Sbs: Service-Specific Participant Eligibility

01. Skills Building/Community Based Rehabilitation Services (CBRS). To be eligible for Skills Building/CBRS, the student must meet one (1) of the following: (7-1-26) a. A student under eighteen (18) years of age meeting the Serious Emotional Disturbance (SED) IDAHO ADMINISTRATIVE CODE IDAPA 16.03.26 Department of Health & Welfare Medicaid Plan Benefits Section 323 Page 83 eligibility criteria in the Children’s Mental Health Services Act, Section 16-2403(13), Idaho Code. The child must experience a substantial impairment in functioning. The level and type of impairment must be documented in the school record. A Department-approved assessment must be used for an initial functional impairment score. Subsequent scores must be obtained annually to determine changes in functioning as a result of mental health treatment. (7-1-26) b. A student eighteen (18) years old or older meeting the criteria of Serious and Persistent Mental Illness (SPMI). This requires that a student participant meet the criteria described in 42 CFR 483.102(b)(1), have at least one (1) additional functional impairment, and have a diagnosis under DSM-V, or later edition, with one (1) of the following: Schizophrenia, Schizoaffective Disorder, Bipolar I Disorder, Bipolar II Disorder, Major Depressive Disorder Recurrent Severe, Delusional Disorder, or Borderline Personality Disorder. The only Not Otherwise Specified (NOS) diagnosis included is Psychotic Disorder NOS for a maximum of one hundred twenty (120) days without a conclusive diagnosis. In addition, the psychiatric disorder must be of sufficient severity to affect the participant’s functional skills negatively, causing a substantial disturbance in role performance or coping skills in at least two (2) of the areas listed below on either a continuous or intermittent basis, at least once per year. The skill areas that are targeted must be consistent with the participant’s ability to engage and benefit from treatment. The detail of the participant’s level and type of functional impairment must be documented in the medical record in the following areas: (7-1-26) i. Vocational or educational; (7-1-26) ii. Financial; (7-1-26) iii. Social relationships or support; (7-1-26) iv. Family; (7-1-26) v. Basic living skills; (7-1-26) vi. Housing; (7-1-26) vii. Community or legal; or (7-1-26) viii. Health or medical. (7-1-26) 02. CHIS. Students are eligible to receive CHIS services in accordance with EPSDT, and behavioral consultation of these rules. (7-1-26) 03. Personal Care Services. To be eligible for personal care services (PCS), the student must have a completed children’s PCS assessment and allocation tool approved by the Department that finds the student requires PCS due to a medical condition that impairs physical or functional abilities. (7-1-26)