DDRS FAQ to proposed changes to DD/Autism waivers

7/31/2019 DDRS FAQ to proposed changes to DD/Autism waivers

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Community Integration and Habilitation WaiverQ&As from

Webinar:

The ultimate goals of the conversion of the Autism and Developmental Disabilities waivers tothe Community Integration & Habilitation (CIH) waiver are to:

Provide the Family Supports Waiver (FSW) to more people, Enable families to intervene earlier in the care for their family member with a

Developmental Disability, including Autism,

More rapidly reduce the wait time to receive funding from the state for services upondiagnosis.

Important facts about the Waivers:

1. If a person is currently on the wait list for any of DDRS waivers - Autism (ASD),Developmental Disabilities (DD), or Support Services (SS), he/she will be moved to theFSW wait list and targeted for the FSW by the earliest application date that he/she hassubmitted. They will not have to re-apply for any waiver, and their position on the listwill be the same as it was on the Autism, DD, or SS wait lists.

2. If a person is currently on the Support Services (SS) waiver he/she will automaticallybegin receiving services through the Family Supports Waiver (FSW). These individualswill receive the same services and benefits as they were on the Supports Services waiver,

as the new waiver is exactly the same, only named differently and includes two moreservices and an increased cap. They will not need to do anything.

3. If a person is on the Autism or the DD Waiver, he/she will automatically begin receivingservices through the Community Integration & Habilitation (CIH) waiver. Theseindividuals will receive the same services and benefits as they were on the Autism or DDwaivers, as the new waiver is exactly the same, only named differently. They will notneed to do anything.

4. An application has been submitted for the increase in funding (from $13,500 to $16,250)on the Family Supports Waiver. BDDS is waiting for approval, and has an estimated

effective date of September 1, 2012.

5. The FSW is a capped waiver, but soon will be expanding to cover direct care service forin-home support.


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Questions and Answers:

Question Answer

Definitions: ASD WaiverBDDS

CIH WaiverCMS

DD WaiverDDRS

FSW Waiver

ICF/IDIPMG

SS Waiver

Autism WaiverBureau of Developmental Disabilities ServicesCommunity Integration & Habilitation WaiverCenters for Medicare and Medicaid ServicesDevelopmental Disabilities WaiverDivision of Disability and Rehabilitative ServicesFamily Supports Waiver

Intermediate Care Facility/Intellectual DisabilityIndiana Professional Management GroupSupport Services Waiver

Waiting List: If I am on another waiver,like the Aged and Disabled(A&D) Waiver, can Imove to the FSW or CIHwaivers?

If you are receiving services through another waiver, youcan move to the FSW only if you are currently on a waitlist for the Autism, Developmental Disabilities, orSupport Services waivers. To move onto the CIHwaiver, an individual must meet specific priority criteria,which include:

Eligible individual in other setting whose healthand welfare is threatened

Eligible individuals transitioning to thecommunity from nursing facilities, extensivesupport needs homes, and state operatedfacilities.

Eligible individuals determined to no longerneed/receive active treatment in group home

Eligible individuals transitioning from 100% statefunded services

Eligible individuals with loss or incapacitation ofthe primary caregiver

Eligible individuals with an aging primarycaregiver

Eligible individuals aging out of Department ofEducation, Department of Child Services, orSupported Group Living

Emergency Placement


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Eligible individuals requesting to leave a LargePrivate Intermediate Care Facility/IntellectualDisabilities (ICF/ID)

Eligible individuals transitioning from CrisisManagement and meet certain other criteria

What do you mean byneeds based when

referring to being placedon a waiver?

As-needed refers to meeting the eligibility and/orpriority criteria that are required for that waivers

services.

Eligibility

Criteria:

What are the criteria forthe FSW?

The criteria for the FSW are the same that are requiredfor receiving any services through DDRS waiverprogram. Individuals meeting the state criteria for adevelopmental disability and meeting the criteria for anICF/ID level of care determination are eligible to receivewaiver services. Developmental Disability" means a

severe, chronic disability of an individual.

Is attributable to intellectual disability, cerebralpalsy, epilepsy, or autism; or

any other condition (other than a sole diagnosisof mental illness) found to be closely related tointellectual disability,

Is manifested before the individual is twenty-two(22) years of age.

Is likely to continue indefinitely. Results in substantial functional limitations in at

least three (3) of the following areas of major lifeactivities:o Self-care.o Understanding and use of language.o Learning.o Mobility.o Self-direction.o Capacity for independent living.

What are the criteria forthe CIH?

The CIH waiver is a needs-based waiver, which meansthat an individual must meet one of the following prioritycriteria:

Eligible individual in other setting whose healthand welfare is threatened Eligible individuals transitioning to the

community from nursing facilities, extensivesupport needs homes, and state operatedfacilities.



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Emergency Placement Eligible individuals requesting to leave a Large

Private Intermediate Care Facilities/IntellectualDisabilities (ICFs/ID)


What do you mean byemergency placement?Can you please defineemergency

Emergency is defined as a situation in which the healthand welfare of an individual is threatened, and alternativeplacement in a supervised group living setting is notavailable or is determined by the division to be aninappropriate option.







Eligible individuals aging out of Department ofEducation, Department of Child Services, or

Supported Group Living Emergency Placement Eligible individuals requesting to leave a Large



I have been deemed Individuals meeting the state criteria for a developmental


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ineligible by BDDS, but

I have a diagnosis ofautism. What should I do?

disability and meeting the criteria for an ICF/ID level ofcare determination are eligible to receive waiverservices. Developmental Disability" means a severe,

chronic disability of an individual.





least three (3) of the following areas of major lifeactivities:o Self-care.o Understanding and use of language.o Learning.o Mobility.o Self-direction.o Capacity for independent living.

If you have been deemed ineligible as not meeting one ofthese criteria, you have the right to appeal the decisionwithin 33 calendar days of the date of the notice.Instructions about this process can be found athttp://www.in.gov/fssa/ddrs/4312.htm.

I didnt receive atargeting letter. What

should I do?

DDRS realizes that many individuals currently on theMedicaid Waiver wait list have application dates formore than one waiverpossibly with different dates. Atargeting letter is sent to individuals who are on a waitlist for a DDRS waiver when his/her application date isbeing targeted. DDRS targets individuals on the DDRSMedicaid Waiver wait list in order of application date,starting with the oldest.

Moving forward, individuals will be targeted for theFSWno matter what DDRS Medicaid waiver wait list

he/she is onby the earliest application date that he/shehas submitted. For example, if you applied for the DDWaiver on January 1, 2001, and the ASD Waiver onMarch 3, 2001, you will be targeted for the FSW basedon your January 1, 2001, application date.

It is the responsibility of an individual or his/her legalguardian to contact his/her local BDDS office once a
http://www.in.gov/fssa/ddrs/4312.htmhttp://www.in.gov/fssa/ddrs/4312.htmhttp://www.in.gov/fssa/ddrs/4312.htm


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year to (1) update any changes to contact information,and (2) indicate preference for remaining on the DDRSMedicaid Waiver wait list. As long as your contactinformation is updated, a targeting letter will reach youupon DDRS targeting of your Medicaid waiver

application date.I am currently on the DDor the Autism Waiver, butdont meet the new CIHcriteria. What willhappen?

If a person is on the Autism or the DD Waiver, he/shewill automatically begin receiving services through theCommunity Integration & Habilitation (CIH) waiver.These individuals will receive the same services andbenefits as they were on the Autism or DD waivers, asthe new waiver is exactly the same, only nameddifferently.

Only individuals who do not currently receive theAutism or DD waivers will be required to meet priority

criteria.What are the Level of Carerequirements for BDDSeligibility? Specifically.

An applicant/participant must meet three of sixsubstantial functional limitations and each of four basicconditions (listed below) in order to meet LOC.The basic conditions are:

intellectual disability, cerebral palsy, epilepsy,autism, or condition similar to intellectualdisability,

the condition identified above is expected tocontinue,

the condition identified above had an age of onsetprior to age 22, and

the applicant needs a combination or sequence ofservices.

The substantial functional limitation categories, asdefined in 42 CFR 435.1009, are:

self-care, learning, self direction, capacity for independent living,

receptive and expressive language, and mobility.

Timeline: When will the FSWreplace the SS Waiver?

The expected effective date of the FSW wavier isSeptember 1, 2012, pending approval by the Centers forMedicare and Medicaid Services.

When will the Autism andDD Waiver be convertedto the new CIH waiver?

The expected effective date of the CIH wavier isSeptember 1, 2012, pending approval by the Centers forMedicare and Medicaid Services.


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How long will people haveto continue to wait on theFSW?

As quickly as the system can bring them into the waiver.Right now, 200 individuals on the waiting list are beingtargeted every 2-3 weeks (5,200/yr).

Residential

Supports

Can I live outside of thehome (not with family)

and still be on the FSW?

Yes! If your physical, emotional, behavioral, social, andmedical needs can be met while pursuing your goals

within the budget of the capped waiver, you areencouraged to live outside of the family home.

DDRS realizes, however, the cost associated with someindividuals living independently will negatively affectthe Divisions ability to put more people onto the FSW

and decrease the Waiver wait list. In many cases, it isless expensive for an individual to remain in the familyhome than to live independently.

Further, there is a current societal shift occurring in

which individualsboth with and without disabilities -tend to stay at home longer or are moving in withroommates rather than living on their own. The Divisionhopes to refrain from separating people withdevelopmental disabilities from the mainstream, andrather, work within the current national trends ofeconomic stability.

What do I do if the cap onthe FSW is not enough forme to live independently?

If youre unable to live alone because ofthe cap on thewaiver, alternatives such as living in your family home,another family members home, or in a house with

housemates are all options.

How do I get on the CIHwaiver if I am currently onthe FSW?

To move onto the CIH waiver, an individual must meetspecific priority criteria, which include:







Eligible individuals aging out of Department ofEducation, Department of Child Services, or


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Supported Group Living



Eligible individuals transitioning from CrisisManagement and meet certain other criteriaIf I am currently an adultin a group home, what willhappen?

If you are currently in a group home and are on thewaiting list for the ASD, DD or SS waivers, you will betargeted for the FSW waiver when DDRS targets yourMedicaid waiver application date. At that time, you canchoose to accept the waiver placement, or remain in thegroup home. Once you decline the waiver placement,however, you will be unable to access it again unless youmeet priority criteria for the CIH.

If you are not on the DDRS Medicaid waiver wait list,you will remain in the group home setting, unless youmeet priority criteria for the CIH. Should this occur, youwill be automatically placed onto the CIH waiver.

Lastly, group home providers are being given the optionto voluntarily convert to waiver homes, as addressed inthe Section 144 report. Should your group homeprovider choose to convert to waiver homes, you willhave the choice to receive waiver services through theCIH waiver, or not receive waiver services and remain in

a group home setting. Ultimately, this conversion wouldallow individuals the opportunity to have more choicesin which providers serve their needs, but not in theirservice delivery.

If I am a child in a grouphome, what will happenwhen I become an adult?

You will transition into an adult group home. However,if you have been on the DDRS Medicaid waiver wait listand are targeted for the FSW prior to becoming an adult,you will have the option to receive waiver servicesthrough the FSW waiver, or not receive waiver servicesand remain in a group home setting.

What is the differencebetween a group home anda waiver home?

A group home is considered a small institutionally basedlong term care facility that provides services for 4 or moreindividuals living in the same home. The group homeprovider may work with a limited number of otherproviders to deliver your services.

A waiver home is your family home, a home withhousemates, or your own home. You have greater choice


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in which providers deliver your services.

Both, however, are considered placements within thecommunity setting.

If I am in a group home,

will I be on the FSW or onthe CIH waiver?

Group homes and waiver services are two different

things. You will not be on a waiver if you live in a grouphome.

If you are currently in a group home and are on thewaiting list for the ASD, DD or SS waivers, you will betargeted for the FSW waiver when DDRS targets yourMedicaid waiver application date. At that time, you canchoose to accept the waiver placement, or remain in thegroup home. Once you decline the waiver placement,however, you will be unable to access it again unless youmeet priority criteria for the CIH.

If you are not on the DDRS Medicaid waiver wait list,you will remain in the group home setting, unless youmeet priority criteria for the CIH. Should this occur, youwill be automatically placed onto the CIH waiver.

Lastly, group home providers are being given the optionto voluntarily convert to waiver homes, as addressed inthe Section 144 report. Should your group homeprovider choose to convert to waiver homes, you willhave the choice to receive waiver services through the

CIH waiver, or not receive waiver services and remain ina group home setting. Ultimately, this conversion wouldallow individuals the opportunity to have more choicesin which providers serve their needs, but not in theirservice delivery.

CIH Specific: Will there still be thebuckets that the budget

will be based on? If so,what are they?

The procedures that are currently used for evaluating anindividuals needs and budgets will remain the same.

FSW

Specific:

When can I receive the

increased budget amount?How do I apply for that?

Initially, the cap for the FSW will be $16,250 per year,

and will take effect as soon as CMS approves our SSWamendment. An announcement will be made when thedate becomes effective and individuals can beginutilizing services up to the cap.

However, if an individual does not need an increasedbudget, he/she should not request one. When and ifhe/she needs increased services, an increase in budget


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can occur.

Providers who serviceindividuals, who arecurrently on the SS waiverin their homes, will they be

able to continue to providethat service?

Yes. Services through the FSW will be no different thanwhat was on the SSW, except that two are being added:

(1)Participant Assistance and Care (PAC), which isa residential service

(2)Case ManagementProviders: Will providers have to re-

apply to qualify as waiverproviders?

No, you will not have to re-apply to provide servicesthrough either the Family Supports Waiver orCommunity Integration & Habilitation Waiver.

Will the state increase thereimbursement rate for anyof the types of direct careworkers to encourage theretention of goodemployees?

DDRS will be implementing its Quality and OutcomeBased Provider Reimbursement Methodology in the nextyear which raises the bar on provider service deliveryand outcomes for consumers. The ResidentialHabilitation and Supports (RHS) rate providers receivewould be contingent upon performance as measured byfive quality indicators, each measured at varying degreesof difficulty. Providers meeting or exceeding all fiveindicators will be rewarded by a higher RHS rate for theyear following the evaluation. Raising standards forservice providers will also promote employment of morequalified staff, which in turn, will result in higher qualityservices for waiver consumers.

Case

Management:

Is IPMG the only providerof case managementservices??

Currently, IPMG is the only case management companythat provides services to individuals receiving DDRSMedicaid Waiver services. However, the contract

between this entity and the State expires on August 31,2012. To provide more choice to individuals andfamilies regarding individual case managers, casemanagement has been added to the SSW and DD waiveramendments that create the FSW and CIH waivers,respectively.

The expected effective date of the case management as awaiver service is September 1, 2012, pending approvalby the Centers for Medicare and Medicaid Services.

Starting July 18, 2012, DDRS will accept proposals fromnew case management companies interested in providingcase management services through the Waiver program.Prospective providers should follow the instructions forbecoming a BDDS approved provider outlined on theProvider Relations webpage located athttp://www.in.gov/fssa/ddrs/2644.htm.

Will I be able to select my Individuals receiving waiver services have always been
http://www.in.gov/fssa/ddrs/2644.htmhttp://www.in.gov/fssa/ddrs/2644.htmhttp://www.in.gov/fssa/ddrs/2644.htm


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own case manager? able to choose their individual case manager.

Existing waiver participants will have greater choice inindividual case managers as soon as the service is madeavailable on the waiver and other case management

providers are approved to provide the service. PendingCMS approval, it is anticipated that the date by whichtheses choices can be made by waiver participants isSeptember 1, 2012.

For individuals transitioning onto the waiver afterSeptember 1, 2012, they will able to choose an individualcase manager from as many case management providersare approved by DDRS at that time.

Where is a list of casemanagers?

A list of approved case management providers will bemade available on DDRS website on September 1,

2012.When will CMS determineif multiple providers canbe case managementvendors?

Pending approval from the Center for Medicare andMedicaid Services (CMS), the effective date forproviding case management as a waiver service isexpected to be September 1, 2012.

General: How is the new waiverbeing funded?

The new FSW will be funded through federal Medicaidfunding and a match contributed by the State. Inaddition, savings from other waiver initiatives will alsofund the Family Supports Waiver (FSW). This waiver isintended to reduce the per capita cost of residentialplacements on the DD Waiver resulting in more financialresources being available for the new Family SupportsWaiver. An annual cap and strong emphasis onidentification and utilization of natural supports willprovide greater certainty in individual Family SupportsWaiver budgets.

The Community Integration and Habilitation (CIH)waiver will continue to be funded through federalMedicaid funding and a match contributed by the State.

How will these changesaffect the state budget? The cost of the DD and Autism Waivers has remainedrelatively flat as budgets established for individualsvaried little from year to year. As a result of the additionof a residential service component onto the SupportServices Waiver and giving it a new name, the newFamily Supports Waiver can be included in the per capitacost calculation. These changes will result in a dramaticdecrease in per capita spending as more individuals are


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transitioned onto this waiver.

How will the change in theDSM5 diagnostic criteriaaffect eligibility?

This change will not affect the Intermediate CareFacility/Intellectual Disability (ICF/ID) level of care.

Individuals meeting the state criteria for adevelopmental disability and meeting the criteria for anICF/ID level of care determination are eligible to receivewaiver services. Developmental Disability" means asevere, chronic disability of an individual.





least three (3) of the following areas of major lifeactivities:o Self-care.o Understanding and use of language.o Learning.o Mobility.o Self-direction.

Capacity for independent living.

Will families who earn a

little bit more have tomake co pays? If so, howwill that be determined?

No. Medicaid eligibility (which is required to receiveMedicaid waiver services) for minors seeking Medicaidwaiver services disregards parental income.

How do I know where weare on the waiting list?

To determine what application date is currently beingtargeted, please contact your local BDDS office.

You can find the phone number for your local BDDSoffice herehttp://www.in.gov/fssa/ddrs/4088.htm.Simply click on the map where your county is located to

view contact information and location addresses.

The BDDS helpline number is another resource: 1-800-545-7763.

Finally, you can also access the Waiver Waiting Listonline portal (http://www.in.gov/fssa/ddrs/4328.htm)where you can see your contact information and youre
http://www.in.gov/fssa/ddrs/4088.htmhttp://www.in.gov/fssa/ddrs/4088.htmhttp://www.in.gov/fssa/ddrs/4088.htmhttp://www.in.gov/fssa/ddrs/4088.htm


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your application. You also have the capability ofsending an email to update any information that isincorrect.

While none of these options will give you an indication

about how many individuals are in front of you, youwill better understand the proximity of your targetingbased upon the date DDRS is targeting at the time ofyour call.

Will Applied BehaviorAnalysis (ABA) be fundedunder the CIH waiver?Will it be funded under theFSW?

Intermediate Behavior Intervention (IBI), which iscurrently available on the DDW and ASW, will remainon the new CIH Waiver and FSW. The definition forthis service can be found athttp://www.in.gov/fssa/files/Part_10_-_Service_Definitions_and_Requirements.pdf.

As DDRS rolls out these new waivers and assesses needsof individuals moving onto the FSW and CIH,discussions and analysis about ABA will continue.

What will happen tochildren on any of thewaivers who are a part ofthe DCS system?

DDRS has a Memorandum of Understanding (MOU)with DCS to work through any situations in which achild with ASD or DD is placed onto Waiver services.

Will people who have co-morbid conditions (MentalHealth and Developmentaldisability qualify for eitherwaiver?

For both the FSW and CIH waivers, individuals meetingthe state criteria for a developmental disability andmeeting the criteria for an ICF/ID level of caredetermination are eligible to receive waiver services.Developmental Disability" means a severe, chronic

disability of an individual.




Is likely to continue indefinitely.

Results in substantial functional limitations in atleast three (3) of the following areas of major lifeactivities:o Self-care.o Understanding and use of language.o Learning.o Mobility.o Self-direction.
http://www.in.gov/fssa/files/Part_10_-_Service_Definitions_and_Requirements.pdfhttp://www.in.gov/fssa/files/Part_10_-_Service_Definitions_and_Requirements.pdfhttp://www.in.gov/fssa/files/Part_10_-_Service_Definitions_and_Requirements.pdfhttp://www.in.gov/fssa/files/Part_10_-_Service_Definitions_and_Requirements.pdfhttp://www.in.gov/fssa/files/Part_10_-_Service_Definitions_and_Requirements.pdf


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o Capacity for independent living.Further, priority criteria must be met for placement ontothe CIH waiver. These criteria are:











What is the process forapplying for a FSW?

The Bureau of Developmental Disabilities ServicesDistrict Offices can provide an application for the FamilySupports Waiver, as well as assist in researchingadditional services. Once it has been determined that anindividual meets the criteria for developmental services,that individual will be placed on the Waiver wait list.Once a waiver slot becomes available based upon theindividuals application date, he/she will be targeted,

or offered a waiver placement.

How do I get on the CIH?

Do I have to be on theFSW first, and thenmoved? That seems totake a long time.

No, an individual will not go onto the FSW first,

necessarily. The Family Supports Waiver is not meant tobe a placeholder waiver for the CIH Waiver.

To be placed onto the CIH waiver, which is a needs-based waiver, an individual must meet one of the prioritycriteria for emergency access, which are listed below:



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Private Intermediate Care Facility/IntellectualDisabilities (ICF/ID)


How will people receivingVR services be handled?Will they be put on awaiver or receive statefunded employmentservices? Do they need awaiver?

Individuals receiving VR services will continue to do soas they are now. It will not be necessary for them to goonto the waiver to continue to receive services throughVR. Further, if an individual does not successfullycomplete VR services, he/she is still able to accessSupported Employed Follow Along (SEFA) throughState funding.

How will high-needindividuals be addressed?What will the waiveramendment address thesehigher cost individuals

needs?

To help ensure the unique needs of high-cost/high-needsindividuals are met, a new service definition will becreated in which specific services that accommodate thispopulation will be defined. Affixed to this servicedefinition will be a rate that can support the increasedresponsibility placed on providers to care for thispopulation. This rate will allow providers to pay qualitystaff to provide safe and effective services.

How to apply for an FSW:Pending approval from CMS, an individual or his/her guardian may apply for the FamilySupports Services Medicaid waiver program through the local Bureau of Developmental


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Disabilities Services (BDDS) office. Individuals (or their guardians) have the right to applywithout questions or delay.

To apply for the Family Supports Services Waiver, the individual or guardian must complete,sign, and date an Application for Long Term Care Services (State Form 4594) including the time

of day that the application is signed. An individual who has not already applied for waiverservices may also need to complete, sign, and date a DDRS Referral and Application (State Form10057) located at http://www.in.gov/fssa/ddrs/3349.htm. Other individual or agencyrepresentatives may assist the individual or guardian in completing the application form andforward it to the BDDS office service the county in which the individual currently resides. Theapplication may be submitted in person, by mail or by fax.

Upon receiving the waiver application, the BDDS staff must contact the individual and/or his/herguardian and discuss the process for determining eligibility for the waiver (documentation of adevelopmental disability, diagnosis within the Autism Spectrum, Medicaid eligibility, and levelof care). If the applicant is not a Medicaid recipient, he/she will be referred to the local Division

of Family Resources to apply for Medicaid. More specific information about applying for DDRSMedicaid waiver services can be found in the 2011 DDRS Waiver Manualhttp://www.in.gov/fssa/files/Part_5_-_Application_and_Start_of_Waiver_Services.pdf.
http://www.in.gov/fssa/files/Part_5_-_Application_and_Start_of_Waiver_Services.pdfhttp://www.in.gov/fssa/files/Part_5_-_Application_and_Start_of_Waiver_Services.pdfhttp://www.in.gov/fssa/files/Part_5_-_Application_and_Start_of_Waiver_Services.pdf


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Start

I am on the SSWaiver waitlist

Automaticplacement on

the FSW waitlistI am on the ASDor DD Waiver

waitlist

I have the DD orASD waiver


the CIH waiver

I have the SS

Waiver


the FSW waiver

Documents

DDRS FAQ to proposed changes to DD/Autism waivers