Paid Consumer-Directed Community Supports (Cdcs)

Participants must purchase FMS and SB services to participate in the CDCS option. Participants must purchase goods and community supports through an FEA who is providing the FMS. (7-1-26) 01. FMS. The Department will enter into a provider agreement with qualified FEAs, as defined in these rules, to provide FMS for payroll and reporting functions to participants who choose the CDCS option. (7-1-26) 02. SB Services. Services provided by a qualified SB to assist in making informed choices, participate in a person-centered planning process, and become skilled at managing their own supports such as negotiating and budgeting. SBs have to apply for requalification annually. (7-1-26) 03. CSW Services. The CSWs provide identified supports to the participant. If the identified support requires specific licensing or certification within the state of Idaho, the identified CSW must obtain the applicable license or certification. Identified supports include activities that address the participant's preference in both FDCS IDAHO ADMINISTRATIVE CODE IDAPA 16.03.26 Department of Health & Welfare Medicaid Plan Benefits Section 805 Page 164 and SDCS, unless otherwise specified, for: (7-1-26) a. Job support for SDCS to help the participant secure and maintain employment or attain job advancement; (7-1-26) b. Personal support to help the participant maintain health, safety, and basic quality of life; (7-1-26) c. Relationship support to help the participant establish and maintain positive relationships with immediate family members, friends, spouse, or others in order to build a natural support network and community; (7-1-26) d. Emotional support to help the participant learn and practice behaviors consistent with their goals and wishes while minimizing interfering behaviors; (7-1-26) e. Learning support for SDCS to help the participant learn new skills or improve existing skills that relate to their identified goals; (7-1-26) f. Transportation support to help the participant accomplish their identified goals; and (7-1-26) g. Skilled nursing support for SDCS identified in the participant's plan that is within the scope of the Nurse Practice Act and is provided by a licensed registered nurse (RN) or licensed practical nurse (LPN) under the supervision of an RN, licensed to practice in Idaho. (7-1-26) 04. Medically Necessary Equipment. Adaptive and therapeutic equipment is medically necessary, meets a medical or accessibility need, and promotes increased independence. FDCS may substitute medical necessity for minimizing the participant’s need for institutionalization. Items may be covered when: (7-1-26) a. Not available through another source; (7-1-26) b. Identified in the participant’s plan; (7-1-26) c. Safe and effective treatment that meets evidence – based treatment criteria; (7-1-26) d. Optimal for the participant’s health, safety and welfare; (7-1-26) e. Least costly alternative that reasonably meets the identified need; (7-1-26) f. For the sole benefit of the participant; and (7-1-26) g. Meets at least one (1) of the following: (7-1-26) i. Assist the ability of the participant to remain in the community; (7-1-26) ii. Enhance community inclusion and family involvement; and (7-1-26) iii. Decrease dependency on formal support services. (7-1-26) 05. Limitations. Services have the following limitations: (7-1-26) a. CDCS Purchased items and services must meet needs related to a developmental disability diagnosis. The use of CDCS and FDCS purchased items by an individual other than the participant is prohibited. The following types of items or services are not covered: (7-1-26) i. For the convenience of a caregiver; (7-1-26) ii. Educational; (7-1-26) IDAHO ADMINISTRATIVE CODE IDAPA 16.03.26 Department of Health & Welfare Medicaid Plan Benefits Section 806 Page 165 iii. Recreational; or (7-1-26) iv. Vocational except pre-vocational and job supports. (7-1-26) b. CDCS services may only be rendered by (1) staff to one (1) participant at a time. Staff may not: (7-1-26) i. Render any other support, service, or supervision, paid or unpaid, to any other individual; or (7-1-26) ii. Perform multiple services concurrently. (7-1-26) c. CDCS and FDCS transportation support is limited to one thousand eight hundred (1,800) miles annually, unless otherwise authorized. (7-1-26)