Sbs: Procedural Requirements

Documentation requirements: (7-1-26) 01. IEP and Other Service Plans. Providers may bill for services covered by a current IEP, transitional Individualized Family Service Plan (IFSP), or Services Plan (SP) defined in the Idaho Special Education Manual for parentally placed private school students with disabilities when designated funds are available for special education and related services. The plan must be within the previous three hundred sixty-five (365) days and the need for one (1) or more medically necessary health-related service and lists all the Medicaid reimbursable services for which the provider is requesting reimbursement. The IEP and transitional IFSP must include: (7-1-26) a. Type, frequency, and duration of the service provided; (7-1-26) b. Title of the provider, including the direct care staff delivering services under the supervision of the professional; (7-1-26) c. Measurable goals, when goals are required for the service; and (7-1-26) d. Specific place of service, if provided in a location other than school. (7-1-26) 02. Evaluations and Assessments. (7-1-26) 03. Service Detail Reports. A service detail report that includes: (7-1-26) a. Name of student; (7-1-26) b. Name, title, and signature of the person providing the service; (7-1-26) c. Date, time, and duration of service; (7-1-26) d. Place of service, if provided in a location other than school; (7-1-26) e. Category of service and brief description of the specific areas addressed; and (7-1-26) f. Student’s response to the service when required for the service. (7-1-26) 04. One Hundred Twenty Day Review. A documented review of progress toward each service plan goal completed at least every one hundred twenty (120) days from the date of the annual plan. (7-1-26) 05. Documentation of Qualifications of Providers. (7-1-26) 06. Recommendations or Referrals Required. SBS require a recommendation or referral within thirty (30) days of the provision of services and at least every three hundred sixty-five (365) days. (7-1-26) 07. Requirements for Cooperation. Each provider must act in cooperation with students’ parent or guardian, and with community and state agencies and professionals who provide like Medicaid services to the student. This includes: (7-1-26) a. Documentation that parents or guardians were notified of the services billed to Medicaid that describes the service, provider, and the type, location, frequency, and duration of the service. (7-1-26) b. Documentation that parents or guardian were provided with a current copy of the child’s plan and any pertinent addenda. (7-1-26) c. Requesting the name of the student’s PCP with a written consent to release and obtain information IDAHO ADMINISTRATIVE CODE IDAPA 16.03.26 Department of Health & Welfare Medicaid Plan Benefits Section 325 Page 87 between the PCP and the school from the parent or guardian. (7-1-26) d. Upon receiving a request for a copy of the evaluations or the current plan, the provider furnishing the requesting agency or professional with a copy of the plan or appropriate evaluation after obtaining consent for release of information from the student's parent or guardian. (7-1-26)