A&D Waiver Services: Provider Qualifications And Duties

01. Employment Status. Unless otherwise specified by the Department, each individual service provider must be an employee of an agency. The Department may enter into provider agreements with individuals in situations when no agency exists, or no FI is willing to provide services. Such agreements are reviewed annually to verify whether coverage by a PAA or FI is still not available. (7-1-26) 02. Fiscal Intermediary Services (FI). An FI providing Consultation services supporting self- direction must: (7-1-26) a. Assure compliance with legal requirements related to employment of providers; (7-1-26) b. Offer supportive services to enable participants or their families to perform the required employer tasks themselves; (7-1-26) c. Bill Medicaid for services authorized by the Department; (7-1-26) d. Collect any participant participation due; (7-1-26) e. Pay providers for service; (7-1-26) f. Perform all necessary withholding as required by state and federal regulations; (7-1-26) g. Assure that providers meet the required standards and qualifications; (7-1-26) h. Maintain liability insurance coverage; (7-1-26) i. Conduct annual participant satisfaction or quality control reviews made available to the Department and the public; and (7-1-26) j. Obtain required background checks and health screens on employees. (7-1-26) 03. Provider Qualifications. Providers of homemaker, respite care, ADH, transportation, chore services, companion services, attendant care, adult residential care, A&D Case Management, and home-delivered meals must meet, either by formal training or demonstrated competency, the training requirements contained in the provider training matrix and the standards for direct care staff and allowable tasks or activities in the Department's A&D waiver as approved by CMS. Direct care workers cannot be a participant’s spouse. (7-1-26) 04. Quality Assurance (QA). Providers must respond to QA reviews within forty-five (45) days of receiving results. If problems are identified, the provider must implement a quality improvement plan and report the results to the Department upon request. (7-1-26) IDAHO ADMINISTRATIVE CODE IDAPA 16.03.26 Department of Health & Welfare Medicaid Plan Benefits Section 544 Page 125 05. Specialized Medical Equipment and Supplies. Must be enrolled with Medicaid as a supplier. Providers must ensure all items meet applicable standards of manufacture, design, and installation. Preference is given to the most cost-effective option to meet a participant’s needs. (7-1-26) 06. Consultation Services. Must be provided through a PAA by a person with demonstrated skills in training participants/family members to hire, fire, train, and supervise their own care providers. (7-1-26) 07. Adult Residential Care. Must ensure that adequate staff are provided to meet the needs of the participants accepted for admission. (7-1-26) 08. Home-Delivered Meals. (7-1-26) a. Each meal meets one third (1/3) of the Recommended Daily Allowance, as defined by the United States Department of Agriculture (USDA); (7-1-26) b. Meals are delivered under the service plan, in a sanitary manner, and at the correct temperature for the specific type of food; (7-1-26) c. Documentation is maintained demonstrating that the meals served are made from the highest USDA grade for each specific food served; and (7-1-26) d. A Registered Dietitian documents the review and approval of menus, menu cycles, and any changes or substitutions. (7-1-26) 09. PERS. Must demonstrate that devices installed in a participant’s home meet Federal Communications Commission (FCC) standards. (7-1-26) 10. Adult Day Health. (7-1-26) a. Providers must notify the Department for the participant when the service is provided in a CFH other than the participant's primary residence. (7-1-26) b. Providers must be free from communicable disease. (7-1-26) 11. Non-Medical Transportation. Possess a valid driver’s license and vehicle insurance. (7-1-26) 12. Attendant Care. Must be employees of an agency. (7-1-26) 13. Homemaker Services. Must be employees of an agency. (7-1-26) 14. Environmental Accessibility Adaptations. Must meet applicable state or local building codes and meet state or local building, plumbing, and electrical requirements for certification. (7-1-26) 15. Residential Habilitation. Employment by a certified residential habilitation agency. Prior to delivering services, complete an orientation program and additional training requirements must be completed within six (6) months of employment. (7-1-26) 16. Day Habilitation. Employed by a certified residential habilitation agency. Prior to delivering services, staff must complete an orientation program and complete additional training within six (6) months of employment. (7-1-26) 17. Respite Care. Receive instructions in the participant’s needs, demonstrate the ability to follow the service plan, and be free of communicable disease. (7-1-26) 18. Supported Employment. Provided by an agency that meets State requirements. (7-1-26) IDAHO ADMINISTRATIVE CODE IDAPA 16.03.26 Department of Health & Welfare Medicaid Plan Benefits Section 545 Page 126 19. Chore Services. Be skilled in the service to be provided; and demonstrate the ability to follow a service plan. (7-1-26) 20. Transition Services. Transition managers. (7-1-26) 21. A&D Case Management. Case Managers must be employed by an agency that is not an FI. Case Managers may not provide other services. (7-1-26)