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Showing posts from November 8, 2015

New FV Guide to Purchasing an #ACA Plan to Cover #ABA

Purchasing an ACA Marketplace Plan to cover ABA therapy
Q: When can I purchase an ACA plan?
A: Open enrollment is November 1, 2015 – January 31, 2016. You can only purchase an ACA plan outside of these dates if you qualify for a special enrollment period (change in family status (for example, marriage or birth of a child) or loss of other health coverage).
Q: Do all ACA Marketplace Plans cover ABA?
A: Yes. All Indiana Marketplace Plans follow the Autism Mandate and cover ABA
Q: The rest of our family doesn’t need an ACA plan. Can I buy one just for my child?
A: Yes, you can buy a “child only” policy on the ACA marketplace at healthcare.gov
Q: Can our child keep the employer based insurance or Medicaid we have for them as well?
A: Yes, your child can have Medicaid or other family private insurance and still get a plan on the ACA Marketplace. Tip: if a navigator or assister says you can not do this, contact the Department of Insurance 317-232-2385
Q: Will we still get the subsidies and co…

#Waiverwise: Recreational Therapy

Waiver services should be person centered. You will create a Service Plan within the budget limit ( $16,545 annually for FSW). There is more information available on this process in the waiver manual.

More information, including service costs, available in the manual: http://provider.indianamedicaid.com/ihcp/manuals/DDRS%20HCBS%20Waiver%20Provider%20Manual.pdf
Recreational Therapy

Recreational Therapy services are services provided under this article and consisting of a medically approved recreational program to restore, remediate, or rehabilitate an individual in order to 
 Improve the individual’s functioning and independence 
 Reduce or eliminate the effects of an individual’s disability

Reimbursable activities under Recreational Therapy services include the following: 
 Organizing and directing adapted sports, dramatics, arts and crafts, social activities, and other recreation services designed to restore, remediate, or rehabilitate 
 Planning, reporting, and write-up when in associati…

5 Questions to Ask When Choosing an #ACA Plan

The Health Insurance Marketplace offers different plan types to meet a variety of needs and budgets. Most people qualify for financial help to make health coverage affordable. Compare plans based on what’s important to you, and choose the combination of price and coverage that fits your needs. Ask yourself these 5 questions as you shop for Marketplace coverage. 

1. Can I get help paying for Marketplace coverage? 
You may be able to qualify for financial help to lower the cost of your coverage. Eight out of ten people who signed up for health coverage at HealthCare.gov qualified for financial help to make their coverage more affordable. In fact, most people found plans that were $75 or less per month. After you fill out a Marketplace application, you’ll learn if you’re eligible for financial help to lower the cost of your monthly premiums and care. This financial help will also apply to your dental coverage if it’s a part of your health plan. 
2. What benefits do health plans cover? 
A…

#Waiverwise: Psychological Therapy

Waiver services should be person centered. You will create a Service Plan within the budget limit ( $16,545 annually for FSW). There is more information available on this process in the waiver manual.

More information, including service costs, available in the manual: http://provider.indianamedicaid.com/ihcp/manuals/DDRS%20HCBS%20Waiver%20Provider%20Manual.pdf

Psychological Therapy

Psychological Therapy services means services provided by a licensed psychologist with an endorsement as a health service provider in psychology, a licensed marriage and family therapist, a licensed clinical social worker, or a licensed mental health counselor. 

Reimbursable Activities Reimbursable activities under Psychological Therapy services include the following: 
 Individual counseling 
 Biofeedback 
 Individual-centered therapy 
 Cognitive behavioral therapy 
 Psychiatric services 
 Crisis counseling
 Family counseling 
 Group counseling 
 Substance abuse counseling and intervention 
 Planning, reporting,…

Barriers for Individuals with #Disabilities in Getting Access to Healthcare

Even after children and adults with special needs have enrolled in a healthcare plan through a State or the Federal Marketplace, some are having difficulties accessing care.  In this blog, we summarize some of the obstacles and how they can be addressed.  New Data The Urban Institute and Robert Wood Johnson Foundation have reported survey results on access to care.  People with disabilities had two to three times more difficulty accessing services than individuals without disabilities.  Common problems included: Affordability was a concern.  (According to one study, adults with disabilities are nearly twice as likely as others to report an unmet need for general doctor care because they cannot afford it or because their health plan will not pay for a treatment.[i])Doctors or hospitals did not accept the insurance.Transportation was a barrier.There were delays in getting needed appointments.Offices were not physically accessible.Addressing Obstacles There are many ways that families can…

#Waiverwise: Prevocational Services

Waiver services should be person centered. You will create a Service Plan within the budget limit ( $16,545 annually for FSW). There is more information available on this process in the waiver manual.

More information, including service costs, available in the manual: http://provider.indianamedicaid.com/ihcp/manuals/DDRS%20HCBS%20Waiver%20Provider%20Manual.pdf

Prevocational Services

Prevocational Services are services that prepare a participant for paid or unpaid employment. Prevocational Services include teaching concepts such as compliance, attendance, task completion, problem-solving, and safety. Services are not job-task oriented, but instead, aimed at generalized results. Services are habilitative in nature and not explicit employment objectives. 

Reimbursable activities under Prevocational Services include the following: 
 Monitoring, training, education, demonstration, or support provided to assist with the acquisition and retention of skills in the following areas: 
 Paid and unpai…

#Waiverwise: Personal Emergency Response System

Waiver services should be person centered. You will create a Service Plan within the budget limit ( $16,545 annually for FSW). There is more information available on this process in the waiver manual.

More information, including service costs, available in the manual: http://provider.indianamedicaid.com/ihcp/manuals/DDRS%20HCBS%20Waiver%20Provider%20Manual.pdf

Personal Emergency Response System

Personal Emergency Response System (PERS) is an electronic device that enables certain individuals at high risk of institutionalization 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. 

 Reimbursable activities include the following: 
 Device installation service 
 Ongoing monthly maintenance of the device 

PERS is limited to those individuals who live…

CIH #Waiver Transformation

The Division of Disability and Rehabilitative Services (DDRS) has posted a service definition matrix to the CIH Transform webpage to gather initial feedback on changes to the current service definitions within the Community Integration and Habilitation (CIH) waiver. 

As DDRS has not yet submitted a waiver amendment to the Centers for Medicare & Medicaid Services (CMS), we would like to offer providers, stakeholders, families and participants the opportunity to review any potential changes prior to the official public comment period that will take place in December 2015. 
Please submit questions or comments to CIHW@fssa.in.gov. An announcement regarding the public comment period will be issued in a few weeks.

#Waiverwise: Participant Assistance and Care (PAC)

Waiver services should be person centered. You will create a Service Plan within the budget limit ( $16,545 annually for FSW). There is more information available on this process in the waiver manual.

More information, including service costs, available in the manual: http://provider.indianamedicaid.com/ihcp/manuals/DDRS%20HCBS%20Waiver%20Provider%20Manual.pdf

Participant Assistance and Care (PAC)
Participant Assistance and Care (PAC) services are provided in order to allow participants (consumers) 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 participant in activities of daily living, selfcare, and mobility with the hands-on assistance, prompting, reminders, supervision, and monitoring needed to ensure the health, safety, and welfare of the participant. 
Reimbursable activities under Participant Assistance and Care services i…

#Waiverwise: Music Therapy

Waiver services should be person centered. You will create a Service Plan within the budget limit ( $16,545 annually for FSW). There is more information available on this process in the waiver manual.

More information, including service costs, available in the manual: http://provider.indianamedicaid.com/ihcp/manuals/DDRS%20HCBS%20Waiver%20Provider%20Manual.pdf

Music Therapy

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 focusing on the acquisition of nonmusical skills and behaviors.

Reimbursable Activities:

 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 
 Interaction with peers and others 
 Attending behavior 
 Independence and self-direction 

 Therapy to reduce maladaptive (stereotypic, compulsive, self-abusive, assault…

#Waiverwise: Intensive Behavioral Intervention

Waiver services should be person centered. You will create a Service Plan within the budget limit ( $16,545 annually for FSW). There is more information available on this process in the waiver manual.

More information, including service costs, available in the manual: http://provider.indianamedicaid.com/ihcp/manuals/DDRS%20HCBS%20Waiver%20Provider%20Manual.pdf

Intensive Behavioral Intervention

Intensive Behavioral Intervention (IBI) is a highly specialized, individualized program of instruction and behavioral intervention. IBI is based upon a functional, behavioral and/or skills assessment of an individual’s treatment needs. The primary goal of IBI is to reduce behavioral excesses, such as tantrums and acting-out behaviors, and to increase or teach replacement behaviors that have social value for the individual and increase access to their community. Program goals are accomplished by the application of research-based interventions. 

Generally, IBI addresses manifestations that are amenable…