reglab/statecodes huggingface dataset:
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 16.03.10.655 - DEVELOPMENTAL THERAPY: PROVIDER QUALIFICATIONS AND DUTIES

Current through August 31, 2023
01.
Developmental Specialist for
				Adults
. To be qualified as a Developmental Specialist for adults, a
				person must have a minimum of two hundred forty (240) hours of
				professionally-supervised experience with individuals who have developmental
				disabilities and either: (3-17-22)
a. Possess
				a bachelor's or master's degree in special education, early childhood special
				education, speech and language pathology, applied behavioral analysis,
				psychology, physical therapy, occupational therapy, social work, or therapeutic
				recreation; or (3-17-22)
b. Possess
				a bachelor's or master's degree in an area not listed above in Subsection
				657.05.a. of this rule and
				have: (3-17-22)
i. Completed a competency
				course jointly approved by the Department and the Idaho Association of
				Developmental Disabilities Agencies that relates to the job requirements of a
				Developmental Specialist; and (3-17-22)
ii. Passed a competency examination approved
				by the Department. (3-17-22)
c. Any person employed as a Developmental
				Specialist in Idaho prior to May 30, 1997, unless previously disallowed by the
				Department, will be allowed to continue providing services as a Developmental
				Specialist as long as there is not a gap of more than three (3) years of
				employment as a Developmental Specialist. (3-17-22)
d. Through the duration of the COVID-19
				public health emergency, Development Specialists for adults may begin rendering
				services prior to completing the training requirements provided that they
				complete the training requirements within thirty (30) days of first rendering
				services, advise the participant or legal guardian that the individual has not
				yet completed the applicable trainings, and comply with any other requirements
				specified by the Department in a COVID-19 information release posted on the
				Department's website at
https://healthandwelfare.idaho.gov/Providers/Providers-Medicaid/InformationReleases/tabid/264/Default.aspx
.
				(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 16.03.10.656 - GENERAL STAFFING REQUIREMENTS

Current through August 31, 2023
01.
Standards for Paraprofessionals Providing Developmental Therapy
. When a
				paraprofessional provides developmental therapy, the agency must ensure
				adequate supervision by a qualified professional during its service hours. All
				paraprofessionals must meet the training requirements under IDAPA 16.03.21,
				"Developmental Disabilities Agencies (DDA)," Section
				410 and must meet the
				qualifications under Section
				655 of these rules. A
				paraprofessional providing developmental therapy must be supervised by a
				Developmental Specialist. For paraprofessionals to provide developmental
				therapy in a DDA, the agency must adhere to the following standards: (3-17-22)
a. Limits to Paraprofessional Activities. The
				agency must ensure that paraprofessionals do not conduct participant
				assessments, establish a plan of service or develop a Program Implementation
				Plan. These activities must be conducted by a professional qualified to provide
				the service. (3-17-22)
b. Frequency
				of Supervision. The agency must ensure that a professional qualified to provide
				the service must, for all paraprofessionals under their supervision, on a
				weekly basis or more often if necessary: (3-17-22)
i. Give instructions; (3-17-22)
ii. Review progress; and (3-17-22)
iii. Provide training on the program(s) and
				procedures to be followed. (3-17-22)
c. Professional Observation. The agency must
				ensure that a professional qualified to provide the service must, on a monthly
				basis or more often if necessary, observe and review the work performed by the
				paraprofessional under their supervision, to ensure the paraprofessional has
				been trained on the program(s) and demonstrates the necessary skills to
				correctly implement the program(s). (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 16.03.10.657 - DEVELOPMENTAL THERAPY: PROVIDER REIMBURSEMENT

Current through August 31, 2023
Payment for developmental therapy provided by a DDA must be
				  in accordance with rates established 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 16.03.10.658 - COVID-19 PUBLIC HEALTH EMERGENCY RESIDENTIAL HABILITATION

Current through August 31, 2023
Through the duration of the COVID-19 public health emergency,
				  the Department will pay for residential habilitation services, as described in
				  Subsection 703.01 of these rules, provided
				  by facilities that have entered into a provider agreement with the Department
				  and are certified as developmental disabilities agencies by the Department.
				  Prior to receiving residential habilitation services from 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. DDA's providing
				  residential habilitation services must comply with any additional requirements
				  specified by the Department in a COVID-19 information release posted on the
				  Department's website at
https://healthandwelfare.idaho.gov/Providers/Providers-Medicaid/InformationReleases/tabid/264/Default.aspx
.
				  (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › ADULTS WITH DEVELOPMENTAL DISABILITIES WAIVER SERVICES › Section 16.03.10.700 - ADULTS WITH DEVELOPMENTAL DISABILITIES WAIVER SERVICES

Current through August 31, 2023
Under 42
				  CFR Section 440.180, it is the intention of
				  the Department to provide waiver services to eligible adult participants to
				  prevent unnecessary institutional placement, provide for the greatest degree of
				  independence possible, enhance the quality of life, encourage individual
				  choice, and achieve and maintain community integration. For an adult
				  participant to be eligible, the Department must find that the participant
				  requires services due to a developmental disability that impairs their mental
				  or physical function or independence, is capable of being maintained safely and
				  effectively in a non-institutional setting, and would, in the absence of such
				  services, need to reside in an ICF/IID. 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 DD waiver 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
				  HCBS Attachment K amendment to the existing Adult Developmental Disability
				  waiver. 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 › ADULTS WITH DEVELOPMENTAL DISABILITIES WAIVER SERVICES › Section 16.03.10.702 - ADULT DD WAIVER SERVICES: ELIGIBILITY

Current through August 31, 2023
Waiver eligibility will be determined by the Department as
				  described in Section 509 of these
				  rules. The participant must be financially eligible for Medical Assistance as
				  described in IDAPA 16.03.05, "Eligibility for Aid for the Aged, Blind, and
				  Disabled (AABD)," Section
				  787. The cited chapter implements
				  and is in accordance with the Financial Eligibility Section of the Idaho State
				  Plan. In addition, waiver participants must meet the following requirements:
				  (3-17-22)
01.
Age of
				Participants
. DD waiver participants must be eighteen (18) years of age
				or older. (3-17-22)
02.
Eligibility Determinations
. The Department must determine that:
				(3-17-22)
a. The participant would qualify
				for ICF/IID level of care as set forth in Section
				584 of these rules, if the waiver
				services listed in Section
				703 of these rules were not made
				available; and (3-17-22)
b. The
				participant could be safely and effectively maintained in the requested or
				chosen community residence with appropriate waiver services. This determination
				must: be made by a team of individuals with input from the person-centered
				planning team; and prior to any denial of services on this basis, be determined
				by the plan developer that services to correct the concerns of the team are not
				available. (3-17-22)
c. The average
				annual cost of waiver services and other medical services to the participant
				would not exceed the average annual cost to Medicaid of ICF/IID care and other
				medical costs. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › ADULTS WITH DEVELOPMENTAL DISABILITIES WAIVER SERVICES › Section 16.03.10.703 - ADULT DD WAIVER SERVICES: COVERAGE AND LIMITATIONS

Current through August 31, 2023
01.
Residential Habilitation
.
				Residential habilitation services consist of an integrated array of
				individually tailored services and supports furnished to eligible participants.
				These services and supports are designed to assist the participants to reside
				successfully in their own homes, with their families, or in certified family
				homes. The services and supports that may be furnished consist of the
				following: (3-17-22)
a. Habilitation services
				aimed at assisting the individual to acquire, retain, or improve their ability
				to reside as independently as possible in the community or maintain family
				unity. Habilitation services include training in one (1) or more of the
				following areas: (3-17-22)
i. Self-direction,
				including the identification of and response to dangerous or threatening
				situations, making decisions and choices affecting the individual's life, and
				initiating changes in living arrangements or life activities;
				(3-17-22)
ii. Money management
				including training or assistance in handling personal finances, making
				purchases, and meeting personal financial obligations; (3-17-22)
iii. Daily living skills including training
				in accomplishing routine housekeeping tasks, meal preparation, dressing,
				personal hygiene, self-administration of medications, and other areas of daily
				living including proper use of adaptive and assistive devices, appliances, home
				safety, first aid, and emergency procedures; (3-17-22)
iv. Socialization including training or
				assistance in participation in general community activities and establishing
				relationships with peers with an emphasis on connecting the participant to
				their community. (Socialization training associated with participation in
				community activities includes assisting the participant to identify activities
				of interest, working out arrangements to participate in such activities and
				identifying specific training activities necessary to assist the participant to
				continue to participate in such activities on an on-going basis. Socialization
				training does not include participation in non-therapeutic activities that are
				merely diversional or recreational in nature); (3-17-22)
v. Mobility, including training or assistance
				aimed at enhancing movement within the person's living arrangement, mastering
				the use of adaptive aids and equipment, accessing and using public
				transportation, independent travel, or movement within the community;
				(3-17-22)
vi. Behavior shaping and
				management includes training and assistance in appropriate expressions of
				emotions or desires, assertiveness, acquisition of socially appropriate
				behaviors; or extension of therapeutic services that consist of reinforcing
				physical, occupational, speech and other therapeutic programs.
				(3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › ADULTS WITH DEVELOPMENTAL DISABILITIES WAIVER SERVICES › Section 16.03.10.704 - ADULT DD WAIVER SERVICES: PROCEDURAL REQUIREMENTS

Current through August 31, 2023
01.
Authorization of Services on a
				Written Plan
. All waiver services must be identified on the plan of
				service and authorized by the process described in Sections
				507 through
				520 of these rules. The plan of
				service must be reviewed by a plan monitor or targeted service coordinator at a
				frequency determined by the person-centered planning team, but at least every
				ninety (90) days. (3-17-22)
02.
Provider Records
. Three (3) types of record information will be
				maintained on all participants receiving waiver services: (3-17-22)
a. Direct Service Provider Information that
				includes written documentation of each visit made or service provided to the
				participant, and will record at a minimum the following information: (3-17-22)
i. Date and time of visit; and
				(3-17-22)
ii. Services provided
				during the visit; and (3-17-22)
iii. A statement of the participant's
				response to the service, if appropriate to the service provided, including any
				changes in the participant's condition; and (3-17-22)
iv. Length of visit, including time in and
				time out, if appropriate to the service provided. Unless the participant is
				determined by the Service Coordinator to be unable to do so, the delivery will
				be verified by the participant as evidenced by their signature on the service
				record. (3-17-22)
v. A copy of the
				above information will be maintained in the participant's home unless
				authorized to be kept elsewhere by the Department. Failure to maintain such
				documentation will result in the recoupment of funds paid for undocumented
				services. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › ADULTS WITH DEVELOPMENTAL DISABILITIES WAIVER SERVICES › Section 16.03.10.705 - ADULT DD WAIVER SERVICES: PROVIDER QUALIFICATIONS AND DUTIES

Current through August 31, 2023
All providers of waiver services must have a valid provider
				  agreement with the Department. Performance under this agreement will be
				  monitored by the Department. (3-17-22)
01.
Residential Habilitation --
				Supported Living
. When residential habilitation services are provided by
				an agency, the agency must be certified by the Department as a Residential
				Habilitation Agency under IDAPA 16.04.17, "Residential Habilitation Agencies,"
				and must supervise the direct services provided. Individuals who provide
				residential habilitation services in the home of the participant (supported
				living) must be employed by a Residential Habilitation Agency. Providers of
				residential habilitation services must meet the following requirements:
				(3-17-22)
a. Direct service staff must meet
				the following minimum qualifications: (3-17-22)
i. Be at least eighteen (18) years of age;
				(3-17-22)
ii. Be a high school
				graduate, or have a GED, or demonstrate the ability to provide services
				according to a plan of service; (3-17-22)
iii. Have current CPR and First Aid
				certifications; (3-17-22)
iv. Be
				free from communicable disease; (3-17-22)
v. Each staff person assisting with
				participant medications has successfully completed the "Assistance with
				Medications" course available through the Idaho Professional Technical
				Education Program approved by the Idaho State Board of Nursing or other
				Department-approved training. (3-17-22)
vi. Residential habilitation service
				providers who provide direct care or services satisfactorily completed a
				criminal background check in accordance with Section
				009 of these rules and IDAPA
				16.05.06, "Criminal History and Background Checks." (3-17-22)
vii. Have appropriate certification or
				licensure if required to perform tasks that require certification or licensure.
				(3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › ADULTS WITH DEVELOPMENTAL DISABILITIES WAIVER SERVICES › Section 16.03.10.706 - ADULT DD WAIVER SERVICES: PROVIDER REIMBURSEMENT

Current through August 31, 2023
01.
Fee for Service
. Waiver
				service providers will be paid on a fee for service basis based on the type of
				service provided as established by the Department. (3-17-22)
02.
Claim Forms
. Provider claims
				for payment will be submitted on claim forms provided or approved by the
				Department. Billing instructions will be provided by the Department.
				(3-17-22)
03.
Rates
.
				The reimbursement rates calculated for waiver services include both services
				and mileage. No separate charges for mileage will be paid by the Department for
				provider transportation to and from the participant's home or other service
				delivery location when the participant is not being provided transportation.
				(3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › SUB AREA: SERVICE COORDINATION SERVICES › Section 16.03.10.720 - SERVICE COORDINATION

Current through August 31, 2023
The Department will purchase service coordination for persons
				  eligible for Enhanced Benefits who are unable, or have limited ability to gain
				  access, coordinate or maintain services on their own or through other means.
				  These rules are not applicable to behavioral health service coordination, also
				  known as case management services, provided under the Idaho Behavioral Health
				  Plan (IBHP) included in IDAPA 16.03.09, "Medicaid Basic Plan Benefits."
				  (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › SUB AREA: SERVICE COORDINATION SERVICES › Section 16.03.10.721 - SERVICE COORDINATION: DEFINITIONS

Current through August 31, 2023
The following definitions apply for Sections
				  721 through
				  736 of these rules.
				  (3-17-22)
01.
Agency
. An
				agency is a business entity that provides management, supervision, and quality
				assurance for service coordination and includes at least two (2) individuals,
				one (1) supervisor and a minimum of one (1) service coordinator.
				(3-17-22)
02.
Brokerage
				Model
. Referral or arrangement for services identified in an assessment.
				This model does not include the provision of direct services.
				(3-17-22)
03.
Conflict of
				Interest
. A situation in which an agency or person directly or
				indirectly influences. or appears to influence the direction of a participant
				to other services for financial gain. (3-17-22)
04.
Crisis
. An unanticipated
				event, circumstance or life situation that places a participant at risk of at
				least one (1) of the following: (3-17-22)
a.
				Hospitalization; (3-17-22)
b. Loss
				of housing; (3-17-22)
c. Loss of
				employment or major source of income; (3-17-22)
d. Incarceration; or (3-17-22)
e. Physical harm to self or others, including
				family altercation or psychiatric relapse. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › SUB AREA: SERVICE COORDINATION SERVICES › Section 16.03.10.722 - SERVICE COORDINATION SERVICES: ELIGIBILITY

Current through August 31, 2023
Participants identified in Sections
				  723 through
				  726 of these rules, who do not
				  receive hospice services or live in hospitals, nursing facilities, or
				  intermediate care facilities for persons with intellectual disabilities, are
				  eligible for service coordination. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › SUB AREA: SERVICE COORDINATION SERVICES › Section 16.03.10.723 - TARGETED SERVICE COORDINATION: ELIGIBILITY: INDIVIDUALS WITH A DEVELOPMENTAL DISABILITY

Current through August 31, 2023
An individual is eligible to receive targeted service
				  coordination if they meet the following requirements in this rule.
				  (3-17-22)
01.
Age
. An
				adult eighteen (18) years of age or older. (3-17-22)
02.
Diagnosis
. Is diagnosed with
				a developmental disability, defined in Section
				66-402, Idaho Code and Section
				500 through
				506 of these rules, that: (3-17-22)
a. Is attributable to an impairment, such as
				an intellectual disability, cerebral palsy, epilepsy, autism or other condition
				found to be closely related to or similar to one (1) of these impairments that
				requires similar treatment or services, or is attributable to dyslexia
				resulting from such impairments; (3-17-22)
b. Results in substantial functional
				limitations in three (3) or more of the following areas of major life activity:
				self-care, receptive and expressive language, learning, mobility,
				self-direction, capacity for independent living, or economic self-sufficiency;
				and (3-17-22)
c. Reflects the need
				for a combination and sequence of special, interdisciplinary or generic care,
				treatment or other services that are of lifelong or extended duration and
				individually planned and coordinated. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › SUB AREA: SERVICE COORDINATION SERVICES › Section 16.03.10.726 - SERVICE COORDINATION: ELIGIBILITY: INDIVIDUALS UP TO THE AGE OF TWENTY-ONE

Current through August 31, 2023
To be eligible for children's service coordination, a
				  participant must meet the following requirements in Subsections
				  726.01 through
				  726.03. Eligibility is
				  determined initially and annually by the Department based on information
				  provided by the service coordination agency or the family. All information
				  necessary to make the eligibility determination must be received by the
				  Department twenty (20) business days prior to the anticipated start date of any
				  service coordination services. The eligibility determination will be made by
				  the Department prior to the initiation of initial and ongoing plan development
				  and services. (3-17-22)
01.
Age
. From the age of thirty-seven (37) months through the month in
				which their twenty-first birthday occurs. (3-17-22)
02.
Diagnosis
. Must have
				special health care needs requiring medical and multidisciplinary
				rehabilitation services identified by a physician or other practitioner of the
				healing arts to prevent or minimize a disability. (3-17-22)
03.
Need Assistance
.
				Medicaid-reimbursed service coordination services are not available for
				participants whose needs can be met by other service coordination or case
				management resources, including paid and non-paid sources. The participant must
				have needs for service coordination for one (1) or more of the following
				problems: (3-17-22)
a. The condition has
				resulted in a level of functioning below normal age level in one (1) or more
				life areas such as school, child care setting, family, or community;
				(3-17-22)
b. The child is at risk
				of placement in a more restrictive environment or the child is returning from
				an out of home placement as a result of the condition; (3-17-22)
c. There is danger to the health or safety of
				the child or the parent is unable to meet the needs of the child;
				(3-17-22)
d. Further complications
				may occur as a result of the condition without provision of service
				coordination services; or (3-17-22)
e. The child requires multiple service
				providers and treatments. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › SUB AREA: SERVICE COORDINATION SERVICES › Section 16.03.10.727 - SERVICE COORDINATION: COVERAGE AND LIMITATIONS

Current through August 31, 2023
Service coordination consists of services provided to assist
				  individuals in gaining access to needed services. Service coordination includes
				  the following activities described in Subsections
				  727.01 through
				  727.10 of this rule.
				  (3-17-22)
01.
Plan Assessment
				and Periodic Reassessment
. Activities that are required to determine the
				participant's needs by development of a plan assessment and periodic
				reassessment as described in Section
				730 of these rules. These
				activities include: (3-17-22)
a. Taking a
				participant's history; (3-17-22)
b.
				Identifying the participant's needs and completing related documentation; and
				(3-17-22)
c. Gathering information
				from other sources such as family members, medical providers, social workers,
				and educators, to form a complete assessment of the participant.
				(3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › SUB AREA: SERVICE COORDINATION SERVICES › Section 16.03.10.728 - SERVICE COORDINATION: PROCEDURAL REQUIREMENTS

Current through August 31, 2023
01.
Prior Authorization for Service Coordination Services
. Services
				must be prior authorized by the Department according to the direction provided
				in the Medicaid Provider Handbook available at
www.idmedicaid.com
.
				(3-17-22)
02.
Service
				Coordination Plan Development
. (3-17-22)
a. A written plan, described in Section
				731 of these rules, must be
				developed and implemented within sixty (60) days after the participant chooses
				a service coordinator. (3-17-22)
b.
				The plan must be updated at least annually (or extended through the duration of
				the declared COVID-19 public health emergency) and amended as necessary.
				(3-17-22)
c. The plan must address
				the service coordination needs of the participant as identified in the
				assessment described in Section
				730 of these rules.
				(3-17-22)
d. The plan must be
				developed prior to ongoing service coordination being provided.
				(3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › SUB AREA: SERVICE COORDINATION SERVICES › Section 16.03.10.729 - SERVICE COORDINATION: PROVIDER QUALIFICATIONS

Current through August 31, 2023
Service coordination services must be provided by an agency
				  as defined in Section
				  721 of these rules.
				  (3-17-22)
01.
Provider
				Agreements
. Service coordinators must be employees or contractors of an
				agency that has a valid provider agreement with the Department.
				(3-17-22)
02.
Supervision
. The agency must provide supervision to all service
				coordinators and paraprofessionals. The agency must clearly document: (3-17-22)
a. Each supervisor's ability to address
				concerns about the services provided by employees and contractors under their
				supervision, and (3-17-22)
b. That
				a paraprofessional is not a supervisor. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › SUB AREA: SERVICE COORDINATION SERVICES › Section 16.03.10.730 - SERVICE COORDINATION: PLAN DEVELOPMENT - ASSESSMENT

Current through August 31, 2023
01.
Assessment Process
. The
				service coordination assessment must be completed by a service coordinator as
				part of the person-centered planning process. The focus of the assessment is to
				identify the participant's need for assistance in gaining and coordinating
				access to care and services. The participant must be included in the assessment
				process. The parent or legal guardian, when appropriate, and pertinent service
				providers as identified by the participant must also be included during the
				assessment process. The assessment component is used to determine the
				prioritized needs and services of the participant and must be documented in the
				plan. When the participant is a child, the assessment must include
				identification of the family's needs to ensure the child's needs are met.
				(3-17-22)
02.
Components of
				an Assessment
. The components in the assessment of a participant's
				service coordination needs must document the following information; (3-17-22)
a. Basic needs; (3-17-22)
b. Medical needs; (3-17-22)
c. Health and safety needs;
				(3-17-22)
d. Therapy needs;
				(3-17-22)
e. Educational needs;
				(3-17-22)
f. Social and integration
				needs; (3-17-22)
g. Personal needs;
				(3-17-22)
h. Family needs and
				supports; (3-17-22)
i. Long range
				planning; (3-17-22)
j. Legal needs;
				and (3-17-22)
k. Financial needs.
				(3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › SUB AREA: SERVICE COORDINATION SERVICES › Section 16.03.10.731 - SERVICE COORDINATION: PLAN DEVELOPMENT - WRITTEN PLAN

Current through August 31, 2023
The service coordination plan is developed using information
				  collected through the assessment of the participant's service coordination
				  needs. The plan must specify the goals and actions to address the service
				  coordination needs of the participant identified in the assessment process. The
				  plan must include goals developed using the person-centered planning process.
				  (3-17-22)
01.
Plan
				Implementation
. The plan must identify activities required to respond to
				the assessed needs of the participant. (3-17-22)
02.
Plan Content
. Plans must
				include the following: (3-17-22)
a. A list of
				problems and needs identified during the assessment; (3-17-22)
b. Identification of each and any potential
				risk or substantiation that there are no potential risks. The plan must
				identify services and actions that will be implemented in case of a participant
				crisis situation. (3-17-22)
c.
				Concrete, measurable goals and objectives to be achieved by the participant;
				(3-17-22)
d. Reference to all
				services and contributions provided by the participant's supports including the
				actions, if any, taken by the service coordinator to develop the support
				system; (3-17-22)
e. Documentation
				of who has been involved in the service planning, including the participant's
				involvement; (3-17-22)
f. Schedules
				for service coordination monitoring, progress review, and reassessment;
				(3-17-22)
g. Documentation of unmet
				needs and service gaps including goals to address these needs or gaps;
				(3-17-22)
h. References to any
				formal services arranged including costs, specific providers, schedules of
				service initiation, frequency or anticipated dates of delivery; and
				(3-17-22)
i. Time frames for
				achievement of the goals and objectives. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › SUB AREA: SERVICE COORDINATION SERVICES › Section 16.03.10.736 - SERVICE COORDINATION: PROVIDER REIMBURSEMENT

Current through August 31, 2023
01.
Duplication
. Participants are only eligible for one (1) type of
				service coordination. If they qualify for more than one (1) type, the
				participant must choose one (1). Service coordination payment must not
				duplicate payment made to public or private sector entities under other program
				authorities for this same purpose. (3-17-22)
02.
Payment for Service
				Coordination
. Subject to the service limitations in Subsection
				736.06 of this rule, only the
				following services are reimbursable: (3-17-22)
a. Service coordination plan development
				defined in Section 721 of these
				rules. (3-17-22)
b. Face-to-face
				contact required in Subsection
				728.06 of these rules.
				(3-17-22)
c. Two-way communication
				between the service coordinator and the participant, participant's service
				providers, family members, primary care givers, legal guardian, or other
				interested persons. (3-17-22)
d.
				Face-to-face contact between the service coordinator and the participant's
				family members, legal representative, primary caregivers, providers, or other
				interested persons. (3-17-22)
e.
				Referral and related activities associated with obtaining needed services as
				identified in the service coordination plan. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › SUB AREA: BREAST AND CERVICAL CANCER PROGRAM › Section 16.03.10.780 - BREAST OR CERVICAL CANCER PROGRAM THROUGH THE WOMEN'S HEALTH CHECK

Current through August 31, 2023
Women who are determined eligible for Medicaid through the
				  Women's Health Check program are eligible for enhanced Medicaid benefits until
				  it is determined that cancer treatment has ended. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › SUB AREA: BREAST AND CERVICAL CANCER PROGRAM › Section 16.03.10.781 - BREAST OR CERVICAL CANCER PROGRAM: DEFINITIONS

Current through August 31, 2023
01.
Primary Treatment
. The
				initial action of treating a patient medically or surgically for cancer using
				conventional treatment modalities. (3-17-22)
02.
Adjuvant Therapy
. Treatment
				that includes either radiation or systemic chemotherapy, or both, as part of
				the plan of care. (3-17-22)
03.
End of Treatment
. Cancer treatment ends: (3-17-22)
a. When the woman's plan of care reflects a
				status of surveillance, follow-up, or maintenance mode; or (3-17-22)
b. If the woman's treatment relies on an
				unproven procedure, as referred to in IDAPA 16.03.09, "Medicaid Basic Plan
				Benefits," Section 390 in lieu
				of primary or adjuvant treatment. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › SUB AREA: BREAST AND CERVICAL CANCER PROGRAM › Section 16.03.10.782 - BREAST OR CERVICAL CANCER PROGRAM: ELIGIBILITY

Current through August 31, 2023
Women eligible for Medical Assistance, as provided for in
				  IDAPA 16.03.05, "Eligibility for Aid to the Aged, Blind, and Disabled (AABD),"
				  Section 802, will be
				  covered while receiving either primary or adjuvant cancer treatment, or both.
				  (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › SUB AREA: BREAST AND CERVICAL CANCER PROGRAM › Section 16.03.10.783 - BREAST OR CERVICAL CANCER PROGRAM: PROCEDURAL REQUIREMENTS

Current through August 31, 2023
The Division of Medicaid, or its successor, is responsible
				  for determining when a woman's treatment has ended. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.11 - INTERMEDIATE CARE FACILITIES FOR PEOPLE WITH INTELLECTUAL DISABILITIES (ICFS/IID) › Section 16.03.11.000 - LEGAL AUTHORITY

Current through August 31, 2023
The Board of Health and Welfare is authorized under Sections
				39-1301 through
				39-1314, Idaho Code, to adopt,
				amend, and enforce rules, regulations, and standards for licensure that promote
				safe and adequate treatment, and to protect the health and safety of
				individuals being cared for in intermediate care facilities for people with
				intellectual disabilities defined in Section
				39-1301(c), Idaho
				Code. The Department is authorized under 42 CFR Part 483 to set conditions of
				participation for intermediate care facilities for individuals with
				intellectual disabilities (ICFs/IID). Under Sections
				56-1002,
				56-1003,
				56-1004,
				56-1004A,
				56-1005,
				56-1007, and
				56-1009, Idaho Code, the
				Department and the Board of Health and Welfare have prescribed powers and
				duties to provide for the administration and enforcement of Department programs
				and rules. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.11 - INTERMEDIATE CARE FACILITIES FOR PEOPLE WITH INTELLECTUAL DISABILITIES (ICFS/IID) › Section 16.03.11.001 - TITLE AND SCOPE

Current through August 31, 2023
01.
Title
. These rules are titled IDAPA 16.03.11, "Intermediate Care
			 Facilities for People with Intellectual Disabilities (ICFs/IID)."
			 (3-17-22)
02.
Scope
.
			 These rules include the licensing standards and requirements for the
			 administration of intermediate care facilities for the active treatment of
			 individuals with intellectual disabilities and related conditions. This service
			 delivery system provides care through small community-based facilities with the
			 least restrictive alternatives including deinstitutionalization, normalization,
			 and individual programming to enhance each individual's self-sufficiency for
			 personal development and health needs. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.11 - INTERMEDIATE CARE FACILITIES FOR PEOPLE WITH INTELLECTUAL DISABILITIES (ICFS/IID) › Section 16.03.11.002 - WRITTEN INTERPRETATIONS

Current through August 31, 2023
The Department may have written statements that pertain to the
				interpretation of this chapter, or to the documentation of compliance with
				these rules. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.11 - INTERMEDIATE CARE FACILITIES FOR PEOPLE WITH INTELLECTUAL DISABILITIES (ICFS/IID) › Section 16.03.11.006 - CONFIDENTIALITY OF RECORDS AND PUBLIC RECORDS ACT COMPLIANCE AND REQUESTS

Current through August 31, 2023
01.
Confidentiality of Records
.
			 Any disclosure of confidential information used or disclosed in the course of
			 the Department's business is subject to the restrictions in state or federal
			 law, and must comply with IDAPA 16.05.01, "Use and Disclosure of Department
			 Records." (3-17-22)
02.
Public Records Act
. The Department will comply with Title 74, Chapter 1,
			 Idaho Code, when requests for the examination and copying of public records are
			 made. Unless otherwise exempted, all public records in the custody of the
			 Department are subject to disclosure. (3-17-22)
03.
Disclosure of an Individual's
			 Identity
. Under Section
			 39-1310, Idaho Code, information
			 received by the Department through filed reports, inspections, or as required
			 by law, will not be disclosed publicly in such a manner as to identify
			 individuals except as necessary in a proceeding involving a question of
			 licensure. (3-17-22)
04.
Public Availability of Survey Reports
. The Department will post on
			 the Division of Licensing and Certification's website, survey reports and
			 findings of complaint investigations relating to a facility at
http://facilitystandards.idaho.gov
.
			 (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.11 - INTERMEDIATE CARE FACILITIES FOR PEOPLE WITH INTELLECTUAL DISABILITIES (ICFS/IID) › Section 16.03.11.009 - CRIMINAL HISTORY AND BACKGROUND CHECK REQUIREMENTS

Current through August 31, 2023
01.
Criminal History and Background
			 Check
. An intermediate care facility for people with intellectual
			 disabilities (ICF/IID) must comply with the Department's criminal history and
			 background check rules in IDAPA 16.05.06, "Criminal History and Background
			 Checks." (3-17-22)
02.
Individuals Subject to Criminal History Checks
. Owners, administrators,
			 employees, and contractors, hired or contracted with after October 1, 2007, who
			 have direct access to individuals residing in an ICF/IID must complete and
			 receive a Department criminal history and background check clearance as
			 provided in IDAPA 16.05.06, "Criminal History and Background Checks."
			 (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.11 - INTERMEDIATE CARE FACILITIES FOR PEOPLE WITH INTELLECTUAL DISABILITIES (ICFS/IID) › Section 16.03.11.020 - LICENSE REQUIRED

Current through August 31, 2023
An intermediate care facility for people with intellectual
				disabilities (ICF/IID) cannot be established, maintained, or operated within
				Idaho without obtaining a license from the Department as required in Sections
				39-1301 through
				39-1314, Idaho Code. An ICF/IID
				must be in compliance with Idaho statutes, federal regulations, and this
				chapter of rules in order to hold a license. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.11 - INTERMEDIATE CARE FACILITIES FOR PEOPLE WITH INTELLECTUAL DISABILITIES (ICFS/IID) › Section 16.03.11.021 - ICF/IID LICENSURE REQUIREMENTS

Current through August 31, 2023
01.
Facility
			 Name
. Each ICF/IID must use a distinctive name for the facility which is
			 registered with the Secretary of State of Idaho. The facility cannot change its
			 name without written notification to the Department at least thirty (30) days
			 prior to the date the proposed name change is to be effective.
			 (3-17-22)
02.
Physical
			 Location
. Each ICF/IID must meet the requirements under Sections
			 67-6530 through
			 67-6532, Idaho Code, for local
			 planning and zoning laws or ordinances. Facilities serving eight (8) or fewer
			 individuals with intellectual disabilities are not required to secure
			 conditional use permits, zoning variances, or zoning clearance.
			 (3-17-22)
03.
Size
			 Limitations
. The maximum size of an ICF/IID must be no more than fifteen
			 (15) beds. An ICF/IID that has continuously operated under current ownership
			 since July 1, 1980, or before, and continues to operate under that ownership,
			 is exempt from this requirement. (3-17-22)
04.
Compliance with Water and
			 Sanitation Rules
. Each ICF/IID must have a statement from the Public
			 Health District indicating that the water supply and sewage disposal systems
			 meet the Department requirements in Sections
			 700 through
			 799 of these rules.
			 (3-17-22)
05.
Approval of
			 Facility Construction Plans
. Each ICF/IID must obtain written Department
			 approval prior to any proposed construction of a facility or alterations to an
			 ICF/IID. Construction or alteration plans must be provided to the Department
			 prior to licensing of the facility. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.11 - INTERMEDIATE CARE FACILITIES FOR PEOPLE WITH INTELLECTUAL DISABILITIES (ICFS/IID) › Section 16.03.11.022 - INSPECTION OF FACILITY

Current through August 31, 2023
01.
Representatives of the Department
. The Department is authorized to enter
			 an ICF/IID, or its buildings associated with its operation, at all reasonable
			 times for the purpose of inspection. The Department may, at its discretion,
			 utilize the services of any legally qualified person or organization, either
			 public or private, to examine and inspect any ICF/IID for licensing
			 requirements. (3-17-22)
02.
Accessible With or Without Prior Notification
. The Department or its
			 representatives may enter a facility for the purpose of inspections with or
			 without prior notification to the facility. (3-17-22)
03.
Inspection of Records
. For
			 the purposes of these rules, the Department is authorized to inspect all
			 records required by the Department to be maintained by the facility.
			 (3-17-22)
04.
Inspection of
			 Outside Services
. The Department is authorized to inspect any outside
			 services that a licensed facility uses for its individuals. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.11 - INTERMEDIATE CARE FACILITIES FOR PEOPLE WITH INTELLECTUAL DISABILITIES (ICFS/IID) › Section 16.03.11.025 - INITIAL APPLICATION FOR LICENSURE

Current through August 31, 2023
Each person or entity planning to operate an ICF/IID must apply
				to the Department for an initial license. (3-17-22)
01.
Form of Application
. The
			 applicant must complete an initial application form provided by the Department.
			 The application and documents required in Subsection
			 025.02 of this rule must be
			 submitted to the Department at least ninety (90) days prior to the planned
			 opening date. (3-17-22)
02.
Documents Required
. In addition to the application form, the following
			 documents must be submitted with the application prior to approval of a
			 license: (3-17-22)
a. A certificate of
			 occupancy from the local building and fire authority. (3-17-22)
b. Acceptable policies and procedures
			 governing the facility, including a sample of an individual record, as required
			 by the Department. (3-17-22)
c. If
			 the facility is owned by a corporation, the names and addresses of all officers
			 and stockholders having more than five percent (5%) ownership.
			 (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.11 - INTERMEDIATE CARE FACILITIES FOR PEOPLE WITH INTELLECTUAL DISABILITIES (ICFS/IID) › Section 16.03.11.026 - CHANGE OF OWNERSHIP (CHOW)

Current through August 31, 2023
A new owner must submit a new application for licensure, and
				receive the license from the Department before operating the facility. A
				"change in ownership" is a change in the person or legal organization that has
				final decision-making authority over the daily operation of an existing
				ICF/IID. (3-17-22)
01.
CHOW of
			 ICF/IID
. An ICF/IID must apply for a change of ownership when: (3-17-22)
a. The form of legal organization of the
			 facility changes, such as when a sole proprietorship becomes a partnership or
			 corporation; (3-17-22)
b. Title of
			 the ICF/IID is transferred from the current licensee to another party;
			 (3-17-22)
c. The ICF/IID is leased
			 to another party, or the facility's existing lease is terminated;
			 (3-17-22)
d. An event occurs that
			 terminates or dissolves a partnership or sole proprietorship; or
			 (3-17-22)
e. The licensee is a
			 corporation; and (3-17-22)
i. The corporation
			 is dissolved; or (3-17-22)
ii. A
			 new corporation is formed through consolidation or merger with one (1) or more
			 other corporations, and the licensed corporation no longer exists.
			 (3-17-22)