Quality Assurance

The Department will implement quality assurance processes to ensure: access to CDCS, participant direction of SSP s and services, participant choice and direction of providers, safe and effective environments, and participant satisfaction with services and outcomes. (7-1-25) 01. Adult Services Outcome Review (ASOR). Each participant will have the opportunity to provide feedback to the Department about their satisfaction with consumer-directed services utilizing the ASOR. (7-1-25) 02. Adult Service Outcomes. Participant experience information will be gathered at least annually i n an interview by the Department, and will address the following participant outcomes: (7-1-25) 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) 03. CSWs and SBs Quality Assurance Activities. CSWs and SBs must participate and comply wit h quality assurance activities identified by the Department including performance evaluations, satisfaction surveys, quarterly review of services provided by a legal guardian, if applicable, and spot audits of time sheets and billin g records. (7-1-25) 04. Participant Choice of Paid CSW. Paid CSWs must be selected by the participant, or their chose n representative, and meet the qualifications identified in this rule. (7-1-25) 05. Complaint Reporting and Tracking Process. The Department will maintain a complain t reporting and tracking process to ensure participants, workers, and other supports have the opportunity to readil y report instances of abuse, neglect, exploitation, or other complaints regarding the HCBS program. (3-17-22) 06. Quality Oversight Committee. A Quality Oversight Committee consisting of participants, famil y members, community providers, and Department designees will review information and data collected from th e quality assurance processes to formulate recommendations for program improvement. (3-17-22) 07. Quarterly Quality Assurance Reviews. On a quarterly basis, the Department will perform a n enhanced review of services for those participants who have waived the criminal history check requirement for a community support worker or who have their legal guardian providing paid services. These reviews will asses s ongoing participant health and safety and compliance with the approved SSP. (7-1-25) 08. HCBS Specific Reviews. The Department will implement quality assurance and improvemen t activities to ensure compliance with the rules in IDAPA 16.03.10, “Medicaid Enhanced Plan Benefits.” (7-1-25) 201. -- 209. (RESERVED) 210. CONTINUATION OF THE CONSUMER-DIRECTED COMMUNITY SUPPORTS (CDCS) OPTION. The following requirements must be met or the Department may require the participant to discontinue the CDC S option: (3-17-22) 01. Required Supports. The participant is willing to work with an SB. (7-1-25) a. The participant can only change FEA services by providing a written request to their current FE A provider at least sixty (60) days in advance, and this change must occur at the end of a fiscal quarter. The request mus t 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 wil l occur at the end of the fiscal quarter. (3-17-22) 02. SSP. The participant's SSP is followed. (7-1-25) 03. Risk and Safety Back-Up Plans. Back-up plans to manage risks and safety are followed. (7-1-25) 04. Health and Safety Choices. The participant's choices do not directly endanger their health, welfar e and safety or endanger or harm others. (3-17-22) 211. -- 299. (RESERVED) FISCAL EMPLOYER AGENTS (Sections 300-314)