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 16.03.10.515 - ADULT DEVELOPMENTAL DISABILITY SERVICES: QUALITY ASSURANCE AND IMPROVEMENT

Current through August 31, 2023
01.
Quality
				Assurance
. Quality Assurance consists of audits and reviews to assure
				compliance with the Department's rules and regulations. If problems are
				identified during the review or audit, the provider must implement a corrective
				action plan within forty-five (45) days after the results are received. The
				Department may take enforcement actions as described in IDAPA 16.03.09,
				"Medicaid Basic Plan Benefits," Section
				205, if the provider fails to
				comply with the corrective action plan, any term or provision of the provider
				agreement, or any applicable state or federal regulation. (3-17-22)
02.
Quality Improvement
. The
				Department may gather and utilize information from providers to evaluate
				customer satisfaction, participant satisfaction, participant experience related
				to home and community-based setting qualities, outcomes monitoring, care
				management, quality assurance, quality improvement activities, and health and
				safety. These findings may lead to quality improvement activities to improve
				provider processes and outcomes for participants. (3-17-22)
03.
Exception Review
. The
				Department will complete an exception review of plans or addendums requesting
				services that exceed the assigned budget authorized by the assessor. Requests
				for these services will be authorized when one (1) of the following conditions
				are met: (3-17-22)
a. Services are needed to
				assure the health or safety of participants and the services requested on the
				plan or addendum are required based on medical necessity as defined in Section
				012 of these rules.
				(3-17-22)
b. Supported employment
				services as defined in Section
				703 of these rules are needed for
				the participant to obtain or maintain employment. The request must be submitted
				on the Department-approved Exception Review Form and is reviewed and approved
				based on the following: (3-17-22)
i. A
				supported employment service recommendation must be submitted that includes:
				recommended amount of service, level of support needed, employment goals, and a
				transition plan. When the participant is transitioned from the Idaho Division
				of Vocational Rehabilitation (IDVR) services, the recommendation must be
				completed by IDVR. When a participant is in an established job, the
				recommendation must be completed by the supported employment agency identified
				on the plan of service or addendum; (3-17-22)
ii. The participant's plan of service was
				developed by the participant and their person-centered planning team and
				includes a goal for supported employment services. Prior to the submission of
				an exception review with an addendum, a comprehensive review of all services on
				the participant's plan must occur. The participant's combination of services
				must support the increase or addition of supported employment services; and
				(3-17-22)
iii. An acknowledgment
				signed by the participant and their legal guardian, if one exists, that
				additional budget dollars approved to purchase supported employment services
				must not be reallocated to purchase any other Medicaid service.
				(3-17-22)