Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › SUB PART: ENHANCED DEVELOPMENTAL DISABILITY SERVICES › Section 16.03.10.508 - ADULT DEVELOPMENTAL DISABILITY SERVICES PRIOR AUTHORIZATION: DEFINITIONS

Current through August 31, 2023
For the purposes of these rules the following terms are used
				  as defined below. (3-17-22)
01.
Adult
. A person who is eighteen (18) years of age or older.
				(3-17-22)
02.
Assessment
. A process that is described in Section
				509 of these rules for program
				eligibility and in Section
				512 of these rules for plan of
				service. (3-17-22)
03.
Clinical Review
. A process of professional review that validates
				the need for continued services. (3-17-22)
04.
Community Crisis Support
.
				Intervention for participants who are at risk of losing housing, employment or
				income, or who are at risk of incarceration, physical harm, family altercations
				or other emergencies. (3-17-22)
05.
Concurrent Review
. A clinical review to determine the need for
				continued prior authorization of services. (3-17-22)
06.
Department-Approved Assessment
				Tool
. Any standardized assessment tool approved by the Department for
				use in determining developmental disability eligibility, waiver eligibility,
				skill level to identify the participant's needs for the plan of service, and
				for determining the participant's budget. (3-17-22)
07.
Exception Review
. A clinical
				review of a plan that falls outside the established standards.
				(3-17-22)
08.
Interdisciplinary Team
. For purposes of these rules, the
				interdisciplinary team is a team of professionals, determined by the
				Department, that reviews requests for reconsideration. (3-17-22)
09.
Level of Support
. An
				assessment score derived from a Department-approved assessment tool that
				indicates types and amounts of services and supports necessary to allow the
				individual to live independently and safely in the community.
				(3-17-22)
10.
Person-Centered Planning Process
. A meeting facilitated by the
				participant or plan developer, comprised of family and individuals significant
				to the participant who collaborate with the participant to develop the plan of
				service. (3-17-22)
11.
Person-Centered Planning Team
. The group who develops the plan of
				service. This group includes, at a minimum, the participant and the service
				coordinator or plan developer chosen by the participant. The person-centered
				planning team may include others identified by the participant or agreed upon
				by the participant and the Department as important to the process.
				(3-17-22)
12.
Plan
				Developer
. A paid or non-paid person identified by the participant who
				is responsible for developing one (1) plan of service and subsequent addenda
				that cover all services and supports, based on a person-centered planning
				process. (3-17-22)
13.
Plan
				Monitor
. A person who oversees the provision of services on a paid or
				non-paid basis. (3-17-22)
14.
Plan of Service
. An initial or annual plan that identifies all
				services and supports based on a person-centered planning process. Plans are
				authorized annually every three hundred sixty-five (365) days.
				(3-17-22)
15.
Prior
				Authorization (PA)
. A process for determining a participant's
				eligibility for services and medical necessity prior to the delivery or payment
				of services as provided by these rules. (3-17-22)
16.
Provider Status Review
. The
				written documentation that identifies the participant's progress toward goals
				defined in the plan of service. (3-17-22)
17.
Right Care
. Accepted
				treatment for defined diagnosis, functional needs and abilities to achieve the
				desired outcome. The right care is consistent with best practice and continuous
				quality improvement. (3-17-22)
18.
Right Place
. Services delivered in the most integrated setting in
				which they normally occur, based on the participant's choice to promote
				independence. (3-17-22)
19.
Right Price
. The most integrated and least expensive services that are
				sufficiently intensive to address the participant's needs. The amount is based
				on the individual's needs for services and supports as identified in the
				assessment. (3-17-22)
20.
Right Outcomes
. Services based on assessed need that ensure the health
				and safety of the participant and result in progress, maintenance, or delay or
				prevention of regression for the participant. (3-17-22)
21.
Service Coordination
.
				Service coordination is an activity which assists individuals eligible for
				Medicaid in gaining and coordinating access to necessary care and services
				appropriate to the needs of an individual. (3-17-22)
22.
Service Coordinator
. An
				individual who provides service coordination to a Medicaid-eligible
				participant, is employed by a service coordination agency, and meets the
				training, experience, and other requirements under Sections
				729 through
				732 of these rules.
				(3-17-22)
23.
Services
. Services paid for by the Department that enable the individual
				to reside safely and effectively in the community. (3-17-22)
24.
Supports
. Formal or informal
				services and activities, not paid for by the Department, that enable the
				individual to reside safely and effectively in the setting of their choice.
				(3-17-22)