Tuesday, March 4, 2008

DDRS policy bulletin-opportunity for public comment

This Quarterly Policy Bulletin for the Division of Disability and Rehabilitative Services (DDRS) is provided here for public review and comment. Any input or comment about the proposed policy changes should be sent to DDRSPolicy@fssa. in.gov. The period for public comment will close on March 17, 2008.

Policy Topic: Behavioral Support Services in an Educational Setting
Comment Period Deadline: March 17, 2008
Anticipated Effective Date: 14 business days following issuance of final Quarterly Bulletin
The Division of Disability and Rehabilitative Services (DDRS) is frequently asked questions
surrounding the delivery of Indiana Medicaid Home and Community Based Services (HCBS)
Waiver services in an educational setting. As defined, Behavioral Support Services means
training, supervision, or assistance in appropriate expression of emotions and desires,
compliance, assertiveness, acquisition of socially appropriate behaviors, and the reduction of
inappropriate behaviors.
The Indiana Medicaid HCBS Waiver Program does not pay for services delivered at school or
during the individual student's school day, as those services are the responsibility of the
Department of Education (DOE). The absence or omission of a necessary service from the
student's Individualized Education Program (IEP)/Individualize d Transition Plan (ITP) in no
way implies that the waiver program shall fund the delivery of that service at or within the
educational/ school setting.
At the request of the parent/legal guardian of an individual student, an approved provider of
Indiana Medicaid HCBS waiver services may be part of the Individualized Education Program
(IEP)/Individualize d Transition Plan (ITP) team. Additionally, with permission from and in
agreement with the school, an approved provider of Indiana Medicaid HCBS waiver services (in
this case, a behavioral consultant), may visit the individual student in his or her
educational/ school setting.
It is acceptable, appropriate and expected that the waiver provider, case manager, and other
professionals involved in the care and training of the student/waiver participant communicate,
collaborate, and otherwise share relevant information to whatever extent may be required in
ensuring consistency of approach in meeting the needs of the student/waiver participant.
Reimbursable activities of Behavioral Support Services are limited to:
Observation of the individual and environment for purposes of development of a plan and
to determine baseline
Development of a behavioral support plan and subsequent revisions
Obtain consensus of the Individualized Support Team that the behavioral support plan is
feasible for implementation
Training in assertiveness
Training in stress reduction techniques
Training in the acquisition of socially accepted behaviors
Training staff, family members, roommates, and other appropriate individuals on the
implementation of the behavioral support plan
Consultation with team members
Consultation with Health Service Providers in Psychology (HSPP)
Questions may be directed to Lynn Jump, Waiver Services Manager, at Lynn.Jump@fssa. in.gov

Policy Topic: Clarification for Residential Habilitation and Support Services
Comment Period Deadline: March 17, 2008
Anticipated Effective Date: 14 business days following issuance of final Quarterly Bulletin
As a clarification for providers of Residential Habilitation and Support Services (RHSS), the
Bureau of Developmental Disabilities Services (BDDS) is reminding you that you are
responsible for the health, safety and welfare of each individual you serve. Your responsibility
extends to assisting each individual in the acquisition, improvement and retention of skills
necessary to successfully support them in their communities of choice.
The information provided below is from the Home and Community-Based Services (HCBS)
provider waiver manual dated February 2007.
Allowable RHSS Activities
RHSS activities include direct supervision, monitoring and training needed to implement the
Individualized Support Plan (ISP) outcomes for the individual through the following:
• Assistance with personal care, meals, shopping, errands, chore and leisure activities,
including transportation to community activities, activities of daily living, and to access
community resources, by assisting and/or accompanying individuals to access public
transportation or by the RHSS provider directly providing transportation.
• Coordination and facilitation of medical and non-medical services to meet healthcare
needs, including physician consults, medications, development and oversight of health
plans, utilization of available supports in a cost effective manner, and maintenance of
each individual's health record.
• Assurance that direct service staff actively participate in the development and
implementation of ISP and Behavioral Support Plans (BSP).
Activities Not Allowed
RHSS do not include the following situations:
• Services furnished to a minor by parents(s), stepparent(s) or legal guardian(s)
• Services furnished to an individual by the individual's spouse
• Services furnished to individuals in Adult Foster Care or Children's Foster Care
• Services that are available under the Medicaid State Plan
• Services furnished to an adult individual by a parent, stepparent and/or legal guardian in
excess of a combined total of 40 hours per week. Example: An individual receives eighty
(80) hours a week in their Plan of Care. Up to forty (40) of those hours may be provided
by any combination of the following: parent(s), step-parent( s) and/or legal guardian(s).
The remaining forty (40) hours must be provided by a caregiver other than the
individual's parent(s), stepparent(s) and/or legal guardian.
Questions may be sent to Kellie Calita, Director of Client Services, at Kellie.Calita@ fssa.in.gov

Policy Topic: Crisis Management Policy
Comment Period Deadline: March 17, 2008
Anticipated Effective Date: 14 business days following issuance of final Quarterly Bulletin
It is the policy of Division of Disability and Rehabilitative Services (DDRS) to provide support
to individuals with developmental disabilities experiencing extreme behavioral or psychiatric
issues resulting in an emergency situation.
Crisis Management Services are for children and adults with developmental disabilities who
are exhibiting extreme behavioral and / or psychiatric issues. These services are:
1. Preventative, proactive, comprehensive and consistent across the state.
2. Multi-tiered to prevent crisis situations from occurring, and to provide responsive
supports and services in the least restrictive manner including:
• 24 hour help line phone support
• In-home support
• Out-of-home short term residential supports
• Follow along.
3. To enable individuals with more challenging behavioral issues to remain in the
community in an efficient and cost-effective manner to the extent that funding is
4. To complement natural and paid supports for an individual – not to replace those
Crisis Management Services are available to individuals of all ages:
1. Who have already been deemed eligible as persons with a developmental
disability via the system established by the State of Indiana; or
2. Who upon evaluation of the crisis management vendor, are determined to likely
be eligible based on the State of Indiana's definition of developmental disability.
BDDS will confirm eligibility as soon as practicable upon receiving notice of an
individual meeting presumptive eligibility as determined by the Crisis
Management vendor.
The Crisis Management vendor will determine the nature, type and duration of responsive
supports and services to be provided to an individual in conjunction with DDRS criteria and

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