Adult Dd Services: Definitions

01. Clinical Review. Process of professional review to validate the need for continued services. (7-1-26) 02. Exception Review. Clinical review of a plan falling outside established standards due to a health or safety risk. (7-1-26) 03. Health. The prevention of deterioration of one’s physical or mental health condition, cognitive functioning, or an increase in maladaptive behavior, and is related to the effects of one’s disability. (7-1-26) 04. Health Risks. Must be established through written documentation and current treatment recommendations from a licensed practitioner of the healing arts under these rules, or other professional licensed by the State of Idaho whose recommendation is within the scope of their license. Such documentation must establish: (7-1-26) a. The current physical or mental condition, or cognitive functioning that will likely deteriorate, or the current maladaptive behavior(s) that will likely increase; and (7-1-26) b. The specific supports or services being requested, including type and frequency if applicable, that will address the identified need. (7-1-26) c. To comply with the documentation requirement, the Department may require the participant to obtain additional consultation or assessment, available to the participant and covered by Medicaid, from a professional licensed by the State of Idaho acting within the scope of their license. If the Department requires additional consultation or assessment, the Department will specify the nature of the consultation or assessment and the necessary documentation. (7-1-26) 05. Safety. Prevention of criminal activity, destruction of property, or injury or harm to self or others. (7-1-26) 06. Safety Risks. Must be documented by the following: (7-1-26) a. Current incident reports; (7-1-26) b. Police reports; (7-1-26) c. Assessments from a licensed practitioner of the healing arts under these rules or a professional licensed in Idaho and whose assessment is within the scope of their license; or (7-1-26) d. Status reports and implementation plans that reflect the type and frequency of intervention(s) in place to prevent the risk and the participant’s progress under such intervention(s). (7-1-26) e. Such documentation must establish: (7-1-26) i. An imminent or likely safety risk; and (7-1-26) ii. The specific supports or services that are being requested, including the type and frequency if IDAHO ADMINISTRATIVE CODE IDAPA 16.03.26 Department of Health & Welfare Medicaid Plan Benefits Section 569 Page 135 applicable, that are likely to prevent that risk. (7-1-26)