reglab/statecodes huggingface dataset:
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.06 - CRIMINAL HISTORY AND BACKGROUND CHECKS › Section 16.05.06.270 - CRIMINAL OR RELEVANT RECORD - ACTION PENDING

Current through August 31, 2023
01.
Notice of Inability to Proceed
. When the applicant is identified
			 as having a pending criminal action for a crime or relevant record that may
			 disqualify them from receiving a clearance for the background check, the
			 Department may issue a notice of inability to proceed. (3-28-23)
02.
Availability to Provide
			 Services
. The applicant is not available to provide service when a
			 notice of inability to proceed or denial is issued by the Department. Any
			 previous clearance issued by the Department will be revoked as described in
			 Section 190 of these
			 rules. (3-28-23)
03.
Reconsideration of Action Pending
. In the case of an inability to
			 proceed status, the applicant can submit documentation that the matter has been
			 resolved to the Department for reconsideration within one hundred and twenty
			 (120) calendar days from the date of notice. When the Department receives this
			 documentation, the Department will notify the applicant of the reconsideration
			 and issue a clearance or denial. When the Department's reconsideration results
			 in a clearance after review, any previously revoked clearance will be restored
			 as described in Section
			 190 of these rules.
			 (3-28-23)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.06 - CRIMINAL HISTORY AND BACKGROUND CHECKS › Section 16.05.06.300 - BACKGROUND CHECK RECORDS

Current through August 31, 2023
Background checks done under this chapter become the property
				of the Department and are held confidential. (3-28-23)
01.
Release of Background Check
			 Records
. A copy of the background check as defined in Section
			 010 of these rules will be
			 released: (3-28-23)
a. To the individual who
			 has requested the background check and upon receipt of a written request to the
			 Department, provided the individual releases the state from all liability;
			 (3-28-23)
b. In response to a
			 subpoena issued by a court of competent jurisdiction; or (3-28-23)
c. As otherwise required by law.
			 (3-28-23)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.07 - THE INVESTIGATION AND ENFORCEMENT OF FRAUD, ABUSE, AND MISCONDUCT › Section 16.05.07.000 - LEGAL AUTHORITY

Current through August 31, 2023
Sections
				56-202(b),
				56-203(1),
				56-203(2),
				56-209,
				56-209h,
				56-227,
				56-227A through D, 56-1001, and
				56-1003, Idaho Code, authorize the Director to adopt rules regarding fraud,
				abuse, and misconduct of public assistance programs. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.07 - THE INVESTIGATION AND ENFORCEMENT OF FRAUD, ABUSE, AND MISCONDUCT › Section 16.05.07.001 - SCOPE

Current through August 31, 2023
These rules protect the integrity of the public assistance
				programs by identifying instances of fraud, abuse, and other misconduct by
				providers and their employees, participants, and by providing that appropriate
				action is taken to correct the problem. Nothing contained within this chapter
				will limit the Department from taking any other action authorized by law,
				including seeking damages under Section
				56-227B, Idaho Code.
				(3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.07 - THE INVESTIGATION AND ENFORCEMENT OF FRAUD, ABUSE, AND MISCONDUCT › Section 16.05.07.002 - WRITTEN INTERPRETATIONS

Current through August 31, 2023
This agency has written statements which pertain to the
				interpretation of the rules of this chapter, or to the documentation of
				compliance with the rules of this chapter. The document is available for public
				inspection and copying at cost in the main office of this agency.
				(3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.07 - THE INVESTIGATION AND ENFORCEMENT OF FRAUD, ABUSE, AND MISCONDUCT › Section 16.05.07.003 - ADMINISTRATIVE APPEALS

Current through August 31, 2023
Appeals and proceedings for any Department actions are governed
				by IDAPA 16.05.03, "Contested Case Proceedings and Declaratory Rulings." An
				appeal does not stay the action of the Department. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.07 - THE INVESTIGATION AND ENFORCEMENT OF FRAUD, ABUSE, AND MISCONDUCT › Section 16.05.07.010 - DEFINITIONS

Current through August 31, 2023
For purposes of this chapter of rules, the following terms
				apply. (3-17-22)
01.
Abuse or
			 Abusive
. Provider practices that are inconsistent with sound fiscal,
			 business, child care, or medical practices, and result in an unnecessary cost
			 to a public assistance program, in reimbursement for services that are not
			 medically necessary, or that fail to meet professionally recognized standards
			 for health care, or in physical harm, pain, or mental anguish to a medical
			 assistance recipient. (3-17-22)
02.
Access to Documentation and Records
. To review and copy records at
			 the time a written request is made during normal business hours. Documentation
			 includes all materials as described in Section
			 101 of these rules.
			 (3-17-22)
03.
Claim
.
			 Any request or demand for payment, or document submitted to initiate payment,
			 for items or services provided under a public assistance program, whether under
			 a contract or otherwise. (3-17-22)
04.
Conviction
. An individual or
			 entity is considered to have been convicted of a criminal offense: (3-17-22)
a. When a judgment of conviction has been
			 entered against the individual or entity by a federal, state, or local court,
			 regardless of whether there is an appeal pending or whether the judgment of
			 conviction or other record relating to criminal conduct has been expunged;
			 (3-17-22)
b. When there has been a
			 finding of guilt against the individual or entity by a federal, state, or local
			 court; (3-17-22)
c. When a plea of
			 guilty or nolo contendere by the individual or entity has been accepted by a
			 federal, state, or local court; or (3-17-22)
d. When the individual or entity has entered
			 into participation in a first offender, deferred adjudication, or other
			 arrangement or program where judgment of conviction has been withheld.
			 (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.07 - THE INVESTIGATION AND ENFORCEMENT OF FRAUD, ABUSE, AND MISCONDUCT › Section 16.05.07.020 - DEPARTMENT ACTIONS

Current through August 31, 2023
When an instance of fraud, abuse, or other misconduct is
				identified, the Department will take action to correct the problem as provided
				in this rule. Such corrective action may include: denial of payment,
				recoupment, payment suspension, provider agreement suspension, termination of
				provider agreement, imposition of civil monetary penalties, exclusion,
				participant lock-in, referral for prosecution, or referral to state licensing
				boards. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.07 - THE INVESTIGATION AND ENFORCEMENT OF FRAUD, ABUSE, AND MISCONDUCT › Section 16.05.07.100 - INVESTIGATION AND AUDITS

Current through August 31, 2023
Investigation and audits of provider fraud, abuse, or
				misconduct conducted by the Department's Bureau of Compliance or its successor
				are governed under these rules. (3-17-22)
01.
Investigation Methods
. Under
			 Sections 56-209h(2)  and
			 56-227(5), Idaho
			 Code, the Department will investigate and identify potential instances of
			 fraud, abuse, or other misconduct by any person related to or involved in
			 public assistance programs administered by the Department. Methods may include:
			 (3-17-22)
a. Review of computerized reports;
			 (3-17-22)
b. Referrals to or from
			 other agencies, health care providers, or persons; (3-17-22)
c. Conducting audits, interviews, and
			 pre-payment and post-payment reviews; (3-17-22)
d. Probability sampling and extrapolation;
			 and (3-17-22)
e. Issuing subpoenas
			 to compel testimony or the production of records. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.07 - THE INVESTIGATION AND ENFORCEMENT OF FRAUD, ABUSE, AND MISCONDUCT › Section 16.05.07.101 - DOCUMENTATION OF SERVICES AND ACCESS TO RECORDS

Current through August 31, 2023
01.
Documentation of Services
. Providers must generate documentation
			 at the time of service sufficient to support each claim or service, and as
			 required by rule, statute, or contract. Documentation must: (3-1722)
a. Be legible and consistent with
			 professionally recognized standards; and (3-17-22)
b. Be retained for a period of five (5) years
			 from the date the item or service was provided. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.07 - THE INVESTIGATION AND ENFORCEMENT OF FRAUD, ABUSE, AND MISCONDUCT › Section 16.05.07.200 - DENIAL OF PAYMENT

Current through August 31, 2023
The following are reasons the Department may deny payment.
				(3-17-22)
01.
Billed Services
			 Not Provided or Not Medically Necessary
. The Department may deny payment
			 for any and all claims it determines are for items or services: (3-17-22)
a. Not provided or not found by the
			 Department to be medically necessary. (3-17-22)
b. Not documented to be provided or medically
			 necessary. (3-17-22)
c. Not
			 provided under professionally recognized standards of health care.
			 (3-17-22)
d. Provided as a result
			 of a prohibited physician referral under 42 CFR Part 411 , Subpart J.
			 (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.07 - THE INVESTIGATION AND ENFORCEMENT OF FRAUD, ABUSE, AND MISCONDUCT › Section 16.05.07.205 - RECOUPMENT

Current through August 31, 2023
The Department may recoup the amount paid for items or services
				listed in Section 200 of these
				rules. If recoupment is impracticable, the Department may pursue any available
				legal remedies it may have. Interest will accrue on overpayments at the
				statutory rate set forth in Section
				28-22-104, Idaho Code, from the
				date of the final determination of the amount owed for items or services until
				the date of recovery. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.07 - THE INVESTIGATION AND ENFORCEMENT OF FRAUD, ABUSE, AND MISCONDUCT › Section 16.05.07.210 - SUSPENSION OF PAYMENTS PENDING INVESTIGATION

Current through August 31, 2023
The Department may suspend public-assistance payments in whole
				or part in a suspected case of fraud or abuse pending investigation and
				conclusion of legal proceedings related to the provider's alleged fraud or
				abuse. When payments have been suspended under this rule, the Department will
				provide for a hearing within thirty (30) days of receipt of any timely filed
				notice of appeal. (3-17-22)
01.
Basis for Suspension of Payments
. When the Department through reliable
			 evidence suspects fraud or abuse, or when a provider fails to provide immediate
			 access to records, public-assistance payments may be withheld or suspended.
			 (3-17-22)
02.
Notice of
			 Suspension of Payments
. The Department may withhold public-assistance
			 payments without first notifying the provider of its intention to do so when
			 the Department is suspending payments of a Medicaid provider. The Department
			 will send written notice within five (5) days of taking such action under
			 42 CFR
			 455.23(b). All other public
			 assistance providers will be notified prior to the suspension of payments.
			 (3-17-22)
03.
Duration of
			 Suspension of Payments
. The withholding of payment actions under this
			 rule will be temporary and will not continue after: (3-17-22)
a. The Department or the prosecuting
			 authorities determine there is insufficient evidence of fraud or willful
			 misrepresentation by the provider; or (3-17-22)
b. Legal proceedings related to the
			 provider's alleged fraud or abuse are completed. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.07 - THE INVESTIGATION AND ENFORCEMENT OF FRAUD, ABUSE, AND MISCONDUCT › Section 16.05.07.220 - PROVIDER AGREEMENT SUSPENSION

Current through August 31, 2023
In the event the Department identifies a suspected case of
				fraud or abuse, it may summarily suspend the provider agreement when necessary
				to prevent or avoid immediate danger to the public health or safety. This
				provider agreement suspension temporarily bars the provider from participation
				in the medical assistance program, pending investigation and Department action.
				The Department will notify the provider of the suspension. The suspension is
				effective immediately upon written, electronic, or oral notification. When a
				provider agreement is suspended under this rule, the Department will provide
				for a hearing within thirty (30) days of receipt of any timely filed notice of
				appeal (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.07 - THE INVESTIGATION AND ENFORCEMENT OF FRAUD, ABUSE, AND MISCONDUCT › Section 16.05.07.230 - TERMINATION OF PROVIDER STATUS

Current through August 31, 2023
Under Section
				56-209h, Idaho Code, the
				Department may terminate the provider agreement or otherwise deny provider
				status for a period of up to five (5) years from the date the Department's
				action becomes final. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.07 - THE INVESTIGATION AND ENFORCEMENT OF FRAUD, ABUSE, AND MISCONDUCT › Section 16.05.07.235 - CIVIL MONETARY PENALTIES

Current through August 31, 2023
Under Section
				56-209h, Idaho Code, the
				Department may assess civil monetary penalties against a provider, any officer,
				director, owner, and managing employee for conduct identified in Idaho Code
				56-209h(6)(a) through (i). (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.07 - THE INVESTIGATION AND ENFORCEMENT OF FRAUD, ABUSE, AND MISCONDUCT › Section 16.05.07.236 - CIVIL MONETARY PENALTY PERCENTAGES

Current through August 31, 2023
The Department will determine the percentage of each penalty by
				the type of conduct, the frequency, and knowledge of the conduct. When more
				than one (1) type of conduct described in Idaho Code 56-209h(6)(a) through (i)
				is found per line item, the penalty percentage will be based on the most
				significant conduct. (3-17-22)
01.
Conduct Resulting in No Overpayment
. The Department determines
			 civil monetary penalties to be assessed for the following types of conduct
			 violations that did not result in an overpayment. (3-17-22)
a. Participant Fees. The provider collected
			 or attempted to collect fees from participants that the provider was not
			 entitled to collect. Violations for this type of conduct will result in a ten
			 percent (10%) penalty. (3-17-22)
b.
			 Minor Rule Violations. Services were provided and properly paid but violated
			 rule, policy, or provider agreement. Minor rule violations will result in a ten
			 percent (10%) penalty. Minor rule violations may include: (3-17-22)
i. Incorrect date spanning;
			 (3-17-22)
ii. Failure to list
			 required provider credentials; or (3-17-22)
iii. Failure to obtain required client
			 signatures. (3-17-22)
c.
			 Significant Rule Violations. Services were provided but violated rule, policy,
			 or provider agreement. Significant rule violations will result in a fifteen
			 percent (15%) penalty. Significant rule violations may include: (3-17-22)
i. Incomplete physician referrals; or
			 (3-17-22)
ii. Failure to maintain
			 documentation once valid Healthy Connections referral is obtained.
			 (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.07 - THE INVESTIGATION AND ENFORCEMENT OF FRAUD, ABUSE, AND MISCONDUCT › Section 16.05.07.237 - CIVIL MONETARY PENALTIES FOR CRIMINAL HISTORY BACKGROUND CHECK VIOLATIONS

Current through August 31, 2023
Under Section
				56-209h(8)(b),
				Idaho Code, the Department may assess civil monetary penalties against a
				provider, any officer, director, owner, or managing employee for failing to
				perform required background checks or failing to meet required time lines for
				completion of background checks as required by rule. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.07 - THE INVESTIGATION AND ENFORCEMENT OF FRAUD, ABUSE, AND MISCONDUCT › Section 16.05.07.240 - MANDATORY EXCLUSIONS FROM THE MEDICAID PROGRAM

Current through August 31, 2023
The Department will exclude from the Medicaid program any
				provider, entity, or person that: (3-17-22)
01.
Conviction of a Criminal
			 Offense
. Has been convicted of a criminal offense related to the
			 delivery of an item or service under a federal or any state health care
			 program, including the performance of management or administrative services
			 relating to the delivery of items or services under any such program.
			 (3-17-22)
02.
Conviction of a
			 Criminal Offense Related to Patient Neglect or Abuse
. Has been
			 convicted, under federal or state law, of a criminal offense related to the
			 neglect or abuse of a patient, in connection with the delivery of a health care
			 item or service, including any offense that the Department concludes entailed,
			 or resulted in, neglect or abuse of patients. The conviction need not relate to
			 a patient who is a program beneficiary. (3-17-22)
03.
Other Exclusions
. Is
			 identified by the Centers for Medicare and Medicaid Services (CMS) as having
			 been excluded by another state, the Office of Inspector General or any person
			 CMS directs the Department to exclude. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.07 - THE INVESTIGATION AND ENFORCEMENT OF FRAUD, ABUSE, AND MISCONDUCT › Section 16.05.07.245 - TERMS OF MANDATORY EXCLUSIONS FROM THE MEDICAID PROGRAM

Current through August 31, 2023
Mandatory exclusions from the Medicaid program imposed under
				Section 240 of these
				rules, will be for not less than ten (10) years. The exclusion may exceed ten
				(10) years if aggravating factors are present. In the case of any mandatory
				exclusion of any person, if the individual has been convicted on two (2) or
				more previous occasions of one (1) or more offenses for which an exclusion may
				be effected under this rule, the period of exclusion will be permanent.
				(3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.07 - THE INVESTIGATION AND ENFORCEMENT OF FRAUD, ABUSE, AND MISCONDUCT › Section 16.05.07.250 - PERMISSIVE EXCLUSIONS FROM THE MEDICAID PROGRAM

Current through August 31, 2023
The Department may exclude any person or entity from the
				Medicaid program for a period of not less than one (1) year: (3-17-22)
01.
Endangerment of Health or Safety of
			 a Patient
. Where there has been a finding by a governmental agency
			 against such person or entity of endangering the health or safety of a patient,
			 or of patient abuse, neglect, or exploitation. (3-17-22)
02.
Failure to Disclose or Make
			 Available Records
. That has failed or refused to disclose, make
			 available, or provide immediate access to the Department, or any licensing
			 board, any records maintained by the provider or required of the provider to be
			 maintained, which the Department deems relevant to determining the
			 appropriateness of payment. (3-17-22)
03.
Other Exclusions
. For any
			 reason for which the Secretary of Health and Human Services, or their designee,
			 could exclude an individual or entity. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.07 - THE INVESTIGATION AND ENFORCEMENT OF FRAUD, ABUSE, AND MISCONDUCT › Section 16.05.07.260 - AGGRAVATING FACTORS

Current through August 31, 2023
For purposes of lengthening the period of mandatory exclusions
				and permissive exclusions from the Medicaid program, the following factors may
				be considered. This is not intended to be an exhaustive list of factors which
				may be considered: (3-17-22)
01.
Financial Loss
. The acts resulted in financial loss to the program
			 of one thousand five hundred dollars ($1,500) or more. The entire amount of
			 financial loss to such program will be considered, including any amounts
			 resulting from similar acts not adjudicated, regardless of whether full or
			 partial restitution has been made to the program. (3-17-22)
02.
Time Acts Were Committed
.
			 The acts were committed over a period of one (1) year or more.
			 (3-17-22)
03.
Adverse
			 Impact
. The acts had a significant adverse physical, mental, or
			 financial impact on one (1) or more program participants or other individuals.
			 (3-17-22)
04.
Length of
			 Sentence
. The length of any sentence imposed by the court related to the
			 same act. (3-17-22)
05.
Prior Record
. The excluded person has a prior criminal, civil, or
			 administrative sanction record. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.07 - THE INVESTIGATION AND ENFORCEMENT OF FRAUD, ABUSE, AND MISCONDUCT › Section 16.05.07.261 - REINSTATEMENT AFTER EXCLUSION FROM MEDICAID PROGRAM

Current through August 31, 2023
An individual or entity who has been excluded from the Medicaid
				Program is not automatically reinstated at the end of the exclusion period. An
				individual or entity excluded by the Department must submit a written
				application for reinstatement to the Department. An applicant excluded by the
				Department must receive written notice of reinstatement from the Department
				before reinstatement is complete. (3-17-22)
01.
Conditions for
			 Reinstatement
. To be reinstated, the applicant must meet the following
			 criteria: (3-17-22)
a. Not be currently
			 excluded from the Medicaid program by the federal government or by any state
			 Medicaid agency; (3-17-22)
b. Not
			 have a currently terminated Medicaid provider number by any state Medicaid
			 agency; (3-17-22)
c. Has all debts
			 to the Department paid in full; (3-17-22)
d. Not be the subject of any civil, criminal,
			 or state licensing authority investigation; (3-17-22)
e. Has not been convicted of any crime during
			 the exclusion period; (3-17-22)
f.
			 Has all the required, valid licensure and credentials necessary to provide
			 services; (3-17-22)
g. Has met and
			 continues to meet all terms and conditions of any court-ordered probation;
			 (3-17-22)
h. Did not work in any
			 capacity as an employee or contractor for any individual or entity receiving
			 Medicaid funds during the applicant's exclusion period; and (3-17-22)
i. Did not submit claims or cause claims to
			 be submitted for Medicaid reimbursement for services or supplies provided,
			 ordered, or prescribed by an excluded individual or entity during the
			 applicant's exclusion period. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.07 - THE INVESTIGATION AND ENFORCEMENT OF FRAUD, ABUSE, AND MISCONDUCT › Section 16.05.07.265 - REFUSAL TO ENTER INTO AN AGREEMENT

Current through August 31, 2023
The Department may refuse to enter into a provider agreement
				for the reasons described in this rule. (3-17-22)
01.
Convicted of a Felony
. The
			 provider has been convicted of a felony under federal or state law.
			 (3-17-22)
02.
Committed an
			 Offense or Act Not in Best Interest of Medicaid Participants
. The
			 provider has committed an offense or act which the Department determines is
			 inconsistent with the best interests of Medicaid participants.
			 (3-17-22)
03.
Failed to
			 Repay
. The provider has failed to repay the Department monies which had
			 been previously determined to have been owed to the Department.
			 (3-17-22)
04.
Investigation
			 Pending
. The provider has a pending investigation for program fraud or
			 abuse. (3-17-22)
05.
Terminated Provider Agreement
. The provider was the managing employee,
			 officer, or owner of an entity whose provider agreement was terminated under
			 Section 230 of these
			 rules. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.07 - THE INVESTIGATION AND ENFORCEMENT OF FRAUD, ABUSE, AND MISCONDUCT › Section 16.05.07.270 - MISCELLANEOUS CORRECTIVE ACTIONS

Current through August 31, 2023
The Department may take lesser action to investigate, monitor
				and correct suspected instances of fraud, abuse, over utilization, and other
				misconduct as provided in this rule. (3-17-22)
01.
Issuance of a Warning
.
			 Issuance of a warning letter describing the nature of suspected violations, and
			 requesting an explanation of the problem and a warning that additional action
			 may be taken if the action is not justified or discontinued.
			 (3-17-22)
02.
Review
.
			 Prepayment review of all or selected claims submitted by the provider with
			 notice that claims failing to meet written guidelines will be denied.
			 (3-17-22)
03.
Referral
. Referral to state licensing boards for review of quality of
			 care and professional and ethical conduct. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.07 - THE INVESTIGATION AND ENFORCEMENT OF FRAUD, ABUSE, AND MISCONDUCT › Section 16.05.07.275 - DISCLOSURE OF CERTAIN PERSONS

Current through August 31, 2023
Prior to entering into or renewing a provider agreement, or at
				any time upon written request by the Department, a provider must disclose to
				the Department the identity of any person described under
				42 CFR
				1001.1001. The Department may refuse to enter
				into or renew an agreement with any provider associated with any person so
				described. The Department may also refuse to enter into, or terminate, a
				provider agreement if it determines that the provider did not fully and
				accurately make any disclosure required under these rules. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.07 - THE INVESTIGATION AND ENFORCEMENT OF FRAUD, ABUSE, AND MISCONDUCT › Section 16.05.07.280 - PROVIDER NOTIFICATION

Current through August 31, 2023
When the Department determines actions defined in Sections
				200 through
				250 of these rules are appropriate,
				it will send written notice of the decision to the provider or person. The
				notice will state the basis for, and the length and effect of the action on
				that person's ability to provide services under state and federal programs, and
				the person's appeal rights. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.07 - THE INVESTIGATION AND ENFORCEMENT OF FRAUD, ABUSE, AND MISCONDUCT › Section 16.05.07.285 - NOTICE TO STATE LICENSING AUTHORITIES

Current through August 31, 2023
The Department will promptly notify all appropriate licensing
				authorities having responsibility for licensing or certification of a
				Department action, and the facts and circumstances of that action. The
				Department may request certain action be taken and that it be informed of
				actions taken. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.07 - THE INVESTIGATION AND ENFORCEMENT OF FRAUD, ABUSE, AND MISCONDUCT › Section 16.05.07.290 - PUBLIC NOTICE

Current through August 31, 2023
The Department will give notice of the action taken and the
				effective date to the public, appropriate beneficiaries, and may give notice as
				appropriate to related providers, the Quality Improvement Organization (QIO),
				institutional providers, professional organizations, contractors, other health
				insurance payors, and other agencies or Departmental divisions.
				(3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.05.07 - THE INVESTIGATION AND ENFORCEMENT OF FRAUD, ABUSE, AND MISCONDUCT › Section 16.05.07.300 - DEPARTMENT OF HEALTH AND HUMAN SERVICES

Current through August 31, 2023
The Department will notify the Office of Inspector General
				within fifteen (15) days after a final action in which a person has been
				excluded, convicted of a criminal offense related to participation in the
				delivery of health care items or services under the Medicaid program, or
				reinstated from a prior exclusion. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.06.01 - CHILD AND FAMILY SERVICES › Section 16.06.01.000 - LEGAL AUTHORITY

Current through August 31, 2023
The Idaho Legislature has delegated to the Department, or the
				Board of Health and Welfare, or both jointly, the responsibility to establish
				and enforce such rules and methods of administration as may be necessary or
				proper to administer social services to people who are in need, under the
				following Sections: 16-1629, 16-1623, 16-2102, 16-2406, 16-2423, and 16-2433,
				39-1209 through 1211, 39-5603, 39-7501, 56-202(b), 56-204A, 56-803, 56-1003,
				56-1004, 56-1004A, and 56-1007, Idaho Code. (3-15-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.06.01 - CHILD AND FAMILY SERVICES › Section 16.06.01.001 - TITLE, SCOPE, AND GOAL

Current through August 31, 2023
01.
Title
. These rules are titled IDAPA 16.06.01, "Child and Family
			 Services." (3-15-22)
02.
Scope
. These rules are established to govern the statewide provision of:
			 (3-15-22)
a. Services associated with child
			 protection, alternate care, and adoption; and (3-15-22)
b. As resources are available, services aimed
			 at preventing child abuse, neglect, and abandonment.
			 (3-15-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.06.01 - CHILD AND FAMILY SERVICES › Section 16.06.01.009 - CRIMINAL HISTORY AND BACKGROUND CHECK REQUIREMENTS

Current through August 31, 2023
01.
Compliance With Department Criminal
			 History and Background Check
. All current Department employees,
			 applicants, transfers, reinstated former employees, student interns, contract
			 employees, Certified Adoption Professionals, volunteers, and others assigned to
			 programs that involve direct contact with children or vulnerable adults as
			 described in Section
			 39-5302, Idaho Code, must comply
			 with the provisions in IDAPA 16.05.06, "Criminal History and Background
			 Checks." (3-15-22)
02.
Availability to Work or Provide Service
. Certain individuals are
			 allowed to provide services after the self-declaration is completed as provided
			 in Section
			 56-1004A, Idaho Code, except when
			 they have disclosed a designated crime listed in IDAPA 16.05.06, "Criminal
			 History and Background Checks." The criminal history check requirements
			 applicable to each provider type are found in the rules that state the
			 qualifications or certification of those providers. (3-15-22)
03.
Adoption
. An individual
			 applying to the Department to be an adoptive parent or petitioning the court
			 for the adoption of a child must comply with the provisions in IDAPA 16.05.06,
			 "Criminal History and Background Checks." (3-15-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.06.01 - CHILD AND FAMILY SERVICES › Section 16.06.01.011 - DEFINITIONS AND ABBREVIATIONS F THROUGH K

Current through August 31, 2023
For the purposes of these rules, the following terms are used:
				(3-15-22)
01.
Family
.
			 Parent(s), legal guardian(s), related individuals including birth or adoptive
			 immediate family members, extended family members and significant other
			 individuals, who are included in the family plan. (3-15-22)
02.
Family Assessment
. An
			 ongoing process based on information gained through a series of meetings with a
			 family to gain mutual perception of strengths and resources that can support
			 them in creating long-term solutions related to identified service needs and
			 safety threats to family integrity, unity, or the ability to care for their
			 members. (3-15-22)
03.
Family Case Record
. Electronic and hard copy compilation of all
			 documentation relating to a family, including legal documents, identifying
			 information, and evaluations. (3-15-22)
04.
Family (Case) Plan
. Also
			 referred to as a family service plan. A written document that serves as the
			 guide for provision of services. The plan, developed with the family, clearly
			 identifies who does what, when, how, and why. The family plan incorporates any
			 special plans made for individual family members. If the family includes an
			 Indian child, or child's tribe, tribal elders or leaders should be consulted
			 early in the plan development. (3-15-22)
05.
Family Services Worker
. Any
			 of the direct service personnel, including social workers, working in regional
			 Child and Family Services Programs. (3-15-22)
06.
Federally-Funded Guardianship
			 Assistance for Relatives
. Benefits described in Subsection
			 702.04 and Section
			 703 of these rules provided to a
			 relative guardian for the support of a child who is fourteen (14) years of age
			 or older, who, without guardianship assistance, would remain in the legal
			 custody of the Department of Health and Welfare. (3-15-22)
07.
Field Office
. A Department
			 of Health and Welfare service delivery site. (3-15-22)
08.
Goal
. A statement of the
			 long-term outcome or plan for the child and family. (3-15-22)
09.
Independent Living
. Services
			 provided to eligible foster or former foster youth, ages fourteen (14) to
			 twenty-three (23), designed to support a successful transition to adulthood.
			 (3-15-22)
10.
Indian
.
			 Any person who is a member of an Indian tribe or who is an Alaska Native and a
			 member of a Regional Corporation as defined in
			 43 U.S.C.
			 1606. (3-15-22)
11.
Indian Child
. Any unmarried
			 person who is under the age of eighteen (18) who is: (3-15-22)
a. A member of an Indian tribe; or
			 (3-15-22)
b. Eligible for
			 membership in an Indian tribe, and who is the biological child of a member of
			 an Indian tribe. (3-15-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.06.01 - CHILD AND FAMILY SERVICES › GENERAL REQUIREMENTS AND SERVICES › Section 16.06.01.020 - GENERAL REQUIREMENTS APPLICABLE TO ALL CHILD AND FAMILY SERVICES PROGRAMS

Current through August 31, 2023
01.
Information, Referral and Screening
. All residents of the state of
				Idaho, regardless of the duration of their residency or their income are
				entitled to receive, upon referral or request: (3-15-22)
a. Accurate and current information about
				services to children and families provided through the Department.
				(3-15-22)
b. Referral to other
				appropriate public or private services available in the community; and
				(3-15-22)
c. A screening to
				determine service needs and safety threats that can be addressed through Child
				and Family Services. (3-15-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.06.01 - CHILD AND FAMILY SERVICES › GENERAL REQUIREMENTS AND SERVICES › Section 16.06.01.030 - CORE CHILD AND FAMILY SERVICES

Current through August 31, 2023
State and federally mandated core services provided by or
				  through regional Child and Family offices include: (4-6-23)
01.
Crisis Services
. Crisis
				Services are an immediate response to ensure safety when a child is believed to
				be in imminent danger because of child abuse, neglect, or abandonment. Crisis
				services require immediate access to services always to assess safety and place
				in alternate care, if necessary, to ensure safety for the child.
				(4-6-23)
02.
Screening
				Services
. Initial contact with families and children to gather
				information to determine whether the child meets eligibility criteria to
				receive child protection or adoption services. When eligibility criteria is not
				met for Department mandated services, appropriate community referrals are made.
				(4-6-23)
03.
Assessment and
				Safety/Service Planning Services
. Assessment process in which the safety
				threats to the child, and the family's concerns, strengths, and resources are
				identified after which a written plan is developed by the worker, together with
				the family and other interested parties. Each plan must have a long-term goal
				that identifies behaviorally-specific and measurable desired results and has
				specific tasks that identify who, how, and when the tasks will be completed.
				(4-6-23)
04.
Prevention
				Services
. Evidence-based services that support children and families and
				are designed to reduce the risk of child abuse, neglect, or abandonment.
				(4-6-23)
a. These services are provided in the
				Family First Prevention Services Act (Public Law 115-123) under the
				categories of mental health, substance use prevention and treatment, and
				in-home parent skill-based programs and services. Additional services can be
				implemented through community education, and partnerships with other community
				agencies such as schools and courts. (4-6-23)
b. The Department sets the maximum hourly or
				flat rates for Prevention Services covered by Title IV-E federal funding and
				are based on the cost for services. When services are provided by private
				providers, payment must be made according to a contract authorized by the Child
				and Family Services Program Manager, based on the cost for services to be
				provided. Current information about services and rates can be obtained from
				Child and Family Services website. (4-6-23)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.06.01 - CHILD AND FAMILY SERVICES › GENERAL REQUIREMENTS AND SERVICES › Section 16.06.01.050 - PROTECTIONS AND SAFEGUARDS FOR CHILDREN AND FAMILIES

Current through August 31, 2023
The federal and state laws that are the basis for these rules
				  include a number of mandatory protections and safeguards intended to ensure
				  timely permanency for children and to protect the rights of children, their
				  families, and their tribes. (3-15-22)
01.
Reasonable Efforts
. Services
				offered or provided to a family intended to prevent or eliminate the need for
				removal of the child from the family, to reunify a child with their family, and
				to finalize a permanent plan. The following efforts must be made and
				specifically documented by the Department in reports to the court. The court
				will make the determination of whether or not the Department's efforts were
				reasonable. (3-15-22)
a. Efforts to prevent or
				eliminate the need for a child to be removed from their home;
				(3-15-22)
b. Efforts to return a
				child home are not required due to a judicial determination of aggravated
				circumstances; and (3-15-22)
c.
				Efforts to finalize a permanent plan, so that each child in the Department's
				care will have a family with whom the child can have a safe and permanent home.
				(3-15-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.06.01 - CHILD AND FAMILY SERVICES › GENERAL REQUIREMENTS AND SERVICES › Section 16.06.01.051 - NOTICE REQUIREMENTS FOR ICWA

Current through August 31, 2023
01.
Notice of
				Pending Proceedings -- Who is Notified
. When there is reason to believe
				that a child is an Indian child, the initial and any subsequent Notice of
				Pending Proceedings must be sent to the Indian child's parent(s), custodian(s),
				and tribe. Notices of Pending Proceedings must be sent to the ICWA Designated
				Agent for the child's tribe via Registered Mail, Return Receipt Requested. All
				Notices of Pending Proceedings must be received by the child's parent(s),
				Indian custodian(s) and tribe at least 10 (ten) days before the proceeding is
				scheduled to occur. Returned receipts are to be kept in the child's file and
				made available for review by the court. (3-15-22)
02.
Rights Under a Notice of Pending
				Proceedings
. Notices of Pending Proceedings must also include notice of
				the tribe's right to intervene; their right to twenty (20) additional days to
				prepare for the proceedings; the right to appointment of counsel if the
				parent(s) or Indian custodian(s) are indigent; and the right to examine all
				documents filed with the court upon which placement may be based.
				(3-15-22)
03.
Notice of
				Pending Proceedings--When Identity or Location of Parent(s), Indian
				Custodian(s), or Tribe is Unknown
. If the identity or location of the
				parent(s) or Indian custodian(s) or the tribe is unknown, the Notice of Pending
				Proceedings must be sent to the Secretary of the Interior by certified mail
				with a return receipt requested at the following address: Department of the
				Interior, Bureau of Indian Services, Division of Human Services, Code 450, Mail
				Stop, 1849 C Street N.W., Washington, D.C. 20240. (3-15-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.06.01 - CHILD AND FAMILY SERVICES › GENERAL REQUIREMENTS AND SERVICES › Section 16.06.01.060 - FAMILY CASE RECORDS

Current through August 31, 2023
01.
Electronic and Physical Files
. The Department will maintain an
				electronic file and a physical file containing information on each family
				receiving services. The physical file will contain non-electronic documentation
				such as originals or original copies of all court orders, birth certificates,
				social security cards, and assessment information that is original outside the
				Department. (3-15-22)
02.
Storage of Records
. All physical family case records must be stored in a
				secure file storage area, away from public access and retained not less than
				five (5) years after the case is closed, after which they may be destroyed.
				(3-15-22)
a. Exception for Adoption Records.
				Complete family case records involving adoptive placements must be forwarded to
				the Department's central adoption unit for permanent storage.
				(3-15-22)
b. Exception for Case
				Records Involving an Indian Child. A case record involving an Indian child must
				be available at any time at the request of an Indian child's tribe or the
				Secretary of the Interior. (3-15-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.06.01 - CHILD AND FAMILY SERVICES › REVIEWS AND HEARINGS › Section 16.06.01.240 - SIX-MONTH REVIEWS FOR CHILDREN IN ALTERNATE CARE PLACEMENT

Current through August 31, 2023
When a judicial review does not occur at the end of a six (6)
				  month period for any child in alternate care placement, the Department will
				  conduct a case review to assure compliance with all applicable state and
				  federal laws, and to ensure the plan focuses on the goals of safety, permanency
				  and well-being of the child. (3-15-22)
01.
Notice of Six-Month Review
.
				The parent(s) or legal guardian(s), foster parent(s) of a child, and any
				preadoptive parent(s) or relative(s) providing care for the child, are to be
				provided with notice of their right to be heard in the six-month review. In the
				case of an Indian child, the child's tribe and any Indian custodian must also
				be provided with notice. This must not be construed to require that any foster
				parent, preadoptive parent, or relative providing care for the child be made a
				party to the review solely on the basis of the receipt of such notice.
				Participants have the right to be represented by the individual of their
				choice. (3-15-22)
02.
Procedure in the Six-Month Review
. The parties who received notice will
				be given the opportunity to participate in the case review. (3-15-22)
03.
Members of Six-Month Review
				Panel
. The six-month review panel must include a Department employee who
				is not in the direct line of supervision in the delivery of services to the
				child or parent(s) or legal guardian(s) being reviewed. The review panel may
				include agency staff, staff of other agencies, officers of the court, members
				of Indian tribes, and citizens qualified by experience, professional
				background, or training. Members of the panel will be chosen by and receive
				instructions from the Department's Child and Family Services Program Manager or
				their designee, to enable them to understand the review process and their roles
				as participants. (3-15-22)
04.
Considerations in Six-Month Review
. Whether conducted by the court
				in a review hearing or a Department review panel, under State law, Federal law
				and regulation, each of the following must be addressed in a six-month review:
				(3-15-22)
a. Determine the extent of
				compliance with the family services plan; (3-15-22)
b. Determine the extent of progress made
				toward alleviating or mitigating the causes necessitating the placement;
				(3-15-22)
c. Review compliance with
				the Indian Child Welfare Act, when applicable; (3-15-22)
d. Determine the safety of the child, the
				continuing need for and appropriateness of the child's placement; and
				(3-15-22)
e. Project a date by
				which the child may be returned and safely maintained at home or placed for
				adoption, legal guardianship, or other permanent placement.
				(3-15-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.06.01 - CHILD AND FAMILY SERVICES › ALTERNATE (OUT-OF-HOME) CARE › Section 16.06.01.400 - AUTHORITY FOR ALTERNATE CARE SERVICES

Current through August 31, 2023
Upon approval of the regional Child and Family Services
				  Program Manager or their designee, the Department may provide or purchase
				  alternative care under the following conditions: (3-15-22)
01.
Department Custody
. When the
				child is in the legal custody or guardianship of the Department; or
				(3-15-22)
02.
Voluntary
				Placement
. Upon agreement with the parent(s) or legal guardian(s) or
				young adult under extended foster care when circumstances interfere with their
				provision of proper care or they are no longer able to maintain a child in
				their home and they can benefit from social work and treatment services.
				(3-15-22)
a. A service plan and an out-of-home
				placement agreement must be developed between the Department and the family.
				The service plan will identify areas of concern, goals, desired results, time
				frames, tasks and task responsibilities. The out-of-home placement agreement
				will include the terms for reimbursement of costs with any necessary
				justification for deviation from Child Support guidelines. (3-15-22)
b. A voluntary agreement for out-of-home
				placement entered into between the Department and the parent(s) or legal
				guardian(s) of a minor child may be revoked at any time by the child's
				parent(s) or legal guardian(s) and the child must be returned to the parent or
				legal guardian upon their request. (3-15-22)
c. A contract between the Department and the
				service provider, if applicable, must also be in effect. (3-15-22)
d. Voluntary out-of-home placements exceeding
				one hundred eighty (180) days without a judicial determination that it is in
				the best interests of the child to continue their current placement cannot be
				reimbursed by Title IV-E funds. (3-15-22)