Pcs: Procedural Requirements

01. Service Plan. All PCS are provided based on a documented service plan according to place of service. (7-1-26) a. PAAs prepare the service plan with participants in their own home or a PCS FACH, based on applicable physician or authorized provider information, assessment results (including any, QIDP assessments or observations), and participant provided information. Service plans must include all medical and non-medical tasks the provider performs, including amount, type, and frequency. Plans must be updated annually or based on treatment results or significant changes in participant needs. (7-1-26) IDAHO ADMINISTRATIVE CODE IDAPA 16.03.26 Department of Health & Welfare Medicaid Plan Benefits Section 554 Page 129 b. CFH/RALF service plans must meet applicable licensing requirements for each residence type. (7-1-26) 02. Supervision. An RN or QIDP provides oversight of PCS as required by the Department. Activities include: (7-1-26) a. Service plan development assistance, including in-home active treatment plans. (7-1-26) b. Review of treatment provided and verified by service delivery records and through on-site participant interviews. (7-1-26) c. Service plan re-evaluations, including on-site visits to evaluate change in a participant’s condition as needed. (7-1-26) d. Immediate notification to any guardian, emergency contact, or family member when a significant change in a participant's physical condition or response to services occurs. (7-1-26) 03. PA. Authorizations are based on the participant’s assessment, individual service plan, and any other medical information supporting medical needs. (7-1-26) 04. Record Requirements in Participant Homes. PCS records must be maintained for all participants in their own homes or in a PCS (FACH), in a format accessible to the participant. (7-1-26) a. Providers must document every visit made to a participant's home and record the date, time, duration, services provided, and any changes noted in a participant’s condition or deviations from the service plan. (7-1-26) b. Participants or legal guardians must verify service delivery by signing the record. (7-1-26) c. Providers must sign the service plan indicating they will deliver services according to the authorization and consistent with HCBS requirements. (7-1-26) d. EVV systems described do not replace documentation requirements but may be used to generate documentation. (7-1-26) 05. Provider Notification. Providers must notify the Department and the medical provider for any significant changes in a participant's condition occur, and document in the participant record. (7-1-26)