Table of Contents

1 Idaho Medicaid provider Handbook Agency Professional March 2, 2021 Page i Table of Contents 1. Agency Professional .. 1 Share of Cost .. 2 Determining How to Bill Units for 15 Minute Timed Codes .. 2 Developmental Disability Agencies .. 2 DDA 3 Prior Authorization .. 4 Program Requirements .. 4 District Health Department services .. 5 Family Planning services .. 5 Child Wellness Exams .. 6 Immunization Program .. 6 Pregnant Women (PW) .. 7 Sexually Transmitted Disease (STD) .. 7 School- based services .. 7 Interpretive services .. 8 Related services Definition .. 8 School Districts and Charter Schools Eligibility.

2 8 Evaluation and Diagnostic 8 Record 9 provider Staff 10 Estimated Annual Expenditure Match .. 11 Payment for services .. 12 Prior Authorization (PA) .. 13 Procedure Codes .. 13 Medicaid Reimbursable Health Related services .. 13 Nursing Agency-PDN .. 16 Covered services .. 16 Nursing Oversight .. 17 Nurse Responsibilities .. 18 Physician Responsibilities .. 18 Reimbursement .. 18 Record 19 Place of Service (POS) 19 DD Targeted Service Coordination .. 19 Definition .. 19 Targeted Service Coordination 20 Agency provider Qualifications .. 21 Crisis Service Coordination.

3 21 Service Coordination for Children with Special Health Care Needs .. 22 Description .. 22 Children s Service Coordination Eligibility .. 22 Agency provider Qualifications .. 23 Crisis Service Coordination .. 24 Prior Authorization .. 24 Idaho Medicaid provider Handbook Agency Professional March 2, 2021 Page ii Notice of Decision (NOD) .. 25 Billing 25 Children s Developmental Disabilities services .. 26 Department Prior Authorization Process .. 26 Eligibility Determination and Assessments .. 27 Family-Centered Planning .. 27 Plan Development .. 27 Plan Monitoring .. 28 Children s DD Benefit Packages.

4 28 Telehealth .. 29 Children s Home and Community based services State Plan Option .. 29 Eligibility .. 29 Program Requirements .. 29 Traditional Option Benefits .. 30 Family-Directed services Option HCBS State Plan .. 35 Covered Service Limit .. 35 waiver services for Children with Developmental Disabilities (DD) .. 35 Eligibility .. 35 Program Requirements .. 36 Traditional Option Children s waiver services .. 37 Family-Directed services Option Children s DD waiver .. 44 Covered Service Limits .. 44 waiver services for Adults with Developmental Disabilities .. 45 Overview of Policy for DD waiver Program.

5 45 Place of Service (POS) Codes .. 45 Plan of Service .. 46 Important Billing Instructions .. 47 Payment .. 48 Share of Cost .. 48 Change of provider Information .. 48 Skilled Nursing services DD waiver .. 49 Service Description .. 49 Agency provider Qualifications .. 49 Behavior Consultation/Crisis Management (BC/CM) DD waiver .. 49 Service Description .. 49 Agency provider Qualifications .. 49 Chore services DD waiver .. 50 Service Description .. 50 Agency provider Qualifications .. 50 Residential Habilitation DD waiver .. 51 Service Description .. 51 Residential Habilitation Supported Living.

6 51 Residential Habilitation Certified Family Home .. 53 Respite Care DD waiver .. 54 Service Description .. 54 Agency provider Qualifications .. 54 Idaho Medicaid provider Handbook Agency Professional March 2, 2021 Page iii Procedure Codes .. 54 Supported Employment services DD waiver .. 55 Service Description .. 55 Agency provider Qualifications .. 55 Procedure Codes .. 56 Non-Medical Transportation DD waiver .. 56 Service Description .. 56 Agency provider Qualifications .. 56 Procedure Codes .. 56 Environmental Accessibility Adaptations DD waiver .. 56 Service Description.

7 56 Agency provider Qualifications .. 57 Specialized Medical Equipment and Supplies DD waiver .. 57 Service Description .. 57 Agency provider Qualifications .. 57 Personal Emergency Response System DD waiver .. 58 Service Description .. 58 Agency provider Qualifications .. 58 Home Delivered Meals DD 58 Service Description .. 58 Agency provider Qualifications .. 58 Adult Day Care (Health) DD waiver .. 59 Service Description .. 59 Agency provider Qualifications .. 59 Consumer Directed services DD waiver .. 60 Community Supports Workers .. 60 Support Broker .. 60 Fiscal Employer Agent.

8 62 Community Crisis Supports .. 63 Transition services DD waiver .. 63 Service Description .. 63 Agency provider Qualifications .. 64 Place of Service (POS) .. 64 Procedure Codes .. 64 Aged & Disabled waiver services .. 64 Medicaid services .. 65 General Information .. 65 Adult Day Care (Health) A&D waiver .. 69 Non-Medical Transportation A&D waiver .. 70 Specialized Medical Equipment and Supplies A&D waiver .. 71 Attendant Care A&D 72 Chore services A&D waiver .. 73 Companion services A&D waiver .. 74 Consultation services A&D waiver .. 75 Homemaker services A&D waiver .

9 76 Home Delivered Meals A&D 76 Idaho Medicaid provider Handbook Agency Professional March 2, 2021 Page iv Environmental Accessibility Adaptations A&D waiver .. 77 Respite Care A&D waiver .. 78 Skilled Nursing services A&D waiver .. 79 Personal Emergency Response System (PERS) A&D waiver .. 81 Day Habilitation services A&D waiver .. 82 Residential Habilitation services A&D waiver .. 83 Supported Employment A&D waiver .. 87 Transition services A&D waiver .. 88 Personal Care services (PCS) .. 89 General Information .. 90 Change in Participant Status .. 92 Exclusions.

10 92 Diagnosis Code .. 92 Place of Service (POS) Code .. 92 Plan of Care (POC) .. 93 Registered Nurse (RN) Responsibilities .. 93 Special Requirements for Individuals with Developmental Disabilities (DD) 94 Functional Assessment/Individual Support Plan and Uniform Assessment Instrument (UAI) .. 94 Procedure Codes .. 95 Record Keeping .. Error! Bookmark not defined. Dental services .. 96 Transition 96 2. Section Modifications .. 99 Idaho Medicaid provider Handbook Agency Professional March 2, 2021 Page 1 of 111 1. Agency Professional Standards of practice require the coordination of care with other agencies operating within the same service area and are not expected to replace or substitute services already provided by other agencies.