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 16.03.10.627 - ICF/IID: EXEMPT COSTS

Current through August 31, 2023
Exempt costs are not subject to the ICF/IID cap.
				  (3-17-22)
01.
Day Treatment
				Services
. As specified in this Section, the cost of day treatment
				services may be reimbursed in this category and may not be subject to the
				ICF/IID cap. (3-17-22)
a. This category
				includes the direct costs of labor, benefits, contracted services, property,
				utilities and supplies for such services up to the limitations provided in this
				Subsection. (3-17-22)
b. When a
				school or another agency or entity is responsible for or pays for services
				provided to a participant regularly during normal working hours on weekdays, no
				costs will be assigned to this category for such services. The Department will
				not reimburse for the cost of services that are paid for or should be paid for
				by an other agency. (3-17-22)
c.
				When ICF/IID day treatment services are performed for participants in a
				licensed Developmental Disability Center, the allowable cost of such services
				will be included in this category, but not more than the amount that would be
				paid according to the Department's fee schedule for individual or group therapy
				for similar services. Amounts incurred or paid by the ICF/IID in excess of what
				would be paid according to the Department's fee schedule for like services are
				not allowable costs and will be reported as non-reimbursable.
				(3-17-22)
d. For day treatment
				services provided in a location other than a certified developmental disability
				center, the maximum amount reportable in this category will also be limited.
				Total costs for such services reported by each provider in this category will
				be limited to the number of hours, up to thirty (30) hours per week per
				participant, of individual or group developmental therapy times the hourly rate
				that would be paid according to the most recent Department fee schedule for the
				same services if provided in a developmental disability center. Costs in excess
				of the limits determined in this Subsection will be classified and reported as
				subject to the ICF/IID cap. Initial rates established under the prospective
				system effective October 1, 1996, and not later than October 1, 1997, will not
				include a limitation of day treatment costs based on the hourly rate, when the
				hours of individual or group therapy were not obtained or audited by the
				Department at the time the rate was published. However, if a provider believes
				that the day treatment cost used to establish the day treatment portion of its
				prospective rate was misstated for rates set for periods beginning October 1,
				1996, through rates beginning October 1, 1997, revisions to the prospective
				rate may be made to the extent the provider demonstrates, to the satisfaction
				of the Department, that the cost used was misstated. Such a revision will be
				considered only if the provider requests a revision and provides adequate
				documentation within sixty (60) days of the date the rate was set. At the
				option of the Department it may negotiate fixed rates for these day treatment
				services. Such rates will be set so the aggregate related payments are lower
				than would be paid with a limitation based on schedules used for licensed
				Developmental Disability Centers. (3-17-22)
e. Financial data including expenses and
				labor hours incurred by or on behalf of the provider in providing day treatment
				services, must be identifiable and separate from the costs of other facility
				operations. Reasonable property costs related to day treatment services and not
				included in the property rental rate, will be separately identified, will be
				reported as day treatment services costs, and will not include property costs
				otherwise reimbursed. Property costs related to day treatment services will be
				separately identified as not related to living unit costs by a final audit
				determination issued prior to October 1, 1996, or will be separate and distinct
				from any property used for ICF/IID services that are or were day treatment
				services. (3-17-22)
f. In the event
				a provider has a change in the number of participants requiring day treatment
				services, the prospective rate may be adjusted by the Department to reflect a
				change in costs related to such a change. Providers receiving such changes may
				be required to provide added documentation to the Department to assure that
				further changes can be identified and the prospective rate adjusted
				accordingly. (3-17-22)