Definitions

01. Community Support Worker (CSW). An individual, agency, or vendor selected and paid by th e participant to provide CSW services. (7-1-25) 02. Consumer-Directed Community Supports (CDCS). A flexible program option for participant s eligible for the Children’s Home and Community Based Services (HCBS) State Plan Option, and Adul t Developmental Disabilities (DD) waiver. Supports include SDCS and FDCS program options described in IDAPA 16.03.10. “Medicaid Enhanced Plan Benefits.” (7-1-25) 03. Family-Directed Community Supports (FDCS). A program option for children eligible fo r Children's HCBS State Plan Option described in IDAPA 16.03.10, “Medicaid Enhanced Plan Benefits.” (7-1-25) 04. Financial Management Services (FMS). Services provided by an FEA. (7-1-25) 05. Fiscal Employer Agent (FEA). An agency that provides FMS to participants who have chosen th e CDCS option. FEA is selected by the participant. (7-1-25) 06. Goods. Tangible products or merchandise that are authorized on the SSP. (7-1-25) 07. Guiding Principles for the CDCS Option. (7-1-25) a. Freedom for the participant to make choices and plan their own life; (3-17-22) b. Authority for the participant to control resources allocated to them to acquire needed supports; (3-17-22) c. Opportunity for the participant to choose their own supports; (3-17-22) d. Responsibility for the participant to make choices and take responsibility for the result of thos e choices; and (3-17-22) e. Shared responsibility between the participant and their community to help the participant becom e an involved and contributing member of that community. (3-17-22) 08. Home and Community Based Services (HCBS). Long-term services and supports that assis t participants to remain in their home and community. (7-1-25) 09. Medical Necessity (Medically Necessary). A service or item is medically necessary if: (7-1-25) a. It is reasonably calculated to prevent, diagnose, or treat conditions in the participant that endange r life, cause pain, or cause functionally significant deformity or malfunction; (7-1-25) b. There is no other equally effective course of treatment available or suitable for the participan t requesting the service that is more conservative or substantially less costly; and (7-1-25) c. It meets any applicable Department criteria. Services that do not meet criteria require a prio r authorization; and (7-1-25) d. Medical services must be: (7-1-25) i. Of a quality that meets professionally recognized standards of health care; and (7-1-25) ii. Substantiated by records including evidence of such medical necessity and quality. (7-1-25) 10. Readiness Review. A review conducted by the Department to ensure that each FEA is prepared t o enter into and comply with the requirements of the provider agreement and this chapter of rules. (7-1-25) 11. Restrictive Intervention. Any intervention that is used to restrict the rights or freedom of movement of a person and includes chemical, mechanical, and physical restraints or seclusion. (7-1-25) 12. Self-Directed Community Supports (SDCS). A program option for adults eligible for the Adul t DD Waiver described in IDAPA 16.03.10, “Medicaid Enhanced Plan Benefits.” (7-1-25) 13. Support and Spending Plan (SSP). A document that functions as a participant’s plan of care whe n the participant is eligible for and has chosen a CDCS option. This document identifies the goods, services, an d supports selected by a participant, including those available outside of Medicaid-funded services that can help th e participant meet desired goals, and the cost of each one. The participant uses this document to manage thei r individualized budget. (7-1-25) 14. Supports. Services provided for a participant, or a person who provides a support service. A support service may be a paid service provided by a CSW, or an unpaid service provided by a natural support, such a s a family member, a friend, neighbor, or other volunteer. (7-1-25) 15. Support Broker (SB). An individual who advocates on behalf of the participant and who is hire d by the participant to provide SB services. (7-1-25) 16. Traditional Adult DD Waiver Services. A program option for participants eligible for the Adul t DD Waiver consisting of the specific Medicaid Enhanced Plan Benefits described in IDAPA 16.03.10, “Medicai d Enhanced Plan Benefits.” (7-1-25) 17. Traditional Children's HCBS State Plan Option Services. A program option for childre n eligible for the Children's HCBS State Plan Option consisting of the specific Medicaid Enhanced Plan Benefits described in IDAPA 16.03.10, “Medicaid Enhanced Plan Benefits.” (7-1-25) 011. -- 100. (RESERVED)