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 16.03.10.523 - CHILDREN'S DD HCBS STATE PLAN OPTION: COVERAGE AND LIMITATIONS

Current through August 31, 2023
All children's DD HCBS must be identified on a plan of
				  service developed by the family-centered planning team. The following services
				  must be prior authorized and are reimbursable when provided in accordance with
				  these rules. (3-17-22)
01.
Respite
. Respite provides supervision to the participant on an
				intermittent or short-term basis because of the need for relief of the primary
				unpaid caregiver or in response to a family emergency or crisis. Respite may be
				provided by a DDA or by an independent respite provider. An independent respite
				provider may be a relative of the participant. Payment for respite does not
				include room and board. Respite may be provided in the participant's home, the
				private home of the independent respite provider, a DDA, or in the community.
				The following limitations apply: (3-17-22)
a.
				Respite must not be provided on a continuous, long-term basis as a daily
				service that would enable an unpaid caregiver to work. (3-17-22)
b. Respite must only be offered to
				participants living with an unpaid caregiver who requires relief.
				(3-17-22)
c. Respite cannot exceed
				fourteen (14) consecutive days. (3-17-22)
d. Respite must not be provided at the same
				time other Medicaid services are being provided with the exception of when an
				unpaid caregiver is receiving family education. (3-17-22)
e. The respite provider must not use
				restraints on participants, other than physical restraints in the case of an
				emergency. Physical restraints may be used in an emergency to prevent injury to
				the participant or others and must be documented in the participant's record.
				(3-17-22)
f. When respite is
				provided as group respite, the following applies: (3-17-22)
i. When group respite is center-based, there
				must be a minimum of one (1) qualified staff providing direct services to every
				two (2) to six (6) participants. As the number and severity of the participants
				with functional impairments or behavioral needs increase, the participant ratio
				must be adjusted accordingly. (3-17-22)
ii. When group respite is community-based,
				there must be a minimum of one (1) qualified staff providing direct services to
				every two (2) to six (6) participants. As the number and severity of the
				participants with functional impairments or behavioral needs increase, the
				participant ratio in the group must be adjusted accordingly.
				(3-17-22)
g. Respite
				cannot be provided as center-based by an independent respite provider. An
				independent respite provider may only provide group respite when the following
				are met: (3-17-22)
i. The independent respite
				provider is a relative; and (3-17-22)
ii. The service is delivered in the home of
				the participants or the independent respite provider.
				(3-17-22)