Service Coordination: Procedural Requirements

01. Prior Authorization. (7-1-26) 02. Plan Development. A plan must be developed and implemented within sixty (60) days after a participant chooses a service coordinator. (7-1-26) 03. Documentation. Agencies must maintain documentation describing services provided, reviewing the continued need for service coordination, and progression towards each service coordination goal. (7-1-26) 04. Freedom of Choice. A participant must have freedom of choice when selecting providers. (7-1-26) 05. Contact and Availability. The plan must identify the frequency, mode of contact, and provider to be contacted, which must meet the participant’s needs. The plan must also identify the frequency of face-to-face contact with each participant. (7-1-26) a. When a provider must conduct a face-to-face contact with a child without a parent or legal guardian present, the provider must notify them prior to the contact and document the notification in the participant’s file. (7-1-26) b. Providers do not have to be available twenty-four (24) hours a day but must include an individualized objective on the plan describing who to contact in an emergency and how the provider will obtain needed services during an emergency. (7-1-26) 06. Conflict of Interest. Providers must be alert to, and avoid, conflicts of interest that interfere with IDAHO ADMINISTRATIVE CODE IDAPA 16.03.26 Department of Health & Welfare Medicaid Plan Benefits Section 634 Page 155 the exercise of professional discretion and impartial judgment. They must inform the participant, parent, or legal guardian when a real or potential conflict of interest arises, take reasonable steps to resolve the issue with the participant’s interests first, and protect their interests to the greatest extent possible. (7-1-26) a. Providers developing a participant’s plan cannot: (7-1-26) i. Be related by blood or marriage to the participant or to any paid caregiver of the participant; (7-1-26) ii. Be financially responsible for the participant; (7-1-26) iii. Make financial or health-related decisions on behalf of the participant; (7-1-26) iv. Hold financial interests in any entity paid to provide care for the participant; or (7-1-26) v. Provide any State Plan HCBS or waiver services to the participant or have an interest in or be employed by providers for the participant. (7-1-26) b. Agencies must guard against conflicts of interest and ensure its employees and contractors meet the conflict-of-interest standards. They must include documentation in each participant’s file, signed by the participant, parent and or legal guardian, that defines “conflict of interest,” and includes a provider-signed statement verifying that conflict of interest was reviewed and explained. (7-1-26)