reglab/statecodes huggingface dataset:
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › SUB-PART: CHILDREN'S DEVELOPMENTAL DISABILITIES (DD) HOME AND COMMUNITY-BASED SERVICES (HCBS) STATE PLAN OPTION › Section 16.03.10.602 - ICF/IID: REPORTING SYSTEM

Current through August 31, 2023
The objective of the reporting requirements is to provide a
				  uniform system of periodic reports that will allow: (3-17-22)
01.
Basis for Reimbursement
. A
				basis of provider reimbursement approximating actual costs. (3-17-22)
02.
Disclosure
. Adequate
				financial disclosure. (3-17-22)
03.
Statistical Resources
. Statistical resources, as a basis for
				measurement of reasonable cost and comparative analysis. (3-17-22)
04.
Criteria
. Criteria for
				evaluating policies and procedures. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › SUB-PART: CHILDREN'S DEVELOPMENTAL DISABILITIES (DD) HOME AND COMMUNITY-BASED SERVICES (HCBS) STATE PLAN OPTION › Section 16.03.10.603 - ICF/IID: REPORTING SYSTEM PRINCIPLE AND APPLICATION

Current through August 31, 2023
The provider will be required to file mandatory annual cost
				  reports. (3-17-22)
01.
Cost
				Report Requirements
. The fiscal year end cost report filing must
				include: (3-17-22)
a. Annual income statement
				(two (2) copies); (3-17-22)
b.
				Balance sheet; (3-17-22)
c.
				Statement of ownership; (3-17-22)
d. Schedule of patient days;
				(3-17-22)
e. Schedule of private
				patient charges; (3-17-22)
f.
				Statement of additional charges to residents over and above usual monthly rate;
				and (3-17-22)
g. Other schedules,
				statements, and documents as requested. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › SUB-PART: CHILDREN'S DEVELOPMENTAL DISABILITIES (DD) HOME AND COMMUNITY-BASED SERVICES (HCBS) STATE PLAN OPTION › Section 16.03.10.605 - ICF/IID: FILING DATES

Current through August 31, 2023
01.
Deadlines
. Deadlines for annual cost reports will be the last day of the
				third month following the fiscal year end or the deadline imposed by Medicare
				if the provider is required to file a Medicare cost report. (3-17-22)
02.
Waivers
. A delay of thirty
				(30) days may be granted for annual cost reports in unusual circumstances.
				Requests for such deferrals and reasons therefore must be in writing and should
				be made prior to the deadline. A written decision will be rendered in writing
				within ten (10) days. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › SUB-PART: CHILDREN'S DEVELOPMENTAL DISABILITIES (DD) HOME AND COMMUNITY-BASED SERVICES (HCBS) STATE PLAN OPTION › Section 16.03.10.606 - ICF/IID: FAILURE TO FILE

Current through August 31, 2023
Failure to submit timely reports may result in a reduction in
				  the interim rate. Failure to file the required cost reports, including required
				  supplemental information, unless a waiver is granted, may result in a reduction
				  of ten percent (10%) in the provider's interim rate(s) the first day of the
				  month following the deadline date. Continued failure to comply will result in
				  complete payment suspension on the first day of the following month. When
				  suspension or reduction has occurred and the provider has filed the required
				  cost reports, amounts accruing to the provider during the period of suspension
				  or reduction will be restored. Loss of license or certification will result in
				  immediate termination of reimbursement, full scope audit and settlement for the
				  cost period. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › SUB-PART: CHILDREN'S DEVELOPMENTAL DISABILITIES (DD) HOME AND COMMUNITY-BASED SERVICES (HCBS) STATE PLAN OPTION › Section 16.03.10.607 - ICF/IID: ACCOUNTING SYSTEM

Current through August 31, 2023
Reports must be filed using the accrual basis and conform
				  with generally accepted accounting principles or within provisions of the
				  guidelines as specified. In any case, the recorded transaction must be capable
				  of verification by Departmental audit. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › SUB-PART: CHILDREN'S DEVELOPMENTAL DISABILITIES (DD) HOME AND COMMUNITY-BASED SERVICES (HCBS) STATE PLAN OPTION › Section 16.03.10.608. - 609 - RESERVED

Current through August 31, 2023
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › SUB-PART: CHILDREN'S DEVELOPMENTAL DISABILITIES (DD) HOME AND COMMUNITY-BASED SERVICES (HCBS) STATE PLAN OPTION › Section 16.03.10.610 - ICF/IID: AUDITS

Current through August 31, 2023
All financial reports are subject to audit by Departmental
				  representatives. (3-17-22)
01.
Accuracy of Recording
. To determine whether the transactions recorded in
				the books of record are substantially accurate and reliable as a basis for
				determining reasonable costs. (3-17-22)
02.
Reliability of Internal
				Control
. To determine that the facilities internal control is
				sufficiently reliable to disclose the results of the to the provider's
				operations. (3-17-22)
03.
Economy and Efficiency
. To determine if Title XIX and Title XXI
				participants have received the required care on the a basis of economy and
				efficiency. (3-17-22)
04.
Application of GAAP
. To determine if GAAP is applied on a consistent
				basis in conformance with applicable federal and state regulations.
				(3-17-22)
05.
Patient Trust
				Fund Evaluation
. To evaluate the provider's policy and practice
				regarding their fiduciary responsibilities for patients, funds and property.
				(3-17-22)
06.
Enhancing
				Financial Practices
. To provide findings and recommendations aimed at
				better financial practices to allow the most economical delivery of patient
				care. (3-17-22)
07.
Compliance
. To provide recommendations that will enable the provider to
				conform more closely with state and federal regulations in the delivery of
				health care to program participants. (3-17-22)
08.
Final Settlement
. To effect
				final settlement when required by Sections
				587 through
				632 of these rules.
				(3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › SUB-PART: CHILDREN'S DEVELOPMENTAL DISABILITIES (DD) HOME AND COMMUNITY-BASED SERVICES (HCBS) STATE PLAN OPTION › Section 16.03.10.611 - ICF/IID: AUDIT APPLICATION

Current through August 31, 2023
01.
Annual
				Audits
. Normally, all annual statements will be audited within the
				following year. (3-17-22)
02.
Limited Scope Audit
. Other statements and some annual audit
				recommendations may be subject to limited scope audits to evaluate provider
				compliance. (3-17-22)
03.
Additional Audits
. In addition, audits may be required where: (3-17-22)
a. A significant change of ownership occurs.
				(3-17-22)
b. A change of management
				occurs. (3-17-22)
c. An overpayment
				of twenty-five percent (25%) or more has resulted for a completed cost period.
				(3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › SUB-PART: CHILDREN'S DEVELOPMENTAL DISABILITIES (DD) HOME AND COMMUNITY-BASED SERVICES (HCBS) STATE PLAN OPTION › Section 16.03.10.612 - ICF/IID: AUDIT STANDARDS AND REQUIREMENTS

Current through August 31, 2023
01.
Review of New Provider Fiscal Records
. Before any program payments
				can be made to a prospective provider the intermediary will review the
				provider's accounting system and its capability of generating accurate
				statistical cost data. Where the provider's record keeping capability does not
				meet program requirements the intermediary will offer limited consultative
				services or suggest revisions of the provider's system to enable the provider
				to comply with program requirements. (3-17-22)
02.
Requirements
. Providers
				Reimbursement Manual (PRM), Section
				2404.3 states: "Examination of
				Pertinent Data and Information -- Providers asking to participate as well as
				those currently participating must permit the intermediary to examine such
				records and documents as are deemed necessary. (3-17-22)
03.
Examination of Records
.
				Examination of records and documents may include: (3-17-22)
a. Corporate charters or other documents of
				ownership including those of a parent or related companies. (3-17-22)
b. Minutes and memos of the governing body
				including committees and its agents. (3-17-22)
c. All contracts. (3-17-22)
d. Tax returns and records, including
				workpapers and other supporting documentation. (3-17-22)
e. All insurance contracts and policies
				including riders and attachments. (3-17-22)
f. Leases. (3-17-22)
g. Fixed asset records (see audit section -
				Capitalization of Assets). (3-17-22)
h. Schedules of patient charges.
				(3-17-22)
i. Notes, bonds and other
				evidences of liability. (3-17-22)
j. Capital expenditure records.
				(3-17-22)
k. Bank statements,
				cancelled checks, deposit slips and bank reconciliations. (3-17-22)
l. Evidence of litigations the facility and
				its owners are involved in. (3-17-22)
m. Documents of ownership including
				attachments that describe the property. (3-17-22)
n. All invoices, statements and claims.
				(3-17-22)
o. Providers Accounting
				Firm. Where a provider engages an accounting firm to maintain its fiscal
				records, the financial audit work papers prepared by the accounting firm are
				considered to be the property of the provider and must be made available to the
				intermediary upon request, under PRM, paragraph 2404.4(Q). (3-17-22)
p. Ledgers, journals, all working papers,
				subsidiary ledgers, records and documents relating to financial operation.
				(3-17-22)
q. All patient records,
				including trust funds and property. (3-17-22)
r. Time studies and other cost determining
				information. (3-17-22)
s. All other
				sources of information needed to form an audit opinion.
				(3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › SUB-PART: CHILDREN'S DEVELOPMENTAL DISABILITIES (DD) HOME AND COMMUNITY-BASED SERVICES (HCBS) STATE PLAN OPTION › Section 16.03.10.613 - ICF/IID: PATIENT FUNDS

Current through August 31, 2023
The safekeeping of patient funds, under the program, is the
				  responsibility of the provider. Accordingly, the administration of these funds
				  requires scrupulous care in recording all transactions for the patient.
				  (3-17-22)
01.
Use
.
				Generally, funds are provided for personal needs of the patient to be used at
				the patient's discretion. The provider agrees to manage these funds and render
				an accounting but may not use them in any way. (3-17-22)
02.
Provider Liability
. The
				provider is subject to legal and financial liabilities for committing any of
				the following acts. This is only a partial listing of the acts contrary to
				federal regulations: (3-17-22)
a. Management
				fees may not be charged for managing patient trust funds. These charges
				constitute double payment as management is normally performed by an employee of
				the provider and their salary is included in reasonable cost reimbursement.
				(3-17-22)
b. Nothing is to be
				deducted from these funds, unless such deductions are authorized by the patient
				or their agent in writing. (3-17-22)
c. Interest accruing to patient funds on
				deposit is the property of the patients and is part of the personal funds of
				each patient. The interest from these funds is not available to the provider
				for any use, including patient benefits. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › SUB-PART: CHILDREN'S DEVELOPMENTAL DISABILITIES (DD) HOME AND COMMUNITY-BASED SERVICES (HCBS) STATE PLAN OPTION › Section 16.03.10.615 - ICF/IID: POST-ELIGIBILITY TREATMENT OF INCOME

Current through August 31, 2023
01.
Treatment of Income
. Where an individual is determined eligible
				for medical assistance participation in the cost of their long term care, the
				Department will reduce its payment to the long term care facility by the amount
				of their income considered available to meet the cost of his care. This
				determination is made in accordance IDAPA 16.03.05, "Eligibility for Aid for
				the Aged, Blind, and Disabled (AABD)," Sections
				721 through
				725. (3-17-22)
02.
SSA Income
. The amount that
				the Participant receives from SSA as reimbursement for their payment of the
				premium for Part B of Title XVIII (Medicare) is not considered income for
				participant liability in accordance with IDAPA 16.03.05, "Eligibility for Aid
				for the Aged, Blind, and Disabled (AABD)." (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › SUB-PART: CHILDREN'S DEVELOPMENTAL DISABILITIES (DD) HOME AND COMMUNITY-BASED SERVICES (HCBS) STATE PLAN OPTION › Section 16.03.10.616. - 619 - RESERVED

Current through August 31, 2023
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › SUB-PART: CHILDREN'S DEVELOPMENTAL DISABILITIES (DD) HOME AND COMMUNITY-BASED SERVICES (HCBS) STATE PLAN OPTION › Section 16.03.10.620 - ICF/IID: PAYMENTS FOR PERIODS OF TEMPORARY ABSENCE

Current through August 31, 2023
Payments may be made for reserving beds in ICFs/IID for
				  participants during their temporary absence if the facility charges private
				  paying participants for reserve bed days, subject to the following limitations:
				  (3-17-22)
01.
Prior Approval for
				Absence
. Therapeutic home visits for ICF/IID residents of up to
				thirty-six (36) days per calendar year so long as the days are part of a
				written treatment plan ordered by the attending physician. Prior approval from
				the BLTC must be obtained for any home visits exceeding fourteen (14)
				consecutive days. (3-17-22)
02.
Limits on Amount of Payments
. Payment for reserve bed days will be
				lesser of the following: (3-17-22)
a. One
				hundred percent (100%) of the audited allowable costs of the facility; or
				(3-17-22)
b. The rate charged to
				private paying participants for reserve bed days. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › SUB-PART: CHILDREN'S DEVELOPMENTAL DISABILITIES (DD) HOME AND COMMUNITY-BASED SERVICES (HCBS) STATE PLAN OPTION › Section 16.03.10.621 - ICF/IID: PAYMENT PROCEDURES

Current through August 31, 2023
Each ICF/IID must submit its claims to the Department in
				  accordance with the procedures established by the Department. The Department
				  will not pay for a claim in behalf of a Participant unless the information on
				  the claim is consistent with the information in the Department's computer
				  eligibility file. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › SUB-PART: CHILDREN'S DEVELOPMENTAL DISABILITIES (DD) HOME AND COMMUNITY-BASED SERVICES (HCBS) STATE PLAN OPTION › Section 16.03.10.622 - ICF/IID: PRINCIPLE PROSPECTIVE RATES

Current through August 31, 2023
Providers of ICF/IID facilities will be paid a per diem rate
				  that, with certain exceptions, is not subject to an audit settlement. The per
				  diem rate for a fiscal period will be based on audited historical costs
				  adjusted for inflation. The provider must report these cost items in accordance
				  with other provisions of this chapter or the applicable provisions of PRM
				  consistent with this chapter. Sections
				  622 through
				  628 of these rules provide
				  procedures and specifications necessary to implement the provisions and
				  accomplish the objectives of the payment system for ICF/IID providers. Total
				  payment will include the following components: Property reimbursement, capped
				  costs, exempt costs, and excluded costs. Except as otherwise provided in this
				  section, rates calculated for state fiscal year 2012 (July 1, 2011 through June
				  30, 2012) will be calculated by using finalized cost reports ended in calendar
				  year 2009 with no cost or cost limit adjustments for inflation to the rate
				  period of July 1, 2011, through June 30, 2012. Rates effective July 1, 2012,
				  and every July 1 thereafter, will be calculated by using audited cost reports
				  ended in the calendar year two (2) years prior to each July 1 (July 1, 2012,
				  rates will use cost reports ended in calendar year 2010 and so forth), with no
				  cost or cost limit adjustments for inflation. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › SUB-PART: CHILDREN'S DEVELOPMENTAL DISABILITIES (DD) HOME AND COMMUNITY-BASED SERVICES (HCBS) STATE PLAN OPTION › Section 16.03.10.623 - ICF/IID: PROPERTY REIMBURSEMENT

Current through August 31, 2023
Beginning October 1, 1996, ICF/IID property costs are
				  reimbursed by a rental rate or based on cost. The following will be reimbursed
				  based on cost as determined by the provisions of this chapter and applicable
				  provisions of PRM to the extent not inconsistent with this chapter: ICF/IID
				  living unit property taxes, ICF/IID living unit property insurance, and major
				  movable equipment not related to home office or day treatment services.
				  Reimbursement of other property costs is included in the property rental rate.
				  Any property cost related to home offices and day treatment services are not
				  considered property costs and will not be reported in the property cost portion
				  of the cost report. These costs will be reported in the home office and day
				  treatment section of the cost report. Property costs, including costs that are
				  reimbursed based on a rental rate, will be reported in the property cost
				  portion of the cost report. The Department may require and utilize an appraisal
				  to establish those components of property costs that are identified as an
				  integral part of an appraisal. Property costs include the following components:
				  (3-17-22)
01.
Depreciation
. Allowable depreciation based on straight line
				depreciation. (3-17-22)
02.
Interest
. All allowable interest expense that relates to financing
				depreciable assets. Interest on working capital loans is not a property cost
				and is subject to the cap. (3-17-22)
03.
Property Insurance
. All
				allowable property insurance. Malpractice insurance, workmen's compensation and
				other employee-related insurances are not property costs. (3-17-22)
04.
Lease Payments
. All
				allowable lease or rental payments. (3-17-22)
05.
Property Taxes
. All
				allowable property taxes. (3-17-22)
06.
Costs of Related Party
				Leases
. Costs of related party leases are to be reported in the property
				cost categories based on the owner's costs. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › SUB-PART: CHILDREN'S DEVELOPMENTAL DISABILITIES (DD) HOME AND COMMUNITY-BASED SERVICES (HCBS) STATE PLAN OPTION › Section 16.03.10.626 - ICF/IID: RETROSPECTIVE SETTLEMENT

Current through August 31, 2023
When retrospective settlement is applicable, it is based on
				  allowable reimbursement in accordance with this chapter and based on an audit
				  report. Retrospective settlement will be subject to the same caps and limits
				  determined for prospective payments. (3-17-22)
01.
A Provider's Failure to Meet Any of
				the Conditions
. A provider's failure to meet any of the conditions of
				participation set forth in 42 CFR 483, Subpart I, may subject
				that provider to retrospective reimbursement for the fiscal year, or any
				portion thereof, during which the condition is not met. The provider's
				projected per diem rate may be adjusted to reflect actual reimbursable costs
				subject to cost limits. (3-17-22)
02.
A First Time Provide
r. A
				first time provider operating a new ICF/IID living unit will be subject to a
				retrospective settlement for the first fiscal year and until the first
				subsequent period wherein a prospective rate is set in accordance with Sections
				603,
				605, and
				606 of these rules and this
				chapter. A budget based on the best available information is required prior to
				opening for participant care so an interim rate can be set. (3-17-22)
03.
New ICF/IID Living Unit
. A
				new ICF/IID living unit for an existing operator is subject to first time
				facility requirements if the new living unit reflects a net increase in
				licensed beds, otherwise the Department may set a prospective rate with the
				non-property rate components based on similar components of rates most recently
				paid for the participants moving into the facility. The property rental rate
				will be set according to applicable provisions of this chapter.
				(3-17-22)
04.
Change of
				Ownership of Existing ICF/IID Living Unit
. Where there is a change of
				ownership of an existing ICF/IID living unit, the provider operating the
				ICF/IID living unit will not receive an adjustment of the provider's
				prospective rate except that the property rental portion of the rate will be
				adjusted subject to property rental provisions of this chapter. However, new
				facility reporting requirements and the cap will apply. (3-17-22)
05.
Fraudulent or False Claims
.
				Providers who have made fraudulent or false claims are subject to retrospective
				settlement as determined by the Department. (3-17-22)
06.
Excluded Costs
. Excluded
				costs may be retrospectively settled according to the provisions of Section
				247 of these rules.
				(3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › SUB-PART: CHILDREN'S DEVELOPMENTAL DISABILITIES (DD) HOME AND COMMUNITY-BASED SERVICES (HCBS) STATE PLAN OPTION › Section 16.03.10.629 - ICF/IID: LEGAL CONSULTANT FEES AND LITIGATION COSTS

Current through August 31, 2023
Costs of legal consultant fees and litigation costs incurred
				  by the provider will be handled in accordance with the following:
				  (3-17-22)
01.
In General
.
				Legal consultant fees unrelated to the preparation for or the taking of an
				appeal of an audit performed by the Department of Health and Welfare, or
				litigation costs incurred by the provider in an action unrelated to litigation
				with the Department of Health and Welfare, will be allowed as a part of the
				total per diem costs of which the Medicaid Program will reimburse a portion
				according to the percentage of Medicaid patient days. (3-17-22)
02.
Administrative Appeals
. In
				the case of the provider contesting in administrative appeal the findings of an
				audit performed by the Department of Health and Welfare, the costs of the
				provider's legal counsel will be reimbursed by the Medicaid Program only to the
				extent that the provider prevails on the issues involved. The determination of
				the extent that the provider prevails will be based on the ratio of the total
				dollars at issue for the audit period at issue in the hearing to the total
				dollars ultimately awarded to the provider for that audit period by the hearing
				officer or subsequent adjudicator. (3-17-22)
03.
Other
. All other litigation
				costs incurred by the provider in actions against the Department of Health and
				Welfare will not be reimbursable either directly or indirectly by the Medicaid
				Program except where specifically ordered by a court of law.
				(3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › SUB-PART: CHILDREN'S DEVELOPMENTAL DISABILITIES (DD) HOME AND COMMUNITY-BASED SERVICES (HCBS) STATE PLAN OPTION › Section 16.03.10.631 - ICF/IID: PROPERTY REIMBURSEMENT LIMITATIONS

Current through August 31, 2023
Beginning October 1, 1996, property costs of an ICF/IID will
				  be reimbursed in accordance with Section
				  630 of these rules except as
				  follows: (3-17-22)
01.
Restrictions
. No grandfathered rates or lease provisions other than
				lease provisions in Section
				630 of these rules will apply to
				ICF/IID facilities. (3-17-22)
02.
Home Office and Day Treatment Property Cost
s. Distinct parts of
				buildings containing ICF/IID living units may be used for home office or day
				treatment purposes. Reimbursement for the property costs of such distinct parts
				may be allowed if these areas are used exclusively for home office or day
				treatment services. The portion of property cost attributed to these areas may
				be reimbursed as part of home office or day treatment costs without a reduction
				in the property rental rate. Reimbursement for home office and day treatment
				property costs will not include costs reimbursed by, or covered by the property
				rental rate. Such costs will only be reimbursed as property cost if the
				facility clearly included space in excess of space normally used in such
				facilities. At a minimum to qualify for such reimbursement, a structure would
				have square feet per licensed bed in excess of the average square feet per
				licensed bed for other ICF/IID living units within four (4) licensable beds.
				(3-17-22)
03.
Leases for
				Property
. Beginning October 1, 1996, ICF/IID facilities with leases will
				be reimbursed as follows: (3-17-22)
a. The
				property costs related to ICF/IID living units other than costs for major
				movable equipment will be paid by a property rental rate in accordance with
				Section 630 of these
				rules. (3-17-22)
b. Leases for
				property other than ICF/IID living units will be allowable based on lease cost
				to the facility not to exceed a reasonable market rate, subject to other
				provisions of this chapter, and PRM principles including principles associated
				with related party leases. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › SUB-PART: CHILDREN'S DEVELOPMENTAL DISABILITIES (DD) HOME AND COMMUNITY-BASED SERVICES (HCBS) STATE PLAN OPTION › Section 16.03.10.632 - ICF/IID: SPECIAL RATES

Current through August 31, 2023
Section
				  56-117, Idaho Code, provides that
				  the Department may pay facilities a special rate for care given to consumers
				  who have medical or behavior long-term care needs beyond the normal scope of
				  facility services. These individuals must have one (1) or more of the following
				  behavior needs; additional personnel for supervision, additional behavior
				  management, or additional psychiatric or pharmacology services. A special rate
				  may also be given to consumers having medical needs that may include
				  individuals needing ventilator assistance, certain medical pediatric needs, or
				  individuals requiring nasogastric or intravenous feeding devices. These medical
				  and behavior needs are not adequately reflected in the rates calculated
				  pursuant to the principles set in Section
				  56-265, Idaho Code. The payment
				  for such specialized care will be in addition to any payments made in
				  accordance with other provisions of this chapter and will be based on a per
				  diem rate applicable to the incremental additional costs incurred by the
				  facility. Payment for special rates will start with approval by the Department
				  and be and reviewed at least yearly for continued need. The incremental cost to
				  a facility that exceeds the rate for services provided pursuant to the
				  provisions of Section
				  632 of these rules, will be
				  excluded from the computation of payments or rates under other provisions of
				  Section 56-265, Idaho Code, IDAPA
				  16.03.09, "Medicaid Basic Plan Benefits," and IDAPA 16.03.10, "Medicaid
				  Enhanced Plan Benefits." (3-17-22)
01.
Determinations
. A determination to approve or not approve a
				special rate will be made on a consumer-by-consumer basis. No rate will be
				allowed if reimbursement for these needs is available from a nonMedicaid
				source. (3-17-22)
02.
Approval
. Special rates will not be paid unless prior authorized by the
				Department. A special rate may be used in the following circumstances:
				(3-17-22)
a. New admissions to a community
				ICF/IID; (3-17-22)
b. For
				individuals currently living in a community ICF/IID when there has been a
				significant change in condition not reflected in the current rate; or
				(3-17-22)
c. The facility has
				altered services to achieve and maintain compliance with state licensing or
				federal certification requirements that have resulted in additional cost to the
				facility not reflected in their current rate. (3-17-22)
d. For the purpose of this rule, an emergency
				exists when the facility must incur additional behavioral or medical costs to
				prevent a more restrictive placement. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › SUB-PART: CHILDREN'S DEVELOPMENTAL DISABILITIES (DD) HOME AND COMMUNITY-BASED SERVICES (HCBS) STATE PLAN OPTION › Section 16.03.10.633 - REIMBURSEMENT PROVISIONS FOR STATE OWNED OR OPERATED ICF/IID FACILITIES

Current through August 31, 2023
Provisions of these rules do not apply to ICF/IID facilities
				  owned or operated by the state of Idaho. Reimbursement of such facilities will
				  be governed by the principles set forth in the PRM, with the exception of
				  depreciation. Assets of such facilities need not be depreciated if they have an
				  acquisition or historical cost of less than five thousand dollars ($5,000).
				  (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › YOUTH EMPOWERMENT SERVICES (YES) HOME AND COMMUNITY-BASED SERVICES (HCBS) STATE PLAN OPTION › Section 16.03.10.635 - YOUTH EMPOWERMENT SERVICES (YES) HOME AND COMMUNITY-BASED SERVICES (HCBS) STATE PLAN OPTION

Current through August 31, 2023
Home and community-based services are provided through the
				  HCBS State Plan option, as allowed in Section
				  1915(i)  of the
				  Social Security Act, for children who are YES program participants. HCBS state
				  plan option services must be delivered in accordance with Sections
				  635 through
				  638 of these rules.
				  (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › YOUTH EMPOWERMENT SERVICES (YES) HOME AND COMMUNITY-BASED SERVICES (HCBS) STATE PLAN OPTION › Section 16.03.10.636 - YOUTH EMPOWERMENT SERVICES (YES) HCBS STATE PLAN OPTION: DEFINITIONS

Current through August 31, 2023
For the purposes of Sections
				  635 through
				  638 of these rules, the following
				  terms are used as defined below. (3-17-22)
01.
Idaho Behavioral Health Plan
				(IBHP)
. The Idaho Behavioral Health Plan is defined in IDAPA 16.03.09,
				"Medicaid Basic Plan Benefits," Section
				011. (3-17-22)
02.
Independent Assessment
. A
				comprehensive clinical diagnostic assessment and a Department-approved
				assessment tool to identify the child's needs, strengths, and degree of
				functional impairment, administered by a Department-designated independent
				assessor. The assessment process also includes the following activities:
				(3-17-22)
a. Evaluation of the child's current
				behavioral health, living situation, relationships, and family functioning;
				(3-17-22)
b. Contacts, as
				necessary, with significant individuals such as family and teachers; and
				(3-17-22)
c. A review of
				information regarding the child's clinical, educational, social, and behavioral
				health, and juvenile/criminal justice history. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › YOUTH EMPOWERMENT SERVICES (YES) HOME AND COMMUNITY-BASED SERVICES (HCBS) STATE PLAN OPTION › Section 16.03.10.637 - YOUTH EMPOWERMENT SERVICES (YES) HCBS STATE PLAN OPTION: ELIGIBILITY REDETERMINATION

Current through August 31, 2023
YES program participant eligibility will be redetermined by
				  an independent assessment every twelve (12) months. The Department may extend
				  participant eligibility to allow for redetermination if the independent
				  assessment is unavoidably delayed. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › YOUTH EMPOWERMENT SERVICES (YES) HOME AND COMMUNITY-BASED SERVICES (HCBS) STATE PLAN OPTION › Section 16.03.10.638 - YOUTH EMPOWERMENT SERVICES (YES) HCBS STATE PLAN OPTION: COVERAGE AND LIMITATIONS

Current through August 31, 2023
The following services are covered for YES participants:
				  (3-17-22)
01.
Respite
				Care
. Respite care provides supervision to the participant on an
				intermittent or short-term basis because of the need for relief of the primary
				unpaid caregiver of a YES program participant. Respite care is available in
				response to a family emergency or crisis, or may be used on a regular basis to
				provide relief to the caregiver. Payment and administration of respite care
				services will be done through the IBHP and will be established by the
				Department in the IBHP contract. (3-17-22)
02.
Person-Centered Planning
. A
				person-centered planning team, comprised of the participant, family members,
				and other support persons significant to the participant, will direct the
				development of the personcentered service plan through a process approved by
				the Department. The process will include support necessary to enable the
				participant and their family to make informed choices and decisions concerning
				the person-centered service plan. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › ADULT DEVELOPMENTAL DISABILITIES HOME AND COMMUNITY BASED SERVICES (HCBS) STATE PLAN OPTION › Section 16.03.10.645 - HOME AND COMMUNITY-BASED SERVICES (HCBS) STATE PLAN OPTION

Current through August 31, 2023
Home and community-based services are provided through the
				  HCBS State Plan option as allowed in Section
				  1915(i)  of the
				  Social Security Act for adults with developmental disabilities who do not meet
				  the ICF/IID level of care. HCBS state plan option services must comply with
				  Sections 310 through
				  319, and Sections
				  645 through
				  657 of these rules. Through the
				  duration of the COVID-19 public health emergency, the Department reserves the
				  right to temporarily alter requirements and processes related to the Adult
				  Developmental Disabilities HCBS State Plan Option program to mitigate spread of
				  disease and to ensure the health and safety of our participants under the
				  guidance and authority of the provisions in a CMS approved 1135 waiver or a
				  state plan amendment to the existing Adult Developmental Disabilities HCBS
				  State Plan Option benefit. In the event additional changes are required in the
				  future, guidance will be posted on the Medicaid Information Releases webpage.
				  (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › ADULT DEVELOPMENTAL DISABILITIES HOME AND COMMUNITY BASED SERVICES (HCBS) STATE PLAN OPTION › Section 16.03.10.646 - COMMUNITY CRISIS SUPPORTS

Current through August 31, 2023
Community crisis supports are interventions for participants
				  who have been determined eligible for developmental disability services and who
				  are at risk of losing housing, employment, or income, or are at risk of
				  incarceration, physical harm, family altercation, or other emergencies.
				  (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › ADULT DEVELOPMENTAL DISABILITIES HOME AND COMMUNITY BASED SERVICES (HCBS) STATE PLAN OPTION › Section 16.03.10.647 - COMMUNITY CRISIS SUPPORTS: ELIGIBILITY

Current through August 31, 2023
Prior to receiving community crisis supports, an individual
				  must be determined by the Department or its contractor to have a developmental
				  disability under Sections
				  500 through
				  506 of these rules and Section
				  66-402, Idaho Code, be eighteen
				  (18) years of age or older, and live in the community. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › ADULT DEVELOPMENTAL DISABILITIES HOME AND COMMUNITY BASED SERVICES (HCBS) STATE PLAN OPTION › Section 16.03.10.648 - COMMUNITY CRISIS SUPPORTS COVERAGE AND LIMITATIONS

Current through August 31, 2023
Community crisis support may be authorized the following
				  business day after the intervention if there is a documented need for immediate
				  intervention, no other means of support are available, and the services are
				  appropriate to rectify the crisis. Community crisis support is limited to a
				  maximum of twenty (20) hours during any consecutive five (5) day period.
				  (3-17-22)
01.
Emergency
				Room
. Crisis services may be provided in an emergency room during the ER
				evaluation process if the goal is to prevent hospitalization and return the
				participant to the community. (3-17-22)
02.
Before Plan Development
.
				Community crisis support may be provided before or after the completion of the
				assessment and plan of service. If community crisis support is provided before
				the completion of the assessment and plan of service, the plan of service must
				include an identification of the factors contributing to the crisis and a
				strategy for addressing those factors in the future. (3-17-22)
03.
Crisis Resolution Plan
.
				After community crisis support has been provided, the provider of the community
				crisis support service must complete a crisis resolution plan and submit it to
				the Department for approval within seventy-two (72) hours of providing the
				service. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › ADULT DEVELOPMENTAL DISABILITIES HOME AND COMMUNITY BASED SERVICES (HCBS) STATE PLAN OPTION › Section 16.03.10.649 - DEVELOPMENTAL THERAPY

Current through August 31, 2023
The Department will pay for developmental therapy provided by
				  facilities that have entered into a provider agreement with the Department and
				  are certified as developmental disabilities agencies by the Department.
				  (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › ADULT DEVELOPMENTAL DISABILITIES HOME AND COMMUNITY BASED SERVICES (HCBS) STATE PLAN OPTION › Section 16.03.10.650 - DEVELOPMENTAL THERAPY: ELIGIBILITY

Current through August 31, 2023
Prior to receiving developmental therapy in a DDA an
				  individual must be determined by the Department or its contractor to have a
				  developmental disability under Sections
				  500 through
				  506 of these rules and Section
				  66-402, Idaho Code be eighteen
				  (18) years of age or older, and live in the community. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › ADULT DEVELOPMENTAL DISABILITIES HOME AND COMMUNITY BASED SERVICES (HCBS) STATE PLAN OPTION › Section 16.03.10.651 - DEVELOPMENTAL THERAPY: COVERAGE REQUIREMENTS AND LIMITATIONS

Current through August 31, 2023
Developmental therapy must be recommended by a physician or
				  other practitioner of the healing arts. (3-17-22)
01.
Requirements to Deliver
				Developmental Therapy
. Developmental therapy may be delivered in a
				developmental disabilities agency center-based program, the community, or the
				home of the participant. Developmental therapy includes individual
				developmental therapy and group developmental therapy. Developmental therapy
				must be delivered by Developmental Specialists or paraprofessionals qualified
				in accordance with these rules, based on an assessment completed prior to the
				delivery of developmental therapy. (3-17-22)
a. Areas of Service. These services must be
				directed toward the rehabilitation or habilitation of physical or developmental
				disabilities in the areas of self-care, receptive and expressive language,
				learning, mobility, self-direction, capacity for independent living, or
				economic self-sufficiency. (3-17-22)
b. Age-Appropriate. Developmental therapy
				includes instruction in daily living skills the participant has not gained at
				the normal developmental stages in their life, or is not likely to develop
				without training or therapy. Developmental therapy must be age-appropriate.
				(3-17-22)
c. Tutorial Activities
				and Educational Tasks are Excluded. Developmental therapy does not include
				tutorial activities or assistance with educational tasks associated with
				educational needs that result from the participant's disability.
				(3-17-22)
d. Settings for
				Developmental Therapy. Developmental Therapy may be provided in home and
				community-based settings as described in Section
				312 of these rules. Developmental
				therapy, in both individual and group formats, must be available in both
				community-based and home-based settings, and be based on participant needs,
				interests, or choices. (3-17-22)
e.
				Staff-to-Participant Ratio. When group developmental therapy is center-based,
				there must be a minimum of one (1) qualified staff, who may be a
				paraprofessional or a Developmental Specialist, providing direct services for
				every twelve (12) participants. The community-based services must occur in
				integrated, inclusive settings and with no more than three (3) participants per
				qualified staff at each session. Additional staff must be added, as necessary,
				to meet the needs of each individual served. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › ADULT DEVELOPMENTAL DISABILITIES HOME AND COMMUNITY BASED SERVICES (HCBS) STATE PLAN OPTION › Section 16.03.10.652 - DEVELOPMENTAL THERAPY: PROCEDURAL REQUIREMENTS FOR INDIVIDUALS WITH AN ISP

Current through August 31, 2023
01.
Eligibility Determination
.
				Prior to the delivery of developmental therapy, the person must be determined
				by the Department or its contractor to be eligible as defined under Section
				66-402, Idaho Code, be eighteen
				(18) years of age or older, and live in the community. (3-17-22)
02.
Intake
. Prior to the
				delivery of developmental therapy: (3-17-22)
a. A DDA will obtain a participant's current
				medical, social, and developmental information from the Department or its
				designee. (3-17-22)
b. The
				participant must have an ISP that is authorized in accordance with IDAPA
				16.03.10, "Medicaid Enhanced Plan Benefits," Sections
				507 through
				515. Developmental therapy provided
				by the DDA must be included on the plan of service and be prior authorized by
				the Department or its designee before a participant can receive the service
				from the agency. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › ADULT DEVELOPMENTAL DISABILITIES HOME AND COMMUNITY BASED SERVICES (HCBS) STATE PLAN OPTION › Section 16.03.10.653 - DEVELOPMENTAL THERAPY: PROCEDURAL REQUIREMENTS FOR INDIVIDUALS WITH AN IPP

Current through August 31, 2023
01.
Eligibility Determination
.
				Prior to the delivery of developmental therapy, the person must be determined
				by the Department or its contractor to be eligible as defined under Section
				66-402, Idaho Code, be eighteen
				(18) years of age or older, and live in the community. (3-17-22)
02.
Intake
. Individuals using
				the Home and Community-Based Services (HCBS) waiver for the Aged and Disabled
				(A&D) or State Plan Personal Care Services and only requesting DDA
				services, have the option to access services through an Individual Program
				Plan. Individuals who select this option are not required to have a
				developmental disability plan developer. Services delivered through an
				Individual Program Plan must be authorized by the Department or its contractor
				and be based on the Aged and Disabled written Individual Service Plan as
				defined in Section 328 of these
				rules. Prior to the delivery of developmental therapy, a DDA must complete an
				Individual Program Plan (IPP) that meets the standards described below.
				(3-17-22)
03.
Individual
				Program Plan (IPP) Definitions
. The delivery of developmental therapy on
				a written plan of care must be defined in terms of the type, amount, frequency,
				and duration of the service. (3-17-22)
a. Type
				of service refers to the kind of service described in terms of: (3-17-22)
i. Group, individual, or family; and
				(3-17-22)
ii. Whether the service
				is home, community, or center-based. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › ADULT DEVELOPMENTAL DISABILITIES HOME AND COMMUNITY BASED SERVICES (HCBS) STATE PLAN OPTION › Section 16.03.10.654 - DEVELOPMENTAL THERAPY: PROCEDURAL REQUIREMENTS

Current through August 31, 2023
01.
Assessment and Diagnostic Services
. DDAs must obtain assessments
				required under Sections
				507 through
				515 of these rules. Four (4) hours
				is the maximum Medicaid reimbursable time allowed for the combination of all
				assessment, evaluation, or diagnostic services provided in any calendar year.
				The following assessment and diagnostic services are reimbursable when provided
				in accordance with these rules: (3-17-22)
a.
				Comprehensive Developmental Assessment; and (3-17-22)
b. Specific Skill Assessment.
				(3-17-22)