Icf/Iid: Coverage And Limitations

The Department pays for services in an ICF/IID whose primary purpose is providing habilitative services and maintaining optimal health status for individuals with intellectual disabilities or related conditions. (7-1-26) 01. Coverage. The minimum content of care and services for ICF/IID residents includes: (7-1-26) a. Room and board; (7-1-26) b. Bed and bathroom linens; (7-1-26) c. Nursing care, including special feeding if needed; (7-1-26) d. Personal services; (7-1-26) e. Supervision; (7-1-26) f. Special diets as prescribed by a participant's provider; (7-1-26) g. All common medicinal supplies that do not require a prescription; (7-1-26) h. Dressings; (7-1-26) i. Administration of intravenous, subcutaneous, or intramuscular injections and infusions, enemas, catheters, bladder irrigations, and oxygen; (7-1-26) j. Application or administration of all drugs; (7-1-26) k. All medical supplies; (7-1-26) l. Social and recreational activities; and (7-1-26) IDAHO ADMINISTRATIVE CODE IDAPA 16.03.26 Department of Health & Welfare Medicaid Plan Benefits Section 503 Page 109 m. Items used by individuals that are reusable and expected to be available. (7-1-26) 02. Limitations. Specialized wheelchairs and seating systems, including repair, designed to fit the needs of a specific resident and cannot be altered to fit another resident cost effectively are not included in ICF/IID content of care. These are paid directly to the supplier. (7-1-26) 03. Temporary Absence. Reimbursement is available for reserving beds for during a temporary absence if the facility charges private payors for reserve bed days. Therapeutic home visits are allowed for up to thirty-six (36) days per calendar year when days are part of a written treatment plan ordered by the attending physician. Prior authorization is required for any home visits exceeding fourteen (14) consecutive days. Reimbursement is the lesser of audited allowable costs, or usual and customary charges. (7-1-26)