Developmental Therapy: Procedural Requirements

DDAs must obtain all assessments required for DD services eligibility, billing no more than four (4) hours for the combination of all assessment, evaluation, or diagnostic services provided in a calendar year. The following assessment and diagnostic services are reimbursable: (7-1-26) 01. Comprehensive Developmental Assessment. Assessments must: (7-1-26) a. Be conducted by a Developmental Specialist and determine necessity of a service, guide treatment, and identify the participant's current strengths, needs, and interests. (7-1-26) b. Be signed and dated by the professional completing the assessment, including their appropriate professional credentials or qualifications. (7-1-26) c. Reflect the current status of the participant with assessments completed or updated at least every two (2) years. (7-1-26) d. Reflect a person's developmental status in the following areas: (7-1-26) i. Self-care; (7-1-26) ii. Receptive and expressive language; (7-1-26) iii. Learning; (7-1-26) iv. Gross and fine motor development; (7-1-26) v. Self-direction; (7-1-26) vi. Capacity for independent living; and (7-1-26) vii Economic self-sufficiency. (7-1-26) 02. Specific Skill Assessments. These assessments must: (7-1-26) a. Further assess an area of limitation or deficit identified on a comprehensive developmental assessment. (7-1-26) b. Relate to a goal on an IPP or ISP. (7-1-26) c. Be conducted by qualified professionals to determine a participant’s skill level within an area. (7-1-26) d. Be used to determine baselines and develop a PIP. (7-1-26) 03. Documentation Requirements. DDAs must maintain records for each participant served. Each record must include documentation of the participant's involvement in and response to the services provided. For each participant, the following documentation is required: (7-1-26) IDAHO ADMINISTRATIVE CODE IDAPA 16.03.26 Department of Health & Welfare Medicaid Plan Benefits Section 606 Page 145 a. Daily entry of all activities conducted toward meeting their objectives. (7-1-26) b. Sufficient progress data accurately assessing a participant's progress toward each objective; (7-1-26) c. Review of data, and, when applicable, changes in the daily activities or implementation procedures by the qualified professional, including their dated initials. (7-1-26) d. Documentation for six (6) month and annual reviews by the Developmental Specialist including a written description of the participant's progress toward their achievement of therapeutic goals, and reasons they continue to need services. (7-1-26) e. Authorized service plan. (7-1-26) 04. PIP Requirements. The DDA must develop a PIP for each DDA objective included on the participant's IPP or ISP. All PIPs must relate to a goal or objective on the participant's IPP or ISP. PIPs must be developed within fourteen (14) days of service start date or receipt of an authorized IPP or ISP and be revised whenever participant needs change. If the PIP is not completed within fourteen (14) days, the participant's records must contain participant-based documentation justifying the delay. The provider addresses goals and objectives as agreed to by the participant until the annual PIP is completed and documents service delivery related to their interim goals and objectives. The PIP must include: (7-1-26) a. Participant’s name. (7-1-26) b. A baseline statement addressing the participant's skill level and abilities related to specific skills to be learned. (7-1-26) c. Measurable, behaviorally stated objectives corresponding to the goals or objectives authorized in the service plan. (7-1-26) d. Written instructions for staff that include curriculum, interventions, task analyses, activity schedules, type and frequency of reinforcement, and data collection including probe, directed at the achievement of each objective. These instructions must be individualized and revised as necessary to promote participant progress toward stated objectives. (7-1-26) e. Identification of the environments where services are provided. (7-1-26) f. Target date for completion. (7-1-26) 05. Informed Objectives. Results from a psychological or psychiatric assessment must be used when developing objectives to ensure therapies provided by the DDA accommodate the participant’s mental health needs and none of the therapeutic methods are contra-indicated or delivered in a manner that presents risks to the participant's mental health status. (7-1-26)