Children's Dd Hcbs State Plan Option: Coverage And Limitations

All children's DD HCBS are identified on a service plan developed by the family-centered planning team and must be prior authorized. (7-1-26) 01. Respite. Supervision on an intermittent or short-term basis for unpaid caregiver relief or in response to a family emergency or crisis, provided by a DDA or an independent provider. Payment does not include room and board. Respite may be provided in a participant's home, the private home of the independent provider, a DDA, or in the community. The following limitations apply: (7-1-26) a. Not be provided to enable an unpaid caregiver to work. (7-1-26) b. Only participants living with an unpaid caregiver are eligible. (7-1-26) c. Cannot exceed fourteen (14) consecutive days. (7-1-26) d. Must not be provided at the same time as other Medicaid services except family education for an unpaid caregiver. (7-1-26) e. Providers must not use restraints on participants, other than physical restraints in the case of an emergency, to prevent injury to the participant or others and as documented in the participant's record. (7-1-26) f. When group respite is community or center-based, there must be at least one (1) qualified staff member providing direct services to every two (2) to six (6) participants. As the number and severity of the participants with functional impairments or behavioral needs increase, the participant ratio must be adjusted accordingly. (7-1-26) g. Independent providers cannot provide center-based respite and may only provide group respite when the provider is a relative and the service is delivered in the participant’s or provider’s home. (7-1-26) 02. Community-Based Supports. Facilitates a participant's independence and integration into the community by providing an opportunity to explore their interests, practice skills learned in other therapeutic environments and learn through interactions in typical community activities. Community-based supports must: (7-1-26) a. Not supplant services provided in school or therapy, or the role of a primary caregiver; (7-1-26) b. Ensure involvement in age-appropriate activities in integrated settings; and (7-1-26) c. Have at least one (1) qualified staff providing direct services for up to six (6) participants when provided as group community-based supports. As the number and severity of the participants with functional impairments or behavioral needs increase, the staff participant ratio must be adjusted accordingly. (7-1-26) IDAHO ADMINISTRATIVE CODE IDAPA 16.03.26 Department of Health & Welfare Medicaid Plan Benefits Section 583 Page 140 03. Family Education. Professional assistance to caregivers to help them meet the participant’s needs by providing an orientation to DDs and to educate them on generalized strategies for behavioral modification and intervention techniques specific to a participant’s diagnosis and the needs identified on the service plan. Training may be provided in a group setting not exceeding five (5) families. Providers must survey the parent or legal guardian's satisfaction of services immediately following a family education session. (7-1-26) 04. Family-Directed Community Supports (FDCS). Families of eligible participants may choose to direct an individualized budget rather than receive traditional children's DD HCBS state plan option services when the participant lives at home with their parent or legal guardian. FDCS must be delivered on a one-to-one basis as identified on the service plan and requires PA and quality assurance. (7-1-26) 05. Limitations for State Plan and Family-Directed Community Supports (FDCS). (7-1-26) a. Services are limited by the participant's individualized budget amount. (7-1-26) b. Services offered under the Medicaid Basic Plan cannot be authorized. (7-1-26) c. Duplication of services cannot be provided: (7-1-26) i. Goals are not separate and unique to each item or service provided; or (7-1-26) ii. When more than one (1) service is provided at the same time, unless otherwise authorized. (7-1-26)