A&D Waiver Services: Procedural Requirements

01. Individual Service Plan. The Department administers the assessment and develops the initial individual service plan. The Department reviews and approves all individual service plans based on information from the assessment and any other medical information that verifies the need for services, and authorizes services by type, scope, and amount. All individual service plans must meet HCBS person-centered planning requirements. (7-1-26) a. Services not in the individual service plan or exceeding those approved by the Department are not eligible for Medicaid payment. (7-1-26) b. The earliest services can be approved is on the date an individual service plan is signed by the participant or their designee. (7-1-26) c. All services that are provided must be based on a documented service plan. (7-1-26) d. A new plan must be developed and approved annually. (7-1-26) e. The plan may be adjusted during the year with an addendum. These adjustments must be based on changes in participant’s need or demonstrated outcomes. Additional assessments or information may be clinically necessary. Adjustment is subject to Department PA. (7-1-26) 02. Provider Records. (7-1-26) a. Providers must document each visit made or service provided to the participant, and record the following: (7-1-26) i. Service date; (7-1-26) ii. Services provided; (7-1-26) iii. Statement of participant's response to services when applicable, including any changes in their condition; and (7-1-26) IDAHO ADMINISTRATIVE CODE IDAPA 16.03.26 Department of Health & Welfare Medicaid Plan Benefits Section 544 Page 124 iv. Length of visit, including time in and out. Unless the Department determines a participant is unable to, service delivery is verified by the participant by signing a service record. (7-1-26) b. Providers must maintain service delivery records accessible to participants. (7-1-26) c. The individual service plan must be available to all providers and the Department. The individual service plan and assessment are available from the Department for providers with a release of information signed by the participant or legal representative. (7-1-26) d. EVV Systems do not replace documentation requirements but may be used to generate documentation. (7-1-26) 03. Provider Notification. Providers must document in the service record and notify the Department, medical provider, case manager, and family when any significant changes in the participant's condition are noted. (7-1-26)