Chis: Coverage And Limitations

01. Service Delivery. CHIS may be delivered in the community, the participant's home, or in a DDA. Duplication of services is not reimbursable. (7-1-26) 02. Required Order. CHIS must be ordered by a provider within their scope of practice. (7-1-26) a. CHIS providers cannot seek reimbursement for services provided more than thirty (30) calendar days prior to the signed and dated order. (7-1-26) b. The order is only required to be completed once and must be received prior to submitting the initial PA request. If the participant has not accessed CHIS for more than three hundred sixty-five (365) calendar days, a new order is required. (7-1-26) 03. Required Screening. Needs are determined through the current version of the Department- approved screening tools. The tool is only required to be completed once and must be completed prior to submitting the initial PA request. New screenings are required for participants who have not accessed CHIS for more than three hundred sixty-five (365) calendar days. (7-1-26) 04. Services. All CHIS ordered on a participant's ACTP must be prior authorized by the Department. Group services must be provided by one (1) qualified staff providing direct services for two (2) or three (3) participants. As the number and needs of the participants increase, the participant ratio in the group must be adjusted IDAHO ADMINISTRATIVE CODE IDAPA 16.03.26 Department of Health & Welfare Medicaid Plan Benefits Section 182 Page 55 from three (3) to two (2). Group services will only be reimbursed when the participant's objectives relate to benefiting from group interaction. The following CHIS are reimbursable services when provided under these rules: (7-1-26) a. Habilitative Skill Building utilizes direct intervention techniques to develop, improve, and maintain, to the maximum extent possible, the developmentally appropriate functional abilities and daily living skills needed by a participant. This service may include teaching and coordinating methods of training with family members or others who regularly participate in caring for the eligible participant. Services include individual or group interventions. (7-1-26) b. Behavioral Intervention utilizes direct intervention techniques to produce positive meaningful changes in behavior that incorporate functional replacement behaviors and reinforcement-based strategies while also addressing any identified habilitative skill building needs or interfering behaviors. Intervention services may include teaching and coordinating methods of training with family members or others who regularly participate in caring for the participant. Services include individual or group interventions. (7-1-26) c. Interdisciplinary Training is a companion service to behavioral intervention and habilitative skill building and assists with implementing a participant's health and medication monitoring, positioning and physical transferring, use of assistive equipment, and intervention techniques in a manner that meets the participant's needs. This service is for collaboration, with the participant present, during the provision of services between the intervention specialist or professional and a provider. (7-1-26) d. Crisis Intervention includes providing training to staff directly involved with the participant, delivering intervention directly with the eligible participant, and developing a crisis plan that directly addresses the behavior occurring and the necessary intervention strategies to minimize the behavior and future occurrences. Crisis intervention is provided in the home or community on a short-term basis not to exceed thirty (30) days. Positive behavior interventions must be used prior to, and in conjunction with, the implementation of any restrictive intervention. Crisis intervention is available for participants who have an unanticipated event, circumstance, or life situation that places a participant at risk of at least one (1) of the following: (7-1-26) i. Hospitalization; (7-1-26) ii. Out-of-home placement; (7-1-26) iii. Incarceration; or (7-1-26) iv. Physical harm to self or others, including a family altercation or psychiatric relapse. (7-1-26) e. The ACTP must contain the following: (7-1-26) i. Clinical interviews must be completed with the parent or legal guardian; (7-1-26) ii. Objective and validated comprehensive skills or developmental assessment. The most current assessment must be used and be from within the last year; (7-1-26) iii. Review of assessments, reports, and relevant history; (7-1-26) iv. Observations in at least one (1) environment; (7-1-26) v. Clinical summary and orders; (7-1-26) vi. A transition plan; and (7-1-26) vii. Be signed by the individual completing the assessment and the parent or legal guardian. (7-1-26) f. Case Management is available to assist participants accessing CHIS by the Department as described in the Medicaid Provider Handbook. (7-1-26) IDAHO ADMINISTRATIVE CODE IDAPA 16.03.26 Department of Health & Welfare Medicaid Plan Benefits Section 183 Page 56