Icf/Iid: Participant Eligibility

Approval for services will be no earlier than the medical provider's signed and dated certification for ICF/IID level of care. (7-1-26) 01. Required Information for Applications. (7-1-26) a. A complete and current medical examination within ninety (90) days of admission, signed and dated by a medical provider, primary and secondary diagnoses, medical findings and history, mental and physical functional capacity, prognosis, mobility status, and medical provider’s statement certifying ICF/IID level of care is needed. (7-1-26) b. An initial plan of care current within ninety (90) days of admission, signed and dated by a medical provider, and includes orders for medications and treatments, diet, and professional rehabilitative and restorative services and special procedures, when needed. (7-1-26) c. A social evaluation current within ninety (90) days of admission, that includes condition at birth, age at onset of condition, summary of functional status, such as skills level, ADL, and family social information. (7-1-26) d. A psychological evaluation conducted by a provider current within ninety (90) days of admission, or infants under three (3) years old may be evaluated by a DD specialist using developmental milestones congruent with the infant’s age. Evaluations include diagnosis, summary of developmental findings, mental and physical functioning capacity, and recommendations for placement and primary need for active treatment. (7-1-26) e. An initial plan of care developed by the admitting ICF/IID. (7-1-26) 02. ICF/IID Eligibility Criteria. (7-1-26) a. Individuals with a primary DD diagnosis or a related condition and qualify based on functional limitations, maladaptive behavior, a combination of both, or medical condition significantly affects their functional IDAHO ADMINISTRATIVE CODE IDAPA 16.03.26 Department of Health & Welfare Medicaid Plan Benefits Section 502 Page 108 level/capabilities. (7-1-26) b. Individual requires and receives intensive inpatient active treatment to advance or maintain their functional level. Active treatment does not include parenting activities directed toward the acquisition of age- appropriate developmental milestones, interventions that address age-appropriate limitations, or general supervision required by all children of the same age. The following criteria evaluate the need for active treatment: (7-1-26) i. Complete medical, social, and psychological evaluations that clearly indicate the functional level of the participant and interventions needed; and (7-1-26) ii. A written plan of care with initial goals and objectives, specifying further evaluations required, and training programs to be developed. (7-1-26) c. Individual requires the level of care provided in an ICF/IID, including active treatment, and, in the absence of available intensive alternative services in the community, would require institutionalization, other than services in an IMD. (7-1-26) d. ICF/IID level of care is redetermined annually related to continued need of community services. (7-1-26) i. Home Care for Certain Disabled Children receive services until the end of the month their redetermination was made. When the redetermination is made less than ten (10) days from the end of a month, payment continues until the end of the following month. (7-1-26) ii. Individuals receiving DD waiver services have thirty (30) days from the determination to transition to other community supports. (7-1-26)