Community Integration and Habilitation Waiver Renewal

For the original publication, please click here. The following is a text version of the original publication.
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To: Division of Disability and Rehabilitative Services 
From: Nicole Norvell, Director, Division of Disability and Rehabilitative Services 
Re: Community Integration and Habilitation Waiver Renewal 
Date: October 1, 2014 

Effective October 1, 2014, the Centers for Medicare and Medicaid (CMS) has approved the state of Indiana’s request to renew the Community Integration and Habilitation Waiver (CIH), which is administered by the Division of Disability and Rehabilitative Services (DDRS). 

The CIH renewal also includes the first Preliminary 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. For more information about the CIH Waiver or the CIH Waiver transition plan, please visit the DDRS website. 

Changes that were approved in the CIH Waiver renewal, IN.0378.R03.00, include:

• Quality Improvement strategies throughout the application reflect changes required per CMS directives as well as clarifications of current practices and data sources within the State. Quality Improvement under Appendices G and I contains additional performance measures for the new sub-assurances
• The removal of references to “mental retardation” replaced with “Individuals with Intellectual Disabilities (IID)”
• Details on FSSA as the single state Medicaid Agency and the current roles and revised organizational structure of the State Medicaid Agency within the Single State Medicaid Agency. 
• DDRS posted Home and Community-Based Settings Waiver Transition Plan for public comment and the comments were summarized and incorporated within the CIH waiver renewal. 
• Level of Care no longer requires ongoing confirmation of a diagnosis after the initial enrollment into the waiver.
• Monthly reporting requirements were changed to quarterly reporting requirements for providers
• HCBS Taxonomy of services are added to each service, as required by CMS 
• Clarification was added to current roles, responsibilities and processes for incident reporting, restraints, restrictive interventions, and prohibition of seclusion, medication management and administration, and state oversight responsibilities.
• Supplemental or Enhanced Payments - Removed

Services changes: 

• The requirement for a minimum of three hours is removed from Adult Day Services
• Case Management - Added accreditation requirement and a revised requirement that case notes need to be at least monthly (no longer weekly) or more often as encounters occur.
• Community Transition Funds – now allowable with– Individual (CHIO) and Structured Family Caregiving (SFC) 
• Music Therapy – added ability to render in groups and divide billing unit rate among the total number in group
• Recreational Therapy – added ability to render in groups and divide billing unit rate among the total number in group
• Residential Habilitation and Support (RHS) Level 3 – Removed
• Structured Family Caregiving - now allows legal guardian to provide the service and removed requirement that daily notes be electronic
• Wellness Coordination – change name of “Risk Mitigation Tool” to “State-approved risk assessment tool”

For Qualified Providers,

• DDRS added service-specific provider qualification references from 460 IAC 6 to each service
• Criminal background checks now are only required by the state at initial application; Addendum clarifies that recheck does occur at specified intervals
• Clarification is added on how providers access the Indiana Medicaid (Indiana Health Coverage Programs (IHCP)) HCBS Waiver Provider Manual and the BQIS Helpline

For Person Centered Planning and Service Delivery: 

• Reflects current practice and expectations as well as clarification of roles.
• Participant Rights – clarifies procedures for requesting a fair hearing; roles, responsibilities and processes for dispute resolution, grievances and complaints

The Approved Services within the CIH Waiver are:

• Adult Day Services
• Behavioral Support Services
• Case Management
• Community-Based Habilitation (Group & Individual)
• Community Transition
• Electronic Monitoring
• Environmental Modifications
• 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
• Respite
• Specialized Medical Equipment and Supplies
• Speech/Language Therapy
• Structured Family Caregiving
• Supported Employment Follow Along
• Transportation
• Wellness Coordination and
• Workplace Assistance