Adult Dd Waiver Services: Coverage And Limitations

01. Residential Habilitation. An integrated array of individually tailored services and supports designed to assist participants reside successfully in their own homes, with their families, or in CFHs. The number of residents in a setting will be limited by an amount in the Idaho Medicaid Provider Handbook, unless otherwise authorized by the Department. Residential Habilitation consists of the following: (7-1-26) a. Habilitation services to help an individual acquire, retain, or improve their ability to reside as independently as possible in the community or maintain family unity, and include training in at least one (1) of the following areas: (7-1-26) i. Self-direction, including the identification of and response to dangerous or threatening situations, making decisions and choices affecting the individual's life, and initiating changes in living arrangements or life activities; (7-1-26) ii. Money management; (7-1-26) iii. Daily living skills; (7-1-26) iv. Socialization not including participation in non-therapeutic activities that are diversional or recreational in nature; (7-1-26) v. Mobility; and (7-1-26) IDAHO ADMINISTRATIVE CODE IDAPA 16.03.26 Department of Health & Welfare Medicaid Plan Benefits Section 612 Page 148 vi. Behavior shaping and management. (7-1-26) b. Personal Assistance Services that assist an individual in ADL, household tasks, and other routine activities as the participant or their primary caregivers are unable to accomplish on their own. (7-1-26) c. Skills training to teach participants and supports to perform activities with greater independence and to reinforce habilitation training. (7-1-26) 02. Chore Services. Intermittent assistance or chore activities when necessary to maintain functional use of the participant’s home or to provide a clean, sanitary, and safe environment. Services are only available when neither the participant, nor anyone else in the home, is capable of performing or financially providing for them, and when no other non-paid support, landlord, agency, or third-party payer is willing or able to provide. Services are limited to those provided in a home rented or owned by the participant. For rental property, the Department examines the lease agreement for landlord responsibilities prior to any authorization of service. (7-1-26) 03. Respite Care. Short-term breaks from caregiving responsibilities to non-paid caregivers. The caregiver or participant selects, trains, and directs the provider. While receiving respite care, participants cannot receive other duplicative services. Respite care does not include room and board payments. Services may be provided in the participant’s residence, the respite provider’s home, the community, a CFH, a DDA, or an ADH facility. (7-1-26) 04. Supported Employment. Competitive work in integrated work settings for individuals for whom competitive employment has not traditionally occurred; or when competitive employment is interrupted or intermittent due to severe disability. The nature and severity of an individual’s disability requires intensive supported employment services or extended services to work. This service is not available when funded under another program. (7-1-26) 05. Non-Medical Transportation (NMT). Transportation enabling a participant to access waiver and other community services and resources. Whenever possible, non-paid supports or public transit providers are used. (7-1-26) 06. Environmental Accessibility Adaptations. Minor housing adaptations necessary for a participant to function with greater independence in their home, or without which, would require institutionalization or pose a risk to health or safety, including: (7-1-26) a. Installations or modifications necessary to accommodate medical equipment and supplies necessary for the health and safety of the participant but excludes those that are not of direct medical or remedial benefit to the participant. (7-1-26) b. Unless otherwise authorized, permanent modifications are limited to the participant's principal residence that is owned by the participant or their non-paid family. (7-1-26) c. Portable or non-stationary modifications may be made when the participant or their non-paid family rents a home, and modifications follow a participant to their next residence. (7-1-26) 07. Specialized Medical Equipment and Supplies. (7-1-26) a. Devices, controls, or appliances enabling a participant to increase their abilities to perform ADL, or to perceive, control, or communicate with the environment in which they live. (7-1-26) b. Items necessary for life support, ancillary supplies, and equipment necessary for the proper functioning of such items, and DME and non-DME not available under State Plan or EPSDT. (7-1-26) c. Items reimbursed under this waiver exclude items that are not of direct medical or remedial benefit to the participant. (7-1-26) 08. Personal Emergency Response System (PERS). Electronic devices enabling participants to IDAHO ADMINISTRATIVE CODE IDAPA 16.03.26 Department of Health & Welfare Medicaid Plan Benefits Section 613 Page 149 secure help in an emergency which connects to a participant’s phone and is programmed to signal a response center when activated. The response center is staffed by trained professionals. PERS is limited to participants who rent or own a home, or live with unpaid caregivers, are alone for extended periods with no caregiver, and require extensive, routine supervision. (7-1-26) 09. Home Delivered Meals. Meals delivered to a participant’s home that promote adequate nutrition. Participants can receive one (1) to two (2) meals per day when they rent or own a home, are alone for extended periods with no caregiver, and are unable to prepare a meal without assistance. (7-1-26) 10. Skilled Nursing. Intermittent or continuous oversight, training, or skilled care within the scope of the Nurse Practice Act provided by an RN or LPN under the supervision of an RN. Services cannot cost more than a Home Health visit. (7-1-26) 11. Behavior Consultation/Crisis Management. Direct consultation and clinical evaluation of participants currently experiencing, or expected to experience, a psychological, behavioral, or emotional crisis. Services may provide training and staff development related to the participant’s needs and provide emergency back- up involving the direct support for a participant in crisis. (7-1-26) 12. Adult Day Health. Supervised, structured services provided outside the participant’s home in a non-institutional, community-based setting, and encompassing health and social services, recreation, supervision for safety, and assistance with ADL needed to ensure optimal function of the participant. Services do not include room and board payments. (7-1-26) 13. Self-Directed Community Supports. DD waiver participants may choose to self-direct an individualized budget rather than receive traditional waiver services. (7-1-26) 14. Transition Services. Goods and services enabling a participant residing in a NF, hospital, IMD, or ICF/IID to transition to a community-based setting immediately following discharge from a facility after a minimum of forty-five (45) days. (7-1-26) a. Services may include: (7-1-26) i. Security deposits required to obtain a lease on an apartment or home; (7-1-26) ii. Cost of essential household furnishings; (7-1-26) iii. Set-up fees or deposits for utility or service access; (7-1-26) iv. Services necessary for health and safety prior to occupancy; (7-1-26) v. Moving expenses; and (7-1-26) vi. Activities to assess need, arrange for, and procure transition services. (7-1-26) b. Exclusions. Ongoing expenses (including utilities), real property, décor, or entertainment and recreational items. (7-1-26) c. Limitations: A total cost of two thousand dollars ($2,000) per participant and only accessed every two (2) years, following a qualifying transition. Services are furnished when a participant is unable to meet an expense or when a support cannot be obtained from other sources. (7-1-26) 15. Limitations. Participants cannot receive DD waiver services in non-HCBS settings or RALFs. (7-1-26)