reglab/statecodes huggingface dataset:
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.13 - CONSUMER-DIRECTED SERVICES › Section 16.03.13.131 - FISCAL EMPLOYER AGENT DUTIES AND RESPONSIBILITIES

Current through August 31, 2023
The fiscal employer agent performs Financial Management
				Services for each participant. Prior to providing Financial Management Services
				the participant and the fiscal employer agent must enter into a written
				agreement. Financial Management Services include: (3-17-22)
01.
Payroll and Accounting
.
			 Providing payroll and accounting supports to participants that have chosen the
			 Consumer-Directed Community Supports option; (3-17-22)
02.
Financial Reporting
.
			 Performing financial reporting for employees of each participant.
			 (3-17-22)
03.
Information
			 Packet
. Preparing and distributing a packet of information, including
			 Department-approved forms for agreements, for the participant hiring their own
			 staff. (3-17-22)
04.
Time
			 Sheets and Invoices
. Processing and paying time sheets for community
			 support workers and support brokers, as authorized by the participant,
			 according to the participant's Department-authorized support and spending plan.
			 (3-17-22)
05.
Taxes
.
			 Managing and processing payment of required state and federal employment taxes
			 for the participant's community support worker and support broker.
			 (3-17-22)
06.
Payments for
			 Goods and Services
. Processing and paying invoices for goods and
			 services, as authorized by the participant, according to the participant's
			 support and spending plan. (3-17-22)
07.
Spending Information
.
			 Providing each participant with reporting information that will assist the
			 participant with managing the individualized budget. (3-17-22)
08.
Quality Assurance and
			 Improvement
. Participating in Department quality assurance activities.
			 (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.13 - CONSUMER-DIRECTED SERVICES › Section 16.03.13.135 - SUPPORT BROKER REQUIREMENTS AND LIMITATIONS

Current through August 31, 2023
01.
Initial Application to Become a Support Broker
. Individuals
			 interested in becoming a support broker must complete the Department-approved
			 application to document that they: (3-17-22)
a. Is eighteen (18) years of age or older;
			 (3-17-22)
b. Has skills and
			 knowledge typically gained by completing college courses or community classes
			 or workshops that count toward a degree in the human services field; and
			 (3-17-22)
c. Has at least two (2)
			 years verifiable experience with the target population and knowledge of
			 services and resources in the developmental disabilities field.
			 (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.13 - CONSUMER-DIRECTED SERVICES › Section 16.03.13.136 - SUPPORT BROKER DUTIES AND RESPONSIBILITIES

Current through August 31, 2023
01.
Support Broker Initial Documentation
. Prior to beginning
			 employment for the participant, the support broker must complete the packet of
			 information provided by the fiscal employer agent and submit it to the fiscal
			 employer agent. This packet must include documentation of: (3-17-22)
a. Support broker application approval by the
			 Department; (3-17-22)
b. A
			 completed criminal history check, including clearance in accordance with
			 Section 009 of these
			 rules and IDAPA 16.05.06, "Criminal History and Background Checks"; and
			 (3-17-22)
c. A completed employment
			 agreement with the participant that identifies the specific tasks and services
			 that are required of the support broker. The employment agreement must include
			 the negotiated hourly rate for the support broker, and the type, frequency, and
			 duration of services. The negotiated rate must not exceed the maximum hourly
			 rate for support broker services established by the Department.
			 (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.13 - CONSUMER-DIRECTED SERVICES › Section 16.03.13.140 - COMMUNITY SUPPORT WORKER LIMITATIONS

Current through August 31, 2023
A paid community support worker must not be the spouse of the
				participant, and, for FDCS, must not be the parent or legal guardian of the
				participant, and must not have direct control over the participant's choices,
				must avoid any conflict of interest, and must not receive undue financial
				benefit from the participant's choices. (3-17-22)
01.
Self-Directed Community Supports
			 (SDCS)
. A legal guardian can be a paid community support worker but must
			 not be paid from the individualized budget for the following: (3-17-22)
a. The legal guardian must not be paid to
			 perform or to assist the participant in meeting the participant
			 responsibilities outlined in Section
			 120 of these rules.
			 (3-17-22)
b. The legal guardian
			 must not be paid to fulfill any obligations they are legally responsible to
			 fulfill as outlined in the guardianship or conservator order from the court.
			 (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.13 - CONSUMER-DIRECTED SERVICES › Section 16.03.13.150 - PAID COMMUNITY SUPPORT WORKER DUTIES AND RESPONSIBILITIES

Current through August 31, 2023
01.
Initial Documentation
. Prior
			 to providing goods or services to the participant, the community support worker
			 must complete the packet of information provided by the fiscal employer agent
			 and submit it to the fiscal employer agent. When the community support worker
			 will be providing services, this packet must include documentation of:
			 (3-17-22)
a. A completed criminal history
			 check, including clearance in accordance with Section
			 009 of these rules and IDAPA
			 16.05.06, "Criminal History and Background Checks," or documentation that this
			 requirement has been waived by the participant. This documentation must be
			 provided on a Department-approved form and include the rationale for waiving
			 the criminal history check and describe how health and safety will be ensured
			 in lieu of a completed criminal history check. Individuals listed on a state or
			 federal provider exclusion list must not provide paid supports;
			 (3-17-22)
b. A completed employment
			 agreement with the participant that specifically defines the type of support
			 being purchased, the negotiated rate, and the frequency and duration of the
			 support to be provided. If the community support worker is provided through an
			 agency, the employment agreement must include the specific individual who will
			 provide the support and the agency's responsibility for tax-related
			 obligations; (3-17-22)
c. Current
			 state licensure or certification if identified support requires certification
			 or licensure; and (3-17-22)
d. A
			 statement of qualifications to provide supports identified in the employment
			 agreement. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.13 - CONSUMER-DIRECTED SERVICES › Section 16.03.13.170 - PERSON-CENTERED PLANNING

Current through August 31, 2023
01.
Direction of the Person-Centered Planning Process
. The participant
			 agrees to direct the person-centered planning process in order to identify and
			 document their support and service needs, wants, and preferences.
			 (3-17-22)
02.
Participant
			 Choice
. The participant decides who they want to participate in the
			 planning sessions in order to ensure the participant's choices are honored and
			 promoted. (3-17-22)
03.
Facilitation of Person-Centered Planning Meetings
. The participant may
			 facilitate their person-centered planning meetings, or these meetings may be
			 facilitated by the chosen support broker. (3-17-22)
04.
Focus of Person-Centered
			 Planning
. The person-centered planning should focus on identifying
			 strengths, capacities, preferences, needs, and desired goals of the participant
			 for all life areas. (3-17-22)
05.
Timeframes of Person-Centered Planning
. The person-centered
			 planning should be completed as timely as possible in order to provide the
			 necessary information required to develop the participant's support and
			 spending plan. Time limitations are not currently mandated in order to allow
			 for extensive, comprehensive planning and thoughtful support and spending plan
			 development. (3-17-22)
06.
HCBS Person-Centered Planning Requirements
. The person-centered planning
			 process must meet all HCBS requirements as defined in IDAPA 16.03.10, "Medicaid
			 Enhanced Plan Benefits," Section
			 316. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.13 - CONSUMER-DIRECTED SERVICES › Section 16.03.13.180 - CIRCLE OF SUPPORTS

Current through August 31, 2023
The circle of support is a means of natural supports for the
				participant and consists of people who encourage and care about the
				participant. Work or duties the circle of supports performs on behalf of the
				participant are not paid. (3-17-22)
01.
Focus of the Circle of
			 Support
. The participant's circle of support should be built and operate
			 with the primary goal of working in the interest of the participant. The
			 group's role is to give and get support for the participant and to develop a
			 plan of action, along with and on behalf of the participant, to help the
			 participant accomplish their personal goals. (3-17-22)
02.
Members of the Circle of
			 Support
. A circle of support may include family members, friends,
			 neighbors, co-workers, and other community members. For the SDCS, when the
			 participant's legal guardian is selected as a community support worker, the
			 circle of support must include at least one (1) non-family member that is not
			 the support broker. For the purposes of this chapter a family member is anyone
			 related by blood or marriage to the participant or to the legal guardian.
			 (3-17-22)
03.
Selection and
			 Duties of the Circle of Support
. Members of the circle of support are
			 selected by the participant and commit to work within the group to: (3-17-22)
a. Help promote and improve the life of the
			 participant in accordance with the participant's choices and preferences; and
			 (3-17-22)
b. Meet on a regular
			 basis to assist the participant to accomplish their expressed goals.
			 (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.13 - CONSUMER-DIRECTED SERVICES › Section 16.03.13.190 - INDIVIDUALIZED BUDGET

Current through August 31, 2023
The Department sets an individualized budget for each
				participant according to an individualized measurement of the participant's
				functional abilities, behavioral limitations, medical needs, and other
				individual factors related to the participant's assessed needs. Using these
				specific participant factors, the budget-setting methodology will correlate a
				participant's characteristics with the participant's individualized budget
				amount, so participants with higher needs will be assigned a higher
				individualized budget amount. The participant must work within the identified
				budget and acknowledge that they understand the budget figure is a fixed
				amount. (3-17-22)
01.
Budget
			 Amount Notification
. The Department notifies each participant of their
			 set budget amount as part of the eligibility determination or annual
			 redetermination process. The notification will include how the participant may
			 appeal the set budget amount. (3-17-22)
02.
Annual Re-Evaluation of Adult
			 Individualized Budgets
. Individualized budgets will be reevaluated
			 annually. At the request of the participant, the Department will also
			 re-evaluate the set budget amount when there are documented changes in the
			 participant's condition that results in a need for services that meet medical
			 necessity criteria, and that is not reflected on the current inventory of
			 individual needs. (3-17-22)
03.
Annual Re-Evaluation of Children's Individualized Budgets
.
			 Individualized budgets will be reevaluated annually. At the request of the
			 participant, the Department will also re-evaluate the set budget amount when
			 there are documented changes that may support placement in a different budget
			 category as identified in IDAPA 16.03.10, "Medicaid Enhanced Plan Benefits,"
			 Section 527.
			 (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.13 - CONSUMER-DIRECTED SERVICES › Section 16.03.13.200 - QUALITY ASSURANCE

Current through August 31, 2023
The Department will implement quality assurance processes to
				ensure: access to consumer-directed services, participant direction of plans
				and services, participant choice and direction of providers, safe and effective
				environments, and participant satisfaction with services and outcomes.
				(3-17-22)
01.
Participant
			 Experience Survey (PES)
. Each participant will have the opportunity to
			 provide feedback to the Department about their satisfaction with
			 consumer-directed services utilizing the PES. (3-17-22)
02.
Participant Experience
			 Outcomes
. Participant experience information will be gathered at least
			 annually in an interview by the Department, and will address the following
			 participant outcomes: (3-17-22)
a. Access to
			 care; (3-17-22)
b. Choice and
			 control; (3-17-22)
c. Respect and
			 dignity; (3-17-22)
d. Community
			 integration; and (3-17-22)
e.
			 Inclusion. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.13 - CONSUMER-DIRECTED SERVICES › Section 16.03.13.210 - CONTINUATION OF THE CONSUMER-DIRECTED COMMUNITY SUPPORTS (CDCS) OPTION

Current through August 31, 2023
The following requirements must be met or the Department may
				require the participant to discontinue the CDCS option: (3-17-22)
01.
Required Supports
. The
			 participant is willing to work with a support broker and a fiscal employer
			 agent. (3-17-22)
a. The participant can only
			 change FEA services by providing a written request to their current FEA
			 provider at least sixty (60) days in advance, and this change must occur at the
			 end of a fiscal quarter. The request must include the name of the new FEA
			 chosen by the participant and provide the specific date the change will occur.
			 (3-17-22)
b. When a participant
			 provides a written request to their current FEA provider to change to a
			 different FEA provider, the current FEA provider must notify the participant of
			 the specific date that the last payroll run will occur at the end of the fiscal
			 quarter. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.13 - CONSUMER-DIRECTED SERVICES › FISCAL EMPLOYER AGENT DUTIES AND RESPONSIBILITIES › Section 16.03.13.300 - FISCAL EMPLOYER AGENT DUTIES AND RESPONSIBILITIES: DEFINITIONS

Current through August 31, 2023
For purposes of Sections
				  300 through
				  314, the following definitions
				  apply: (3-17-22)
01.
Employee
. A community support worker employed by a participant
				receiving services under the CDCS option. (3-17-22)
02.
Employer
. A participant
				receiving services under the CDCS option. (3-17-22)
03.
Provider
. The term
				"provider" specifically refers to the fiscal employer agent providing financial
				management services to individuals participating in consumer-direction.
				(3-17-22)
04.
SFTP
.
				Secure File Transfer Protocol. A secure means of transferring data that allows
				certain Department staff to access information regarding consumer-direction
				participants. (3-17-22)
05.
Vendor
. Provides goods and services rendered by agencies and independent
				contractors in accord with a participant's support and spending plan.
				(3-17-22)
06.
Medicaid
				Billing Report
. A report generated every payroll period by the provider;
				it provides a list and count of unduplicated participants and payroll
				expenditures by service code, based on the date of service time frame specified
				by the user. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.13 - CONSUMER-DIRECTED SERVICES › FISCAL EMPLOYER AGENT DUTIES AND RESPONSIBILITIES › Section 16.03.13.301 - FISCAL EMPLOYER AGENT DUTIES AND RESPONSIBILITIES: CONSUMER-DIRECTED COMMUNITY SUPPORTS

Current through August 31, 2023
01.
Federal
				Tax ID Requirement
. The fiscal employer agent must obtain a separate
				Federal Employer Identification Number (FEIN) specifically to file tax forms
				and to make tax payments on behalf of program participants under Section
				3504 of the Internal Revenue Code
				(26 USC
				3504). In addition, the provider must:
				(3-17-22)
a. Maintain copies of the
				participant's FEIN, IRS FEIN notification letter, and Form SS-4 Request for
				FEIN in the participant's file. (3-17-22)
b. Retire participant's FEIN when the
				participant is no longer an employer under consumer-directed community supports
				(CDCS). (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.13 - CONSUMER-DIRECTED SERVICES › FISCAL EMPLOYER AGENT DUTIES AND RESPONSIBILITIES › Section 16.03.13.302 - FISCAL EMPLOYER AGENT DUTIES AND RESPONSIBILITIES: CUSTOMER SERVICE

Current through August 31, 2023
01.
Customer Service System
. The
				provider must provide a customer service system to respond to all inquiries
				from participants, employees, agencies, and vendors. The provider must:
				(3-17-22)
a. Provide staff with customer
				service training with an emphasis on consumer-direction. (3-17-22)
b. Ensure staff are trained and have the
				skills to assist participants with enrollment and to help them understand their
				account statements. (3-17-22)
c.
				Ensure that fiscal employer agent personnel are available during regular
				business hours, 8 a.m. to 5 p.m. Mountain Time, Monday through Friday,
				excluding state holidays. (3-17-22)
d. Provide translation and interpreter
				services (i.e., American Sign Language and services for persons with limited
				English proficiency). (3-17-22)
e.
				Provide prompt and consistent response to verbal and written communication.
				Specifically: (3-17-22)
i. All voice mail
				messages must be responded to within one (1) business day; and
				(3-17-22)
ii. All written and
				electronic correspondence must be responded to within five (5) business days.
				(3-17-22)
f. Maintain a
				toll-free phone line where callers speak to a live person during business hours
				and are provided the option to leave voice mail at any time, all day, every
				day. (3-17-22)
g. Maintain a
				toll-free fax line that is available all day, every day, exclusively for
				participants and their employees. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.13 - CONSUMER-DIRECTED SERVICES › FISCAL EMPLOYER AGENT DUTIES AND RESPONSIBILITIES › Section 16.03.13.303 - FISCAL EMPLOYER AGENT DUTIES AND RESPONSIBILITIES: PERSONAL AND CONFIDENTIAL INFORMATION

Current through August 31, 2023
The provider must implement and enforce policies and
				  procedures regarding documents that are mailed, faxed, or emailed to and from
				  the provider to ensure documents are tracked and that confidential information
				  is not compromised, is stored appropriately and not lost, and is traceable for
				  historical research purposes. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.13 - CONSUMER-DIRECTED SERVICES › FISCAL EMPLOYER AGENT DUTIES AND RESPONSIBILITIES › Section 16.03.13.304 - FISCAL EMPLOYER AGENT DUTIES AND RESPONSIBILITIES: ENROLLMENT PROCESS

Current through August 31, 2023
01.
Submission of Participant
				Enrollment and Employee Packets for Department Approval
. The provider
				must submit the following for participant enrollment and employee packets to
				the Department for approval. (3-17-22)
a. The
				participant enrollment packet must include: (3-17-22)
i. Fiscal employer agent authorization form;
				(3-17-22)
ii. Employer Appointment
				of Agent - IRS Form; (3-17-22)
iii.
				Tax Information Form; and (3-17-22)
iv. Employer information. The employer
				information must include: (3-17-22)
(1)
				Instructions for completing forms; (3-17-22)
(2) Payroll schedule, including deadlines for
				submission of time cards; (3-17-22)
(3) Sample employment agreements;
				(3-17-22)
(4) Sample Request for
				Vendor Payment form; (3-17-22)
(5)
				Sample independent provider agreement; and (3-17-22)
(6) Other sample employment agreements as
				needed. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.13 - CONSUMER-DIRECTED SERVICES › FISCAL EMPLOYER AGENT DUTIES AND RESPONSIBILITIES › Section 16.03.13.305 - FISCAL EMPLOYER AGENT DUTIES AND RESPONSIBILITIES: PAYMENT PROCESS

Current through August 31, 2023
01.
Process Payroll
. The
				provider must process payroll, including time sheets and taxes, in accordance
				with the participant's support and spending plan. The payroll process must
				include: (3-17-22)
a. Payment of employer and
				withholding taxes to State Tax Commission and Internal Revenue Service.
				(3-17-22)
b. Payment of invoices to
				vendors. (3-17-22)
c. Management of
				participant budget funds as per authorized support and spending plan.
				(3-17-22)
d. Garnishment of wages
				as per court orders. (3-17-22)
e.
				Preparation of year-end federal and state tax forms. (3-17-22)
f. Payment of worker's compensation insurance
				premiums. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.13 - CONSUMER-DIRECTED SERVICES › FISCAL EMPLOYER AGENT DUTIES AND RESPONSIBILITIES › Section 16.03.13.306 - FISCAL EMPLOYER AGENT DUTIES AND RESPONSIBILITIES: ANNUAL PARTICIPANT SURVEY

Current through August 31, 2023
01.
Requirement to Conduct Annual Participant Satisfaction Survey
. Starting
				October 1 of each calendar year, each provider who has been providing services
				for at least six (6) months must conduct an annual participant satisfaction
				survey. (3-17-22)
a. Three (3) weeks prior to
				the survey launch, the provider must present the questions to the Department
				staff for approval. (3-17-22)
b.
				Once the questions are approved by the Department, the provider can send out
				the survey. (3-17-22)
c. The
				provider must survey its participants who receive services under
				consumer-directed services, such as participants with disabilities, family
				members of participants, and participants whose primary language is other than
				English. (3-17-22)
d. The provider
				must provide options for participants to respond to the surveys, other than by
				mail, for those participants who may not be able to respond by that method.
				(3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.13 - CONSUMER-DIRECTED SERVICES › FISCAL EMPLOYER AGENT DUTIES AND RESPONSIBILITIES › Section 16.03.13.307 - FISCAL EMPLOYER AGENT DUTIES AND RESPONSIBILITIES: QUALITY ASSURANCE

Current through August 31, 2023
01.
Required Elements of Quality
				Insurance Process
. The provider must provide a quality assurance process
				that includes: (3-17-22)
a. Implementation of
				a quality management plan; (3-17-22)
b. Preparation of a quarterly, quality
				management analysis report; (3-17-22)
c. Distribution, collection, and analysis of
				an annual participant satisfaction survey; and (3-17-22)
d. A review of the monthly complaint summary
				and resolutions, monitoring of standards, and implementation of program
				improvements as needed. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.13 - CONSUMER-DIRECTED SERVICES › FISCAL EMPLOYER AGENT DUTIES AND RESPONSIBILITIES › Section 16.03.13.308 - FISCAL EMPLOYER AGENT DUTIES AND RESPONSIBILITIES: DISASTER RECOVERY PLAN

Current through August 31, 2023
01.
Disaster
				Recovery Plan
. The provider must develop and maintain a Disaster
				Recovery Plan for electronic and hard copy files that includes restoring
				software and data files, and hardware backup if management information systems
				are disabled or servers are inoperative. The results of the Disaster Recovery
				Plan must ensure the continuation of payroll and invoice payment systems. The
				provider must submit the Disaster Recovery Plan for Department approval during
				the readiness review. (3-17-22)
02.
Requirement to Report a Disaster
. The provider must report to the
				Department if management information systems are disabled or servers are
				inoperative within twenty-four (24) hours of the event. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.13 - CONSUMER-DIRECTED SERVICES › FISCAL EMPLOYER AGENT DUTIES AND RESPONSIBILITIES › Section 16.03.13.309 - FISCAL EMPLOYER AGENT DUTIES AND RESPONSIBILITIES: TRANSITION PLAN

Current through August 31, 2023
01.
Transition Plan Objectives
.
				The provider must provide a transition plan to the Department within ninety
				(90) days after successful completion of the readiness review. The objectives
				of the transition plan are to minimize the disruption of services and provide
				an orderly and controlled transition of the provider's responsibilities to a
				successor at the conclusion of the agreement period or for any other reason the
				provider cannot complete responsibilities described in this chapter of rules.
				(3-17-22)
02.
Transition Plan
				Requirements
. The transition plan must: (3-17-22)
a. Be updated at least ninety (90) days prior
				to termination of the provider agreement. (3-17-22)
b. Include tasks, and subtasks for
				transition, a schedule for transition, operational resource requirements, and
				training to be provided. (3-17-22)
c. Provide for transfer of data,
				documentation, files, and other records relevant to the agreement in an
				electronic format accepted by the Department. (3-17-22)
d. Provide for the transfer of any current,
				Idaho-specific policy and procedure manuals, brochures, pamphlets, and all
				other written materials developed in support of agreement activity to the
				Department. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.13 - CONSUMER-DIRECTED SERVICES › FISCAL EMPLOYER AGENT DUTIES AND RESPONSIBILITIES › Section 16.03.13.310 - FISCAL EMPLOYER AGENT DUTIES AND RESPONSIBILITIES: PERFORMANCE METRICS

Current through August 31, 2023
01.
Readiness Review
. The
				provider must complete a readiness review conducted by the Department with the
				provider prior to providing fiscal employer agent services. (3-17-22)
a. Required Level of Expectation: The
				provider must complete one hundred percent (100%) of the readiness review.
				(3-17-22)
b. Method of Monitoring:
				The Department will access SFTP site for review of provider documents and
				conduct an onsite review. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.13 - CONSUMER-DIRECTED SERVICES › FISCAL EMPLOYER AGENT DUTIES AND RESPONSIBILITIES › Section 16.03.13.311 - FISCAL EMPLOYER AGENT DUTIES AND RESPONSIBILITIES: REPORTS

Current through August 31, 2023
01.
Account Summary Statements
.
				This report provides an overview of each participant account and includes the
				services accessed and the remaining dollar amount in the budget. In addition to
				the provider providing this report each month, a participant may request this
				report for a specified timeframe. Each month, the provider must mail a hard
				copy of the report to each participant and also make the report available on a
				secure website for those who prefer to access the information electronically.
				The provider must generate the report after every payroll and post it on a
				secure SFTP site for the Department to access. This SFTP site must have a user
				name and password protection. (3-17-22)
a.
				Report Format: The provider must provide the account summary statement in
				Microsoft Excel. (3-17-22)
b.
				Report Due Date: The provider must post the account summary statement by the
				10th day of each month. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.13 - CONSUMER-DIRECTED SERVICES › FISCAL EMPLOYER AGENT DUTIES AND RESPONSIBILITIES › Section 16.03.13.312 - FISCAL EMPLOYER AGENT DUTIES AND RESPONSIBILITIES: PAYMENT REQUIREMENTS

Current through August 31, 2023
01.
Requirement to Accept a Per Member Per Month (PMPM) Payment
. The
				Department will pay, and the provider must accept a per member per month (PMPM)
				payment that covers a comprehensive set of fiscal employer agent services. The
				Department will set allowable reimbursement rates for PMPM based on a
				methodology approved by CMS in the DD HCBS Waiver. The provider can only bill
				the PMPM rate for the months services are actually provided for participants,
				The provider must provide transition, training, and closeout services during
				the active agreement, at no additional cost to the Department.
				(3-17-22)
02.
PMPM Payment
				Process Requirements
. The payment (PMPM) must include all administrative
				costs, travel, transition, training, and closeout services. The Department will
				not pay for participants who do not have a support and spending plan. For the
				purposes of PMPM payment, one (1) month must include all payroll batch dates
				within that specific calendar month. (3-17-22)
03.
Requirement to Complete a Readiness
				Review
. The provider must complete a readiness review prior to billing
				for services. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.13 - CONSUMER-DIRECTED SERVICES › FISCAL EMPLOYER AGENT DUTIES AND RESPONSIBILITIES › Section 16.03.13.313 - TERMINATION OF FISCAL EMPLOYER AGENT PROVIDER AGREEMENTS

Current through August 31, 2023
01.
Termination of the Provider
				Agreement
. The following must occur in the event of termination of the
				provider agreement: (3-17-22)
a. The provider
				must ensure continuation of services to participants for the period in which a
				Per Member per Month (PMPM) payment has been made, and submit the information,
				reports and records, including the Medicaid Billing Report (reconciliation) as
				specified in Section 310 of these
				rules. (3-17-22)
b. The provider
				must provide to the Department a written notice ninety (90) days in advance and
				the change notification must occur at the end of the next calendar quarter.
				(3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.13 - CONSUMER-DIRECTED SERVICES › FISCAL EMPLOYER AGENT DUTIES AND RESPONSIBILITIES › Section 16.03.13.314 - REMEDIES TO NONPERFORMANCE OF A FISCAL EMPLOYER AGENT SERVICE PROVIDER

Current through August 31, 2023
01.
Remedial Action
. If any of
				the services do not comply with the performance metrics under Section
				310 of these rules, the Department
				will consult with the provider and may, at its sole discretion, require any of
				the following remedial actions, taking into account the scope and severity of
				the noncompliance, compliance history, the number of noncompliances, the
				integrity of the program, and the potential risk to participants. (3-17-22)
a. Require the provider to take corrective
				action to ensure that performance meets the performance metrics under Section
				310 of these rules;
				(3-17-22)
b. Reduce payment to
				reflect the reduced value of services received; (3-17-22)
c. Require the provider to subcontract all or
				part of the service at no additional cost to the Department; or
				(3-17-22)
d. Terminate the provider
				agreement with notice. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.14 - HOSPITALS › Section 16.03.14.000 - LEGAL AUTHORITY

Current through August 31, 2023
The Idaho legislature has delegated to the Board of Health and
				Welfare the power to promulgate rules governing hospitals, pursuant to Section
				39-1307, Idaho Code.
				(3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.14 - HOSPITALS › Section 16.03.14.001 - TITLE AND PURPOSE

Current through August 31, 2023
01.
Title
. These rules are titled Idaho Department of Health and Welfare
			 Rules, IDAPA 16.03.14, "Hospitals." (3-17-22)
02.
Purpose
. The purpose of the
			 rules is to provide for the development, establishment and enforcement of
			 standards for the care and treatment of individuals in hospitals and for the
			 construction, maintenance and operation of hospitals that, in the light of
			 advancing knowledge, will promote safe and adequate treatment of such
			 individuals in hospitals. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.14 - HOSPITALS › Section 16.03.14.010 - DEFINITIONS AND ABBREVIATIONS - A THROUGH M

Current through August 31, 2023
For the purposes of this chapter, the following terms and
				definitions apply. (3-17-22)
01.
Anesthesiologist
. A physician who meets the requirements for
			 certification by the American Board of Anesthesiology or the American
			 Osteopathic Board of Anesthesiology. (3-17-22)
02.
Anesthetist
. A person who
			 is: (3-17-22)
a. A dentist who has
			 successfully completed a three (3) year residency in anesthesiology approved by
			 the American Medical Association. (3-17-22)
b. A physician whose competence in the
			 practice of anesthesiology is approved by the medical staff, of the hospital in
			 which he works. (3-17-22)
c. A
			 licensed registered nurse who meets the requirements for certification (CRNA)
			 by the Council on Certification of the American Association of Nurse
			 Anesthetists. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.14 - HOSPITALS › Section 16.03.14.011 - DEFINITIONS AND ABBREVIATIONS - N THROUGH Z

Current through August 31, 2023
For the purposes of this chapter, the following terms and
				definitions apply. (3-17-22)
01.
New Construction or New Hospitals
. Includes the following:
			 (3-17-22)
a. New buildings to be used as
			 hospitals; and (3-17-22)
b.
			 Additions to existing hospitals; and (3-17-22)
c. Conversion of existing buildings or
			 portions thereof for use as a hospital; and (3-17-22)
d. Remodeling, alteration, addition or
			 upgrading of a hospital or hospital building system that affects the structural
			 integrity of the building, that changes functional operation, that affects fire
			 safety or that adds beds, departments or services over those for which the
			 hospital is currently licensed. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.14 - HOSPITALS › Section 16.03.14.100 - LICENSURE

Current through August 31, 2023
Pursuant to Section
				39-1303, Idaho Code, no person or
				governmental unit, acting separately or jointly with any other person or
				governmental unit shall establish, conduct or maintain a hospital in this state
				without a license issued pursuant to Sections
				39-1301 through
				39-1314, Idaho Code.
				(3-17-22)
01.
Application for
			 License
. Pursuant to Section
			 39-1304, Idaho Code, an
			 application for a license shall be made to the licensing agency upon forms
			 provided it and shall contain such information as the licensing agency
			 reasonably requires, that shall include affirmative evidence of ability to
			 comply with such reasonable standards, rules and regulations as are lawfully
			 prescribed herein, and to include evidence of a request for a determination of
			 review ability if a program providing prospective review for hospitals is in
			 effect. (3-17-22)
02.
Issuance and Renewal of License
. Pursuant to Section
			 39-1305, Idaho Code, upon receipt
			 of an application for license, the licensing agency shall issue a license if
			 the applicant and hospital facilities meet the requirements established in
			 these rules. (3-17-22)
a. A license, unless
			 suspended or revoked, shall be renewable annually upon filing by the licensee
			 and approval by the licensing agency of an annual report upon such uniform
			 dates and containing such information in such form as the licensing agency
			 prescribes. (3-17-22)
b. Each
			 license will be issued only for the premises and persons or governmental units
			 named in the application and shall not be transferable or assignable except
			 with the written approval of the licensing agency.
			 (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.14 - HOSPITALS › Section 16.03.14.105 - DENIAL OR REVOCATION OF LICENSE

Current through August 31, 2023
Pursuant to Section
				39-1306, Idaho Code, relating to
				hearings and review, after notice and opportunity for hearing to the applicant
				or licensee, the licensing agency is authorized to deny, or revoke a license in
				any case in which it finds that conditions exist that endanger the health or
				safety of any patient. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.14 - HOSPITALS › Section 16.03.14.110 - COMPLIANCE DEADLINE

Current through August 31, 2023
Pursuant to Section
				39-1308, Idaho Code, any hospital
				that is in operation at the time of implementation of any applicable
				regulations will be given a reasonable time under the particular circumstances,
				not to exceed one (1) year from the date of implementation, within which to
				comply with the applicable rules and regulations. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.14 - HOSPITALS › Section 16.03.14.120 - INSPECTIONS AND CONSULTATIONS

Current through August 31, 2023
01.
Inspections
. Pursuant to Section
			 39-1309, Idaho Code, the licensing
			 agency will make or cause to be made such inspections and investigations as it
			 deems necessary. Any licensee or applicant desiring to alter, add to or remodel
			 its existing facility, or to construct new facilities or convert an existing
			 structure to hospital use, is referred to Subsection
			 002.26 and Section
			 600, for construction standards and
			 review procedures that must occur prior to commencing such structural changes.
			 (3-17-22)
02.
Consultations
. Consultations may be provided at the option of the
			 licensing agency. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.14 - HOSPITALS › Section 16.03.14.130 - CONFIDENTIALITY

Current through August 31, 2023
Pursuant to Section
				39-1310, Idaho Code, information
				received by the licensing agency through filed reports, inspections, or as
				otherwise authorized under this law, will not be disclosed publicly in such a
				manner as to identify individuals except in a proceeding involving the question
				of licensure. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.14 - HOSPITALS › Section 16.03.14.140 - PENALTIES

Current through August 31, 2023
01.
Penalty for Operating Hospital
			 Without License
. Any person establishing, conducting, managing, or
			 operating a hospital, as defined, without a license shall be guilty of a
			 misdemeanor punishable by imprisonment in a county jail for a period of time
			 not exceeding six (6) months, or by a fine not exceeding three hundred dollars
			 ($300), or by both, and each day of continuing violations shall constitute a
			 separate offense. (3-17-22)
02.
Injunction to Prevent Operation Without License
. Notwithstanding
			 the existence or pursuit of any other remedy, the licensing agency may in the
			 manner provided by law maintain an action in the name of the state for
			 injunction or other process against any person or governmental unit to restrain
			 or prevent the establishment, conduct, management or operation of a hospital as
			 defined, without a license. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.14 - HOSPITALS › Section 16.03.14.150 - LICENSING PROVISIONS

Current through August 31, 2023
01.
General
			 License Requirements
. (3-17-22)
a.
			 Before any person can directly or indirectly operate a hospital, he must make
			 application and receive a valid license for the operation of the hospital. No
			 patient will be admitted until a valid license is issued. (3-17-22)
b. Applicants for license and licensees must
			 conform to the rules and minimum standards for hospitals in Idaho.
			 (3-17-22)
c. Facilities making an
			 initial application for a license shall be issued a temporary license when the
			 licensing agency determines that all application information is acceptable and
			 that the facility is at least in substantial compliance with these rules and
			 standards. The temporary license provides the Department time to determine the
			 facility's on-going capability to provide services and to meet these rules. A
			 temporary license may not be issued for a period that exceeds six (6) months.
			 (3-17-22)
d. If a hospital that is
			 required to be licensed under these rules does not normally provide a
			 particular service or department, the section or sections of these regulations
			 relating to such service or department will not be applicable.
			 (3-17-22)
e. The licensing agency
			 can upon written application submitted by the hospital allow the substitution
			 of procedures, equipment, or facilities for those specified in these rules,
			 when such procedure, equipment, or facility has been demonstrated to be at
			 least equivalent to those prescribed. Such substitution shall be in writing and
			 placed on file with the licensing agency and the hospital. The foregoing
			 provision shall not apply to new construction. (3-17-22)
f. No facility can create the impression it
			 is a hospital, unless it does in fact meet the legal definition of a hospital
			 and is so licensed by the Board. (3-17-22)
g. A provisional license may be issued to a
			 hospital that is in substantial compliance with the rules but is temporarily
			 unable to meet all requirements. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.14 - HOSPITALS › Section 16.03.14.200 - GOVERNING BODY AND ADMINISTRATION

Current through August 31, 2023
There shall be an organized governing body, or equivalent, that
				has ultimate authority and responsibility for the operation of the hospital.
				(3-17-22)
01.
Bylaws
. The
			 governing body shall adopt bylaws in accordance with Idaho Code, community
			 responsibility, and identify the purposes of the hospital and that specify at
			 least the following: (3-17-22)
a. Membership
			 of Governing Body, that consists of: (3-17-22)
i. Basis of selecting members, term of
			 office, and duties; and (3-17-22)
ii. Designation of officers, terms of office,
			 and duties. (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.14 - HOSPITALS › Section 16.03.14.220 - PATIENT RIGHTS

Current through August 31, 2023
A hospital must protect and promote each patient's rights.
				Patient rights are provided for and described in Sections
				220 through
				234 of these rules.
				(3-17-22)
01.
Informed in
			 Advance of Patient Care
. A hospital must inform each patient, or when
			 appropriate, the patient's representative or caregiver, of the patient's rights
			 in advance of furnishing or discontinuing patient care whenever possible.
			 (3-17-22)
02.
Identify Who Is
			 Responsible for Medical Decisions
. The hospital must identify who is
			 responsible for making medical decisions and representing the patient if the
			 patient is unable to make those decisions. (3-17-22)
03.
Specify Procedures to Inform
			 Patient of Patient Rights
. (3-17-22)
a. The hospital must specify a procedure to
			 inform patients, their representative, or caregiver of their rights before
			 providing care. (3-17-22)
b. In an
			 emergency, rights may be provided after emergent care is provided.
			 (3-17-22)
c. The procedure must
			 include a method to document that patients were informed of their rights or the
			 reasons they were not informed before care was provided.
			 (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.14 - HOSPITALS › Section 16.03.14.225 - PATIENT GRIEVANCES

Current through August 31, 2023
The hospital must establish a clearly explained process for the
				prompt resolution of patient grievances. (3-17-22)
01.
Grievance by Patient or Patient's
			 Representative
. A patient's grievance is a formal or informal, written
			 or verbal complaint that is made to the hospital by a patient, or the patient's
			 representative, regarding the patient's care, alleged abuse or neglect, or
			 issues related to the hospital's compliance with Idaho state licensure rules.
			 When a complaint is resolved at the time of the complaint by staff present, it
			 is not considered a grievance and does not require investigation.
			 (3-17-22)
02.
Grievance
			 Process
. The grievance process must include: (3-17-22)
a. The hospital must inform each patient how
			 to submit a grievance. Grievances may be submitted to any professional staff
			 member. (3-17-22)
b. Grievances
			 must be investigated. The grievance process must specify time frames for review
			 of the grievance and the provision of a response. (3-17-22)
c. The hospital must document the steps taken
			 to investigate the grievance and the results of the grievance process.
			 (3-17-22)
Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.14 - HOSPITALS › Section 16.03.14.229 - LAW ENFORCEMENT RESTRAINTS

Current through August 31, 2023
The use of law enforcement restraint devices are not considered
				safe, appropriate health care restraint interventions for use by hospital staff
				to restrain patients. (3-17-22)
01.
Law Enforcement Use of Restraint Devices
. The use of handcuffs,
			 manacles, shackles, other chain-type restraint devices, or other restrictive
			 devices applied by non-hospital employed or contracted law enforcement
			 officials for custody, detention, and public safety reasons are not governed by
			 these rules. (3-17-22)
02.
Law Enforcement Maintains Custody and Direct Supervision
. When a law
			 enforcement officer applies handcuffs, manacles, shackles, other chain-type
			 restraint devices to a patient, the law enforcement officer must maintain
			 custody and direct supervision of the prisoner who is the hospital's patient.
			 (3-17-22)
a. The law enforcement officer is
			 responsible for the use, application, and monitoring of these restrictive
			 restraint devices in accordance with state law. (3-17-22)
b. The hospital is responsible for an
			 appropriate patient assessment and the provision of safe, appropriate care to
			 its patient who is in the custody of a law enforcement officer.
			 (3-17-22)