with the actual one-on-one direct care/therapy 
service delivery with the waiver individual 
• Direct therapeutic intervention 
• Design, fabrication, training and assistance with adaptive aids and devices 
• Consultation or demonstration of techniques with other service providers and family members 
• One hour of billed therapy service must include a minimum of 45 minutes of direct patient care with 
the balance of the hour spent in related patient services. 
Service Standards 
The following service standards apply to Occupational Therapy: 
• Individual Occupational Therapy services must be reflected in the PCISP regardless of the funding 
source. 
• The need for such services must be documented by an appropriate assessment and authorized in the 
PCISP. 
• Documentation of this service being requested on Indiana Medicaid State Plan shall be included in 
the PCISP. 
Documentation Standards 
Documentation standards for Occupational Therapy services include the following: 
• Documentation by appropriate assessment by a qualified therapist 
• Services provided under both the Indiana Medicaid State Plan and the waiver must be outlined in the 
PCISP 
• Appropriate credentials for service provider 
• Attendance record, therapist logs and/or chart detailing services provided, dates and times 
• 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 
If individuals under the age of 21 choose to use Occupational Therapy, they should access Occupational 
Therapy services through EPSDT. 
One hour of billed therapy service must include a minimum of 45 minutes of direct individual care/therapy 
with the balance of the hour spent in related individual services.

[Audio] Section 10 of the DDRS HCBS Waivers discusses the specific guidelines and limitations for Home Modifications under the F-S-W and C-I-H waivers. These waivers offer crucial services to individuals with disabilities to improve their independence and overall quality of life. Now, we will examine the activities that are not allowed under Occupational Therapy, a service covered by these waivers. It is important to note that therapy services cannot be given in educational or school settings, or as part of a school day, in order to avoid duplicating services and ensure the individual receives the best care possible. Additionally, activities cannot be provided in a nursing facility, as this is not an appropriate setting for occupational therapy services. Furthermore, it is important to note that services covered under the Indiana Medicaid State Plan cannot be duplicated under the F-S-W and C-I-H waivers. This means that a Medicaid State Plan Prior Authorization denial must be obtained before reimbursement is available for this service under the waivers. Lastly, therapy services cannot be provided by the parent of a minor child or by the spouse of a participant. This is to prevent Living-Related Incidents and ensure that therapy services under this service do not duplicate those provided by any other service. Moving on to provider qualifications, it is essential that providers meet specific criteria in order to deliver services under the F-S-W and C-I-H waivers. This includes being enrolled as an active Medicaid provider and approved by the FSSA DDRS. Providers must also comply with the Indiana Administrative Code, specifically 460 I-A-C 6, which includes requirements such as documentation of criminal histories, insurance, and financial status. Additionally, providers must comply with B-D-S service standards, guidelines, policies, and manuals, including those set by FSSA DDRS and this module. These resources can be accessed on the I-H-C-P Provider Reference Modules page at in.gov/medicaid/providers. It is also important to note that in cases where licensure or certification is necessary, providers of waiver-funded services must obtain and maintain Indiana-specific licensure or certification to ensure the appropriate delivery of services.. 

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Library Reference Number: PRPR10014 
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Policies and procedures as of July 1, 2024 
Version: 11.1 
Activities Not Allowed 
The following activities are not allowed under Occupational Therapy: 
• Therapy services furnished to the individual within the educational/school setting or as a component 
of the individual’s school day 
• Activities delivered in a nursing facility 
• Services that are available through the Indiana Medicaid State Plan (a Medicaid State Plan PA 
denial is required before reimbursement is available through the Medicaid waiver for this service) 
• Service provided by the parent of a minor child participant or the spouse of a participant (also 
known as LRIs) 
Note:  Therapies provided through this service will not duplicate therapies provided under 
any other service. 
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 6-5-17 Occupational Therapy 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 Provider Reference Modules page 
at in.gov/medicaid/providers 
• Where licensure/certification is required, providers rendering waiver-funded services must 
obtain/maintain Indiana-specific licensure/certification 
• For licensed occupational therapist, meet requirements set forth in IC 25-23.5 
Section 10.17: Participant Assistance and Care for the 
FSW 
The following subsections provide information and requirements for Participant Assistance and Care 
(PAC) services for the FSW. 
Service Definition 
PAC services are provided to allow individuals with intellectual/developmental disabilities to remain and 
live successfully in their own homes, function and participate in their communities, and avoid 
institutionalization. PAC services support and enable the individual in activities of daily living, self-care 
and mobility with hands-on assistance, prompting, reminders, support and monitoring needed to ensure the 
health and safety, of the individual.

[Audio] We will discuss the Service Definitions and Requirements for F-S-W and C-I-H Waivers in this section of our presentation on DDRS HCBS Waivers. During an acute care hospitalization, H-C-B-S provides assists to help individuals maintain their current level of functioning and support new or additional needs identified by the person-centered planning team. The H-C-B-S provided must not duplicate services available in the hospital setting, ensuring effective and efficient care. We understand the importance of family involvement in the care of individuals with intellectual/developmental disabilities and may choose a relative as the provider of Personal Assistance Care (P-A-C--) during the person-centered planning process. An annual review is conducted to ensure the relative is still the best choice for providing these services. Under the Indiana Medicaid State Plan, individuals have access to any appropriate services available. P-A-C services are only available under the F-S-W and not available under the CIH, H&W, or T-B-I waivers. P-A-C services include reimbursable activities such as assistance with personal care, meals, shopping, errands, and scheduling appointments. We strive to ensure individuals with intellectual/developmental disabilities receive the necessary support to lead fulfilling lives and maintain their independence. Thank you for your attention.. 

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Policies and procedures as of July 1, 2024 
 
Version: 11.1 
HCBS provided during an acute care hospitalization assists the individual to maintain current levels of 
functioning and support, provides ongoing coordination of care, and ensures that new or additional needs 
are identified and addressed by the person-centered planning team as the individual prepares to return to the 
community. 
The HCBS provided in an acute care hospital must not be duplicative of services available in the acute care 
hospital setting. 
A relative of the individual may be a provider of PAC. The decision that a relative is the best choice of 
persons to provide these services is a part of the person-centered planning process and is documented in the 
PCISP. When the provider is a relative, there is an annual review by the IST to determine whether the 
individual’s relative should continue to be the provider of PAC. 
Additional Information: 
• 
Individuals will use any appropriate services available under the Indiana Medicaid 
State Plan. 
• 
Utilization of PAC services does not prohibit the use of any other service available 
under the FSW that is outlined on the PCISP. 
• 
PAC services are available only under the FSW. PAC is not available under the CIH, 
H&W or TBI waivers. 
Reimbursable Activities 
Reimbursable activities under PAC services include the following: 
• Activities may include any task or tasks of direct benefit to the individual that would generally be 
performed independently by persons without intellectual/developmental disabilities or by family 
members for or on behalf of persons with intellectual/developmental disabilities 
• Examples of activities include but are not limited to the following: 
– Assistance with personal care, meals, shopping, errands, scheduling appointments, chores and 
leisure activities (excluding the provision of transportation) 
– Assistance with mobility – including but not limited to transfers, ambulation, use of assistive 
devices 
– Assistance with correspondence and bill-paying 
– Escorting the individual to community activities and appointments 
– Support and person-centered monitoring of the individual 
– Reinforcement of behavioral support 
– Adherence to risk plans 
– Reinforcement of principle of health and safety 
– Completion of task list 
• Participating on the IST for the development or revision of the PCISP (staff must attend the IST 
meeting to claim reimbursement) 
– PAC is available individually or as a shared service. Shared/group services in group sizes no 
greater than four participants to onepaid staff member of the PAC provider (unit rate divided by 
number of PAC participants sharing service).  
As authorized under Section 3715 of the Coronavirus Aid, Relief and Economic Security (CARES) Act, 
PAC services may be provided to an individual in an acute care hospital when such services are:  
• Identified in an individual’s person-centered service plan (or comparable plan of care) 
• Provided to meet needs of the individual that are not met through the provision of hospital services

[Audio] We understand that P-A-C services are a part of the DDRS HCBS Waivers program and therefore must comply with specific standards to ensure a smooth transition between acute care settings and home and community-based settings while preserving the individual's functional abilities. The following service standards apply to P-A-C-: * P-A-C services must have a written PCISP/service authorization that addresses the specific needs determined by the individual's assessment and identified in the PCISP. * Ability to consult with a nurse as needed (on staff or on call for the provider). * The following documentation standards must be adhered to: plus P-A-C services documentation must include: Recorded completion of tasks on an individual-specific task list (created by the I-S-T--) that includes identification of paid staff members as well as the date and start/stop time of each waiver-funded shift. Documentation in compliance with 460 I-A-C 6. 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. * There are limitations to P-A-C services:. 

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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 
• Not a substitute for services that the hospital is obligated to provide through its conditions of 
participation or under federal or state law, or under another applicable requirement 
• Designed to ensure smooth transitions between acute care settings and home- and community-based 
settings, and to preserve the individual’s functional abilities 
Reimbursable waiver-funded PAC services furnished to a waiver participant by a paid relative and/or legal 
guardian may not exceed a total of 40 hours per week per paid relative and/or legal guardian caregiver. 
(Definition of a relative follows the Activities Not Allowed section.)  
Service Standards 
The following service standards apply to PAC: 
• PAC services must follow a written PCISP/service authorization addressing the specific needs 
determined by the individual’s assessment and identified in the PCISP 
• Ability to consult with a nurse as needed (on staff or on call for the provider) 
Documentation Standards 
PAC services documentation must include: 
• Recorded completion of tasks on an individual-specific task list (created by the IST) that includes 
identification of paid staff members as well as the date and start/stop time of each waiver-funded 
shift 
• Documentation in compliance with 460 IAC 6 
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 
The following are limitations on PAC services: 
• Reimbursable waiver-funded PAC services furnished to a waiver individual by a paid relative and/or 
legal guardian may not exceed a total of 40 hours per week per paid relative and/or legal guardian. 
(See Activities Not Allowed for definition of relative)  
• Shared/group services in group sizes no greater than four individuals to one paid staff member of 
the PAC provider (unit rate divided by number of PAC individuals sharing service) 
Activities Not Allowed 
PAC services will not be provided to household members other than to the waiver individuals.  
• Reimbursable waiver funded services furnished to a waiver participant 18 years or over or by any 
relatives and/or legal guardians may not exceed a total of 40 hours per week per relative.  
Reimbursement is not available through PAC in the following circumstances:  
• When services are furnished to a minor by the parents, stepparents or legal guardians  
• When services are furnished to an individual by the individual’s spouse  
• When Indiana Medicaid State Plan services are available for the same tasks

[Audio] We will discuss the service definitions and requirements for F-S-W and C-I-H Waivers under the DDRS HCBS program. Firstly, it is important to note that these services are only available for individuals who are eligible under the Rehabilitation Act of 1973 or Sections 602 (16) and (17) of the Individuals with Disabilities Education Act. Furthermore, these services are not to be used for homeschooling, special education, or related activities. Additionally, F-S-W and C-I-H Waivers can be utilized for homemaker or maid services, as well as a substitute for care provided by a registered nurse, licensed practical nurse, licensed physician, behaviorist, licensed therapist, or other health professional. Transportation costs can also be covered under these waivers. However, it is important to note that group sizes are limited to four individuals per one paid staff member from the provider of P-A-C services. Any group exceeding this limit must be approved by the Interdisciplinary Support Team (I-S-T--). Moreover, individuals who are using different support options, such as P-A-C or Day Habilitation, cannot receive group supports together. This type of activity is not allowed. Lastly, regarding hospitalizations, providers may only bill for P-A-C reimbursement during the time when an individual is admitted to an acute care hospital setting for inpatient medical care or other related services. All conditions specified in guidance under Section 2.3: Billing and Reimbursement for Waiver Services must be met for reimbursement to be approved. However, providers may not bill for P-A-C reimbursement during extended hospital stays or when individuals require long-term care in a facility-based setting, such as nursing homes, rehabilitation centers, or treatment facilities. It is crucial to follow these guidelines and requirements to ensure that individuals receive the appropriate care and support they need under the F-S-W and C-I-H Waivers. Thank you for your attention to this information.. 

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Published: Sept. 9, 2024 
 
Policies and procedures as of July 1, 2024 
 
Version: 11.1 
• When services provided are available under the Rehabilitation Act of 1973 or section 602 (16) and 
(17) of the Individuals with Disabilities Education Act 
• For homeschooling, special education and related activities 
• For homemaker or maid service 
• As a substitute for care provided by a registered nurse, licensed practical nurse, licensed physician, 
behaviorist, licensed therapist or other health professional 
• For transportation costs 
• Group sizes greater than four individuals to one paid staff member from the provider of PAC 
services, or group sizes exceeding the maximum allowable group size determined by the IST for 
each group individual  
• Group supports delivered to individuals who are utilizing different support options. For example, 
one individual in the group is using PAC and another individual in the same group setting is using 
Day Habilitation. This type of activity would not be allowed. 
• Regarding hospitalizations: 
– Providers may only bill for PAC reimbursement during the time when an individual receiving 
HCBS waiver services is admitted to an acute care hospital setting for inpatient medical care or 
other related services for surgery, acute medical condition, or injuries if all conditions specified 
in guidance under Section 2.3: Billing and Reimbursement for Waiver Services in this module 
are met 
– Providers may not bill for PAC reimbursement during the time when an individual is admitted 
for an extended stay hospitalization, or when individuals require long term care in a facility-
based setting including but not limited to nursing homes, rehabilitation centers and/or treatment 
facilities. (As specified under guidance in Section 2.3: Billing and Reimbursement for Waiver 
Services in this module, the care and support of an individual who is admitted to a hospital or 
facility for long-term is a nonbillable PAC activity) 
Related/relative implies any of the following natural, adoptive and/or step relationships, whether by blood 
or by marriage, inclusive of half and/or in-law status:  
• Aunt (natural, step, adopted) 
• Brother (natural, step, half, adopted, in-law) 
• Child (natural, step, adopted) 
• First cousin (natural, step, adopted) 
• Grandchild (natural, step, adopted) 
• Grandparent (natural, step, adopted) 
• Nephew (natural, step, adopted) 
• Niece (natural, step, adopted) 
• Parent (natural, step, adopted, in-law) 
• Sister (natural, step, half, adopted, in-law) 
• Spouse (husband or wife) 
• Uncle (natural, step, adopted)  
Available individually or as a shared service:  
• Shared/group services in group sizes no greater than four individuals to one paid staff member of 
the PAC provider (unit rate divided by number of PAC individuals sharing service)

[Audio] It is clear that there are specific standards and restrictions for home modifications, including activities that are not permitted, the qualifications of providers, and the licenses and certifications that are required. If you require additional information on any of these areas, please do not hesitate to contact us. We appreciate your time and focus.. 

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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 
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 6-11 Financial Status  
– 460 IAC 6-12-1 and 460 IAC 6-12-2 Insurance  
– 460 IAC 6-14-4 Staff Training and 460 IAC 6-14-4 Training  
– 460 IAC 6-14-5 Requirements for Direct Care Staff  
• Training in completion of Task List  
• 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 10.18: Personal Emergency Response System 
for FSW and CIH Waiver 
The following subsections provide information and requirements for Personal Emergency Response System 
(PERS) services for the FSW and CIH Waiver. 
Service Definition 
PERS is an electronic device that enables individuals to secure help in the event of an emergency. The 
individual may also wear a portable “help” button to allow for mobility. The system is connected to the 
person’s phone and programmed to signal a response center after a “help” button is activated. The response 
center is staffed by trained professionals. 
Additional Information: 
• 
The purpose of equipment or a device under PERS is to enable the individual to secure 
help in an emergency. If a device doesn’t have the ability to initiate a call for help, it 
doesn’t fit this service definition.  
• 
PERS is limited to those individuals who live alone, or who are alone for significant 
parts of the day and have no regular caregiver for extended periods of time, and who 
would otherwise require extensive supervision.  
• 
If the intent and purpose of equipment or a device is to either locate an individual who 
is lost or to enable the individual to periodically “check in,” such as to report making it 
home safely from an outing, then Remote Supports would be the appropriate service.  
• 
A human rights committee may need to determine the appropriateness of a device if it 
is to be worn by the individual as a tracking device.  
• 
The PERS service described in this section is available under the FSW and CIH 
Waiver. For information on the PERS service available under the H&W and TBI 
Waivers, see Section 12.22: Personal Emergency Response System for H&W and TBI 
Waivers.

[Audio] We have discussed that Personal Emergency Response System (P-E-R-S-) is a reimbursable activity under Section 10: Service Definitions and Requirements for F-S-W and C-I-H Waivers. However, there are certain limitations and restrictions that must be followed when providing pers services. First and foremost, pers is only available to individuals who live alone, or who are alone for significant parts of the day, and have no regular caregiver for extended periods of time, and who would otherwise require extensive supervision. Additionally, reimbursement is not available for pers when the individual requires constant support to maintain health and safety, or when provided by the parent of a minor child participant or the spouse of a participant (also known as LRIs). Furthermore, providers must meet certain criteria to be eligible for reimbursement. They must be enrolled as an active Medicaid provider, be FSSA DDRS-approved, and comply with Indiana Administrative Code, 460 I-A-C 6, including but not limited to documenting criminal histories, having insurance, and maintaining a personal emergency response system. Providers must also comply with any applicable B-D-S service standards, guidelines, policies, and manuals, including FSSA DDRS policies and this module, accessible from the I-H-C-P Provider Reference Modules page at in.gov/medicaid/providers. In conclusion, providing pers services requires adherence to specific criteria and limitations.. 

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Published: Sept. 9, 2024 
 
Policies and procedures as of July 1, 2024 
 
Version: 11.1 
Reimbursable Activities 
Reimbursable activities include the following: 
• Device installation service 
• Ongoing monthly maintenance of the device 
Service Standards 
Service standards require that PERS must be included in the PCISP. 
Documentation Standards 
Documentation standards for a PERS include the following: 
• An identified need in the PCISP 
• Documentation of expense for installation 
• Documentation of monthly rental fee 
Limitations 
PERS is limited to those individuals who live alone, or who are alone for significant parts of the day, and 
have no regular caregiver for extended periods of time, and who would otherwise require extensive 
supervision. 
Activities Not Allowed 
Reimbursement is not available for PERS when the individual requires constant support to maintain health 
and safety. 
This service will not be reimbursed when provided by the parent of a minor child participant or the spouse 
of a participant (also known as LRIs). 
Provider Qualifications 
Providers must meet the following criteria: 
• Be 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 6-5-18 Personal Emergency Response System Supports 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 Provider Reference Modules page 
at in.gov/medicaid/providers

 part 10

On this slide, we will discuss the specific criteria and limitations for Home Modifications under the DDRS HCBS Waivers, specifically focusing on Intensive Behavioral Intervention (I-B-I--) services. Section 10 of the waivers outlines the service definitions and requirements for F-S-W and C-I-H Waivers, with a focus on I-B-I services. These services are intended for individuals with challenging behavioral issues that may put them at risk of being placed in a more restrictive residential setting. The goal of I-B-I services is to develop effective behavior management strategies and teach individuals, families, and caregivers how to respond to and manage intense and challenging behaviors. The need for I-B-I services is determined through a functional and behavioral needs assessment, and they are specified in the Personal Care and Integrated Supports Plan (P-C-I-S-P).  When it comes to I-B-I services, there are certain requirements that must be met, including a detailed functional and behavioral assessment, reinforcement, specific and ongoing objective measurement of progress, and family training and involvement for skill generalization and communication promotion. Additionally, there is a focus on acquiring, generalizing, and maintaining new behaviors across various environments and individuals. Caregivers, I-B-I direct care staff, and other waiver service providers must also receive training.  To ensure success, I-B-I also includes breaking down targeted skills into small and attainable steps for behavior change, utilizing systematic instruction and consistent structure, and providing one-on-one structured therapy. The treatment approach is tailored to the specific needs of the individual. Skills training must include measurable goals and objectives, with specific targets that may include acquiring, generalizing, and maintaining new behaviors across various environments and individuals.

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This presentation will discuss the definitions and requirements for F-S-W and C-I-H waivers under the DDRS HCBS program. These waivers allow individuals with intellectual and developmental disabilities to receive customized home modifications. We will examine the criteria and limitations for these modifications, including disallowed activities, provider qualifications, and necessary licenses and certifications. A crucial factor to consider when implementing these modifications is the individual's behavior and response to them. Therapists must understand the individual's behavior in order to provide effective modifications. Additionally, we must also consider the consequences of these modifications, including the therapist's reaction and the impact on the individual's progress and well-being. To support the individual's learning and progress, we use a natural environment training approach, which focuses on learner-directed, motivating, and reinforcing training. This is in contrast to the more controlled reinforcement used in intensive trial training. Our interventions are based on behavior analysis research and have been proven effective for individuals with intellectual and developmental disabilities. These interventions may include precision teaching, direct instruction, and pivotal response training. We also use errorless teaching and other prompting procedures to support learning and progress. By understanding these methods and techniques, we can ensure successful home modifications for individuals with intellectual and developmental disabilities.

This is slide number 4 out of 14 in our presentation on DDRS HCBS Waivers. This section will discuss the service definitions and requirements for F-S-W and C-I-H Waivers. These waivers outline specific criteria and limitations for Home Modifications, including prohibited activities, necessary provider qualifications, and required licenses/certifications. One important aspect of these waivers is the need for regular reporting to relevant parties. The I-B-I case supervisor will provide a written and visual report to pertinent parties at least once a month. These parties include the individual, I-B-I director, guardian, B-D-S service coordinator, waiver case manager, and all service providers and other involved entities. The I-B-I director will also provide a written and visual report to pertinent parties at least quarterly. These parties include the individual, I-B-I case supervisor, guardian, B-D-S service coordinator, waiver case manager, and all service providers and other entities. It should be noted that the services offered under the I-B-I waiver are limited to additional services not covered under the Indiana Medicaid State Plan, such as EPSDT, but align with the waiver objectives of preventing institutionalization. In terms of documentation standards, there are specific requirements for Intensive Behavioral Intervention services. This includes following the services outlined in the P-C-I-S-P and documenting in accordance with 460 I-A-C 6. Similar to regular reporting, the I-B-I case supervisor and director are responsible for providing these reports to relevant parties on a monthly and quarterly basis, respectively. Additionally, these reports must be uploaded to the document library of the state's case management system by the selected service provider on or before the 15th day of the following month. Lastly, there are limitations to be aware of. If an individual under the age of 21 chooses to receive services under these waivers, they must adhere to the aforementioned reporting and documentation requirements. Please proceed to the next slide for further information.

Slide number five out of fourteen in our presentation on DDRS HCBS Waivers discusses the service definitions and requirements for F-S-W and C-I-H Waivers. Specifically, we will be focusing on the qualifications and necessary licenses and certifications for providers. Providers offering waiver-funded services must meet certain criteria, including being an active Medicaid provider and being approved by FSSA DDRS. They must also adhere to Indiana Administrative Code 460 I-A-C 6, which outlines regulations regarding criminal histories, insurance, financial status, and staff training. Additionally, providers must follow all applicable B-D-S service standards, guidelines, policies, and manuals, including those provided by FSSA DDRS and this module. These can be accessed on the I-H-C-P Provider Reference Modules page at in.gov/medicaid/providers. If a provider offers services requiring licensure or certification, they must obtain and maintain Indiana-specific licensure or certification. For instance, an I-B-I director must be a licensed psychologist or psychiatrist, while an I-B-I case supervisor must be a Board Certified Behavior Analyst or Board-Certified Assistant Behavior Analyst. Moving on to section 10.15, we will now discuss Music Therapy for F-S-W and C-I-H Waivers. This therapy utilizes music in the treatment of a person's disability, targeting both physiological and psychosocial aspects. The goal is to improve nonmusical skills and behaviors through therapeutic methods. It is important to note that the ultimate focus of Music Therapy must be on therapeutic benefits, rather than the acquisition of musical skills. Thank you for taking the time to listen to this information on provider qualifications and music therapy services for F-S-W and C-I-H Waivers. For more detailed information on these topics, please refer to the provided resources.

Section 6 of this presentation focuses on the DDRS HCBS Waivers and the service definitions and requirements for F-S-W and C-I-H Waivers. These waivers were created to support individuals with disabilities and promote their independence and self-direction. One key aspect of these waivers is the need for individuals to actively participate in therapy sessions and demonstrate attending behavior. The waivers also cover therapy to prevent or reduce disruptive behaviors and to improve emotional expression and creativity. Music therapy is a service provided by a music therapist or through demonstration techniques to other service personnel or family members. It can be offered individually or in a group, with a maximum group size of four individuals per music therapist. The unit rate for this service is divided by the number of individuals in the group. Service standards must be followed when providing music therapy under these waivers, including reflecting it in the individual's PCISP, maintaining appropriate documentation, and complying with state requirements. All attendance records, therapist logs, and charts must be kept and any required reports must be uploaded to the state's case management system.

Hello, this is slide seven of our presentation on DDRS HCBS waivers. This section will focus on the service definitions and requirements for F-S-W and C-I-H waivers. We will outline specific criteria and limitations for services, including disallowed activities, provider qualifications, and necessary licenses and certifications.
                                    
                                    Let's begin with the activities that are not allowed under Music Therapy. These include any services that are reimbursable through the Indiana Medicaid State Plan, therapy services provided within an educational or school setting, and specialized equipment which should be purchased under the Specialized Medical Equipment and Supplies service. Additionally, music therapy services are not allowed in nursing facilities, and group sizes must not exceed four individuals per music therapist or the maximum allowable size determined by the I-S-T for each individual group.
                                    
                                    Moving on to provider qualifications, all providers must meet certain criteria. This includes being enrolled as an active Medicaid provider and being FSSA DDRS-approved. Furthermore, providers must comply with Indiana Administrative Code, including documentation of criminal histories, insurance, and financial status. Specifically for music therapy services, providers must also comply with B-D-S service standards and be certified by a Certification Board for Music Therapists, accredited by a National Commission for Certifying Agencies.
                                    
                                    It is important for providers to also be aware of any applicable policies and guidelines, including those from FSSA DDRS and the I-H-C-P-, which can be accessed from the I-H-C-P Provider Reference Modules page at in.gov/medicaid/providers.
                                    
                                    Thank you for your attention to this section on service definitions and requirements for F-S-W and C-I-H waivers. We hope this has provided a clear understanding of the criteria and limitations for Home Modifications, including disallowed activities and necessary qualifications for providers. Please continue to follow along as we dive further into the details of these waivers in the rest of our presentation.

This is slide number 8 out of 14 in our presentation on 'Def. and Req. for F-S-W and C-I-H Waivers  outlining the specific criteria and limitations for Home Modifications, including disallowed activities, provider qualifications, and necessary licenses/certifications.' In this slide, we will discuss the service definitions and requirements for DDRS HCBS Waivers, specifically related to Occupational Therapy. Section 10 of the DDRS HCBS Waivers covers the services that can be reimbursed under these waivers. These services include evaluation, training, and direct therapeutic intervention for gross and fine motor function, self-care, sensory and perceptual motor function, as well as screening and assessments. Design, fabrication, training, and assistance with adaptive aids and devices are also covered. Consultation and demonstration of techniques with other service providers and family members are also included. It is important to note that at least 45 minutes of every hour billed for therapy must consist of direct patient care, while the remaining 15 minutes may be spent in related patient services. Moving on, let's discuss the service standards for Occupational Therapy. It is required that individual Occupational Therapy services be documented in the Person-Centered Individualized Support Plan (P-C-I-S-P), regardless of the funding source. The need for these services must also be supported by an appropriate assessment and authorized in the PCISP. Additionally, documentation of this service being requested on Indiana Medicaid State Plan must be included in the PCISP. When it comes to documentation standards, a qualified therapist must conduct the appropriate assessment. Services provided under both the Indiana Medicaid State Plan and the waiver must be outlined in the PCISP, and the service provider must have the necessary credentials for providing Occupational Therapy. Adequate documentation, including attendance records, therapist logs, and charts with dates and times of services provided, must be kept in compliance with 460 IAC 6 Supported Living Services and Supports requirements. Monthly/quarterly reports must also be submitted, as applicable. Thank you for your attention during this slide of our presentation.

Section 10 of the DDRS HCBS Waivers discusses the specific guidelines and limitations for Home Modifications under the F-S-W and C-I-H waivers. These waivers offer crucial services to individuals with disabilities to improve their independence and overall quality of life. Now, we will examine the activities that are not allowed under Occupational Therapy, a service covered by these waivers. It is important to note that therapy services cannot be given in educational or school settings, or as part of a school day, in order to avoid duplicating services and ensure the individual receives the best care possible. Additionally, activities cannot be provided in a nursing facility, as this is not an appropriate setting for occupational therapy services. Furthermore, it is important to note that services covered under the Indiana Medicaid State Plan cannot be duplicated under the F-S-W and C-I-H waivers. This means that a Medicaid State Plan Prior Authorization denial must be obtained before reimbursement is available for this service under the waivers. Lastly, therapy services cannot be provided by the parent of a minor child or by the spouse of a participant. This is to prevent Living-Related Incidents and ensure that therapy services under this service do not duplicate those provided by any other service. Moving on to provider qualifications, it is essential that providers meet specific criteria in order to deliver services under the F-S-W and C-I-H waivers. This includes being enrolled as an active Medicaid provider and approved by the FSSA DDRS. Providers must also comply with the Indiana Administrative Code, specifically 460 I-A-C 6, which includes requirements such as documentation of criminal histories, insurance, and financial status. Additionally, providers must comply with B-D-S service standards, guidelines, policies, and manuals, including those set by FSSA DDRS and this module. These resources can be accessed on the I-H-C-P Provider Reference Modules page at in.gov/medicaid/providers. It is also important to note that in cases where licensure or certification is necessary, providers of waiver-funded services must obtain and maintain Indiana-specific licensure or certification to ensure the appropriate delivery of services.

We will discuss the Service Definitions and Requirements for F-S-W and C-I-H Waivers in this section of our presentation on DDRS HCBS Waivers. During an acute care hospitalization, H-C-B-S provides assists to help individuals maintain their current level of functioning and support new or additional needs identified by the person-centered planning team. The H-C-B-S provided must not duplicate services available in the hospital setting, ensuring effective and efficient care. We understand the importance of family involvement in the care of individuals with intellectual/developmental disabilities and may choose a relative as the provider of Personal Assistance Care (P-A-C--) during the person-centered planning process. An annual review is conducted to ensure the relative is still the best choice for providing these services. Under the Indiana Medicaid State Plan, individuals have access to any appropriate services available. P-A-C services are only available under the F-S-W and not available under the CIH, H&W, or T-B-I waivers. P-A-C services include reimbursable activities such as assistance with personal care, meals, shopping, errands, and scheduling appointments. We strive to ensure individuals with intellectual/developmental disabilities receive the necessary support to lead fulfilling lives and maintain their independence. Thank you for your attention.

We understand that P-A-C services are a part of the DDRS HCBS Waivers program and therefore must comply with specific standards to ensure a smooth transition between acute care settings and home and community-based settings while preserving the individual's functional abilities. The following service standards apply to P-A-C-:
                                    
                                    * P-A-C services must have a written PCISP/service authorization that addresses the specific needs determined by the individual's assessment and identified in the PCISP.
                                    * Ability to consult with a nurse as needed (on staff or on call for the provider).
                                    * The following documentation standards must be adhered to:
                                    	 plus  P-A-C services documentation must include:
                                    		 Recorded completion of tasks on an individual-specific task list (created by the I-S-T--) that includes identification of paid staff members as well as the date and start/stop time of each waiver-funded shift.
                                    		 Documentation in compliance with 460 I-A-C 6.
                                    		 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.
                                    
                                    * There are limitations to P-A-C services:

We will discuss the service definitions and requirements for F-S-W and C-I-H Waivers under the DDRS HCBS program. Firstly, it is important to note that these services are only available for individuals who are eligible under the Rehabilitation Act of 1973 or Sections 602 (16) and (17) of the Individuals with Disabilities Education Act. Furthermore, these services are not to be used for homeschooling, special education, or related activities.

Additionally, F-S-W and C-I-H Waivers can be utilized for homemaker or maid services, as well as a substitute for care provided by a registered nurse, licensed practical nurse, licensed physician, behaviorist, licensed therapist, or other health professional. Transportation costs can also be covered under these waivers. However, it is important to note that group sizes are limited to four individuals per one paid staff member from the provider of P-A-C services. Any group exceeding this limit must be approved by the Interdisciplinary Support Team (I-S-T--). Moreover, individuals who are using different support options, such as P-A-C or Day Habilitation, cannot receive group supports together. This type of activity is not allowed.

Lastly, regarding hospitalizations, providers may only bill for P-A-C reimbursement during the time when an individual is admitted to an acute care hospital setting for inpatient medical care or other related services. All conditions specified in guidance under Section 2.3: Billing and Reimbursement for Waiver Services must be met for reimbursement to be approved. However, providers may not bill for P-A-C reimbursement during extended hospital stays or when individuals require long-term care in a facility-based setting, such as nursing homes, rehabilitation centers, or treatment facilities.

It is crucial to follow these guidelines and requirements to ensure that individuals receive the appropriate care and support they need under the F-S-W and C-I-H Waivers. Thank you for your attention to this information.

It is clear that there are specific standards and restrictions for home modifications, including activities that are not permitted, the qualifications of providers, and the licenses and certifications that are required. If you require additional information on any of these areas, please do not hesitate to contact us. We appreciate your time and focus.

We have discussed that Personal Emergency Response System (P-E-R-S-) is a reimbursable activity under Section 10: Service Definitions and Requirements for F-S-W and C-I-H Waivers. However, there are certain limitations and restrictions that must be followed when providing pers services. First and foremost, pers is only available to individuals who live alone, or who are alone for significant parts of the day, and have no regular caregiver for extended periods of time, and who would otherwise require extensive supervision. Additionally, reimbursement is not available for pers when the individual requires constant support to maintain health and safety, or when provided by the parent of a minor child participant or the spouse of a participant (also known as LRIs). Furthermore, providers must meet certain criteria to be eligible for reimbursement. They must be enrolled as an active Medicaid provider, be FSSA DDRS-approved, and comply with Indiana Administrative Code, 460 I-A-C 6, including but not limited to documenting criminal histories, having insurance, and maintaining a personal emergency response system. Providers must also comply with any applicable B-D-S service standards, guidelines, policies, and manuals, including FSSA DDRS policies and this module, accessible from the I-H-C-P Provider Reference Modules page at in.gov/medicaid/providers. In conclusion, providing pers services requires adherence to specific criteria and limitations.