Definitions: I Through O

01. Idaho Medicaid Provider Handbook. A document that contains policy for the implementation and operations of the Medicaid program. (7-1-26) 02. In-State Care. Medical services not including long-term care provided within Idaho or in counties bordering Idaho. (7-1-26) 03. Inspection of Care Team (IOCT). Interdisciplinary team providing inspection of care in licensed ICFs/IID composed of: (7-1-26) a. An RN; and (7-1-26) b. A QIDP; and when required, a: (7-1-26) i. Consultant physician; (7-1-26) ii. Consultant social worker; or (7-1-26) iii. When appropriate, other health and human services employees or consultants of the Department. (7-1-26) 04. Instrumental Activities of Daily Living (IADL). Activities performed to support ADL, including, but not limited, to managing money, preparing meals, shopping, light housekeeping, communicating, or accessing the community. (7-1-26) 05. Integration. Promoting a lifestyle for HCBS participants like other community members, including those living in and accessing community resources to enhance the social image and personal competence of HCBS participants. (7-1-26) 06. Interim Reimbursement Rate (IRR). Rate paid for each Medicaid patient day intended to result in total Medicaid payments approximating the amount paid at audit settlement and intended to include any payments IDAHO ADMINISTRATIVE CODE IDAPA 16.03.26 Department of Health & Welfare Medicaid Plan Benefits Section 006 Page 18 allowed over the percentile cap. (7-1-26) 07. Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID). An entity licensed as an ICF/IID and federally certified to provide care to Medicaid and Medicare participants with developmental disabilities. (7-1-26) 08. Level of Care. The classification in which a participant is placed, based on severity of need for institutional care. (7-1-26) 09. Level of Support. Amount of services and supports necessary to allow a participant to live independently and safely in the community, as derived from a Department-approved assessment tool. (7-1-26) 10. Licensed Bed Capacity. Number of beds approved by the State’s Licensure and Certification Agency for rendering patient care. (7-1-26) 11. Lower of Cost or Charges. Payment to providers (other than public providers furnishing services free of charge or at nominal charges to the public) that is the lesser of the reasonable cost of services or customary charges of like services. Public providers furnishing services free of charge or at a nominal charge are reimbursed fair compensation; considered reasonable cost. (7-1-26) 12. Major Movable Equipment. Major movable equipment as defined in Section 56-101(16), Idaho Code, that also has a unit cost of five thousand dollars ($5,000) or more. (7-1-26) 13. Medicaid-Related Ancillary Costs. Services considered to be ancillary by Medicare cost reporting principles. Medicaid-related ancillary costs are determined by apportioning direct and indirect costs associated with each ancillary service to Medicaid participants by dividing Medicaid charges into total charges for that service. The resulting percentage, when multiplied by the ancillary service cost, is considered Medicaid-related ancillaries. (7-1-26) 14. Medical Assistance (Medicaid). Payments for part or all of the cost of services, capitation payments, or managed care costs funded by Titles XIX or XXI of the federal Social Security Act (SSA). (7-1-26) 15. Medical Necessity (Medically Necessary). A service or item is medically necessary if: (7-1-26) a. It is reasonably calculated to prevent, diagnose, or treat conditions in the participant that endanger life, cause pain, or cause functionally significant deformity or malfunction; (7-1-26) b. There is no other equally effective course of treatment available or suitable for the participant requesting the service that is more conservative or substantially less costly; (7-1-26) c. It meets any applicable Department criteria. Services that do not meet criteria require a PA; (7-1-26) d. Medical services must be of a quality that meets professionally recognized standards of health care and is substantiated by records including evidence of such medical necessity and quality. Those records must be made available to the Department upon request. (7-1-26) 16. Medical, Social, and Developmental Assessment (MSDA) Summary. Form used by the Department to gather a participant medical, social, and developmental history and other summary information required for all DD HCBS program participants under a service plan used to assess and authorize services. (7-1-26) 17. Medical Supplies. Healthcare-related items that are consumable, disposable, or cannot withstand repeated use by more than one (1) individual, are suitable for use in any setting in which normal life activities take place, and are reasonable and medically necessary for the treatment of a disability, illness, or injury for a Medicaid participant. (7-1-26) 18. Minimum Data Set (MDS). Set of screening, clinical, and functional status elements, including IDAHO ADMINISTRATIVE CODE IDAPA 16.03.26 Department of Health & Welfare Medicaid Plan Benefits Section 007 Page 19 common definitions and coding categories, forming the foundation of a comprehensive assessment for all residents of long-term care facilities certified under Medicare or Medicaid. Updated versions of the MDS are evaluated and incorporated into rate setting as necessary. (7-1-26) 19. Minor Movable Equipment. Minor movable equipment as defined in Section 56-101(18), Idaho Code, with a unit cost under five thousand dollars ($5,000.) (7-1-26) 20. Nominal Charges. A public provider’s charges are nominal where aggregate charges amount to less than one-half (1/2) of the reasonable cost of the services provided. (7-1-26) 21. Order. Written instructions from a healthcare professional acting within the scope of their practice for a participant’s treatment, medications, tests or procedures. Orders shall include: (7-1-26) a. Participant’s name; (7-1-26) b. Description of item or service; (7-1-26) c. Length of need, if applicable; (7-1-26) d. Quantity, if applicable; (7-1-26) e. Provider’s name, National Provider Identification (NPI) and signature; and (7-1-26) f. Date of signature. (7-1-26) 22. Ordinary. Costs incurred that are customary for normal operation of a business. (7-1-26) 23. Orthotic. Pertaining to or promoting the support of an impaired joint or limb. (7-1-26)