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 16.03.10.524 - CHILDREN'S DD HCBS STATE PLAN OPTION: PLAN OF SERVICE PROCESS

Current through August 31, 2023
In collaboration with the participant, the Department must
				  ensure that the participant has one (1) plan of service. This plan of service
				  is developed within the individualized participant budget referred to in
				  Section 522 of these
				  rules and must identify all services. The plan of service must identify
				  services and supports if available outside of Medicaid-funded services that can
				  help the participant meet desired goals. Paid plan development must be provided
				  by the Department, or its contractor, in accordance with Section
				  316 of these rules.
				  (3-17-22)
01.
History and
				Physical
. Prior to the development of the plan of service, the plan
				developer must obtain a current history and physical completed by a
				practitioner of the healing arts. This is required at least annually or more
				frequently as determined by the practitioner. For participants in Healthy
				Connections, the Healthy Connections physician may conduct the history and
				physical and refer the participant for other evaluations. (3-17-22)
02.
Plan of Service Development
.
				The plan of service must be developed with the child participant, the
				participant's decision-making authority, and facilitated by the Department, or
				its designee. If the participant is unable to attend the family-centered
				planning meeting, the plan of service must contain documentation to justify the
				participant's absence. With the decision-making authority's consent, the
				family-centered planning team may include other family members or participants
				who are significant to the participant. (3-17-22)
03.
Requirements for
				Collaboration
. Providers of children's DD HCBS must coordinate with the
				family-centered planning team as specified on the plan of service.
				(3-17-22)
04.
Plan
				Monitoring
. The family-centered planning team must identify the
				frequency of monitoring, which must be at least every six (6) months and
				document the plan monitor's name along with the monitoring frequency on the
				plan. The plan developer is considered the plan monitor and must meet
				face-to-face with the participant and the participant's decision-making
				authority at least annually. Plan monitoring includes reviewing the plan of
				service with the participant and the participant's decision-making authority to
				identify the current status of services, any barriers to services, and any
				necessary changes to the plan of service. (3-17-22)
05.
Provider Status Reviews
. The
				service providers identified in Section
				526 of these rules must report the
				participant's progress toward goals to the plan monitor. The provider must
				complete a six (6) month and annual provider status review. The six (6) month
				status review must be submitted thirty (30) days prior to the six (6) month
				date listed on the plan of service. The annual provider status review must be
				submitted to the plan monitor forty-five (45) calendar days prior to the
				expiration of the existing plan of service. (3-17-22)
06.
Addendum to the Plan of
				Service
. A plan of service may be adjusted during the year with an
				addendum to the plan and these adjustments must be based on changes in a
				participant's need and requested by the parent or legal guardian. Adjustment of
				the plan of service requires the decision-making authority's signature and
				prior authorization by the Department. The Department will distribute the
				addendum to the providers involved in the addendum's implementation. Upon
				receipt by the provider, the addendum must be reviewed, signed, and returned to
				the Department, with a copy maintained in the participant's record.
				(3-17-22)
07.
Annual
				Reauthorization of Services
. A participant's plan of service must be
				reauthorized annually. The Department must review and authorize the new plan of
				service prior to the expiration of the current plan. (3-17-22)
08.
Annual Eligibility Determination
				Results
. An annual determination must be completed in accordance with
				Section 522 of these
				rules. (3-17-22)
09.
Adjustments to the Annual Budget and Services
. The annual budget
				may be adjusted when there are documented changes that may support placement in
				a different budget category as identified in Section
				522 of these rules. Services may be
				adjusted at any time during the plan year. (3-17-22)
10.
Reapplication After a Lapse in
				Service
. For participants who are re-applying for service, the assessor
				must evaluate whether assessments are current and accurately describe the
				status of the participant. (3-17-22)