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Wellness Coordination services means the development, maintenance and routine monitoring of the waiver participant’s Wellness Coordination plan and the medical services required to manage his/her health care needs.
Wellness Coordination services extend beyond those services provided through routine doctor/health care visits required under the Medicaid State Plan and are specifically designed for participants requiring assistance of an RN/LPN to properly coordinate their medical needs.
Conditions and Requirements: Necessity for Wellness Coordination services will typically be reserved for participants assessed with health scores of 5 or higher through the State’s objective based allocation process. Participants assessed with health scores of 0-4 would not require assistance of an RN/LPN to coordinate medical needs. As medical events occur and/or a participant’s medical needs change, the Individualized Support Team is expected to obtain reassessment for potential revision to the health score and to ensure utilization of the appropriate tier of services.
Reimbursement is available for Wellness Coordination Services when the following circumstances are present:
Coordination of Wellness Services by the RN/LPN provider must include, but is not limited to the following:
Activities Not Allowed
Reimbursement for Wellness Coordination services is not available under the following circumstances:
Wellness Coordination services must be documented in agency files
C-1/C-3: Provider Specifications for Service
DDRS will allow both “Agency” and “Individual” provider types
DDRS Approved Wellness Coordination Agencies and/or Individuals
Be either a registered nurse (RN) or a licensed practical nurse (LPN) under IC 25-23-1 working under the supervision of an RN
Must be enrolled as an active Medicaid provider
Must be DDRS-approved
Must comply with Indiana Administrative Code, 460 IAC 6 (noting that Wellness Coordination is referred to as Health Care Coordination within 460 IAC 6)
Must comply with any applicable BDDS service standards, guidelines, policies and/or manuals, including DDRS Waiver Manual and DDRS BDDS Policy Manual
Verification of Provider Qualifications
Entity Responsible for Verification:
Initially, BDDS. For Re-approval, BDDS or BQIS.
Frequency of Verification:
Up to 3 years.