Community Integration and Habilitation Waiver Amendment

For the original publication, please click here. The following is a text version of the original publication.
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To: Bureau of Developmental Disabilities Services Consumers Providers and Stakeholders
From: Nicole Norvell, Director, Division of Disability and Rehabilitative Services
Re: Community Integration and Habilitation Waiver Amendment
Date: July 9, 2015

Effective July 1, 2015, the Centers for Medicare and Medicaid (CMS) has approved the Indiana Family and Social Services Administration’s request to amend the Community Integration and Habilitation Waiver (CIH), which is administered by the Division of Disability and Rehabilitative Services (DDRS).

The CIH amendment also includes an update to the CIH Comprehensive Transition Plan required by CMS to ensure that the Home and Community Based Service (HCBS) programs offered by the state follow CMS’ final rule on HCBS settings, CMS-2249 & CMS-2296, published January 16, 2014.

General changes that were approved in the CIH Waiver amendment, IN.0378.R03.01, effective July 1, 2015, include: 

• Clarification of whether days were "calendar" or "business" days.
• Addition of a Transition Plan (#1) explaining how the State will assist individuals who might be adversely affected by the elimination or limitations on any services furnished under the currently approved waiver, or when existing services may be available in lesser amounts in the amendment.
• Addition of a comprehensive CIHW Transition Plan (#2) related to the Final Rule changes announced by CMS in January 2014 and a CMS-required statement pertaining to the waiver amendment being subject to any provisions or requirements in the approved Statewide transition plan.
• Clarification pertaining to the State’s use of contracted entities in the administration of the waiver.
• Clarification of the standards/qualifications the State requires when hiring staff who determine a participant’s eligibility (level of care) using the State’s level of care assessment tool and clarified the four basic conditions required for meeting level of care.
• Clarification of roles, responsibilities, and timelines related to remediation of level of care issues, processes for incident reporting, restraints, restrictive interventions, prohibition of seclusion, medication management and administration, monitoring and follow-up regarding grievances, complaints, and sentinel events, as well as State oversight responsibilities.
• Addition of a list of aversive techniques that are prohibited by the State.
• Clarification of how the participant’s annual freedom of choice forms are documented and stored.
• Clarification that the IST determines the party or parties responsible for development of risk plan(s).

For providers:

• Changed monthly reporting requirements to quarterly reporting requirements for providers
• Clarified that Criminal Background checks are only required by the State at initial application and that recheck does occur at specified intervals
• Clarification of how providers access the Division of Disability and Rehabilitative Services Home and Community-Based Services Waiver Provider Manual and the BQIS Helpline

Service changes:

• Adult Day Services - removed requirement for 3-hour minimum and now allows billing in quarter hour units from one quarter hour unit up to the maximum 12-hours per day
• Community Based Habilitation - Individual (CHIO) - will be limited to ten (10) hours per month from their residential provider for participants who also utilize Residential Habilitation and Support (RHS) Daily services
• Electronic Monitoring - previously prohibited all utilization with RHS service, but may now be used as a component of the new RHS Daily service, although Electronic Monitoring may not be separately billed when utilized as a component of RHS Daily
• Extended Services - a new service replacing Supported Employment Follow Along (SEFA) services as of July 1, 2015, with clarification of activities applicable to group services.
• Facility Based Habilitation(Group & Individual) - clarified language from requiring delivery in a "DDRS-approved facility" to "in the facility of a DDRS-approved provider"
• Prevocational services – added prohibition for overlapping utilization with Extended Services effective July 1, 2015, and applicable only to new enrollees and other waiver participants who are not utilizing a combination of SEFA and Prevocational services as of June 30, 2015
• Support Employment Follow Along (SEFA) - to be replaced by Extended Services effective July 1, 2015 · Residential Habilitation and Support - modified due to addition of RHS Daily services effective July 1, 2015
• RHS Daily services - added as a new residential service with a daily billing structure effective July 1, 2015
• Transportation - clarified that Transportation may be used to access places of employment
• Workplace Assistance - reference to SEFA to be replaced with reference to Extended Services as of July 1, 2015

The Approved Services within the CIH Waiver amendment are:

• Adult Day Services
• Behavioral Support Services
• Case Management
• Community-Based Habilitation (Group & Individual)
• Community Transition
• Electronic Monitoring
• Environmental Modifications
• Extended Services (beginning July 1, 2015)
• Facility Based Support
• Facility Based Habilitation (Group & Individual)
• Family and Caregiver Training
• Intensive Behavioral Intervention
• Music Therapy
• Occupational Therapy
• Personal Emergency Response System
• Physical Therapy
• Pre-Vocational Services
• Psychological Therapy
• Recreational Therapy
• Rent & Food for Unrelated Live-In Caregiver
• Residential Habilitation and Support (billed hourly)
• Residential Habilitation and Support – Daily (RHS Daily)
• Respite
• Specialized Medical Equipment and Supplies
• Speech/Language Therapy
• Structured Family Caregiving
• Supported Employment Follow Along (ended June 30, 2015)
• Transportation
• Wellness Coordination
• Workplace Assistance

For more information about the CIH Waiver or the CIH Waiver Transition Plan, please see the DDRS Announcements page. 

Questions about the CIH amendment or the CIH waiver program should be directed to 1-800-545-7763 or to BQIS.Help@fssa.in.gov.