Idaho Admin. Code r. 16.03.13.160

Current through September 2, 2024

Section 16.03.13.160 - SUPPORT AND SPENDING PLAN DEVELOPMENT

01.Support and Spending Plan Requirements. The participant, with the help of their support broker, must develop a comprehensive support and spending plan based on the information gathered during the person-centered planning. The support and spending plan is not valid until authorized by the Department and must include the following:

a. The participant's preferences and interests by identifying all the supports and services, both paid and non-paid, the participant wants and needs to live successfully in their community.

b. Paid or non-paid consumer-directed community supports that focus on the participant's wants, needs, and goals in the following areas:

i. Personal health and safety including quality of life preferences;

ii. Securing and maintaining employment;

iii. Establishing and maintaining relationships with family, friends and others to build the participant's circle of supports;

iv. Learning and practicing ways to recognize and minimize interfering behaviors; and

v. Learning new skills or improving existing ones to accomplish set goals.

c. Support needs such as:

i. Medical care and medicine;

ii. Skilled care including therapies or nursing needs;

iii. Community involvement;

iv. Preferred living arrangements including possible roommate(s); and

v. Response to emergencies including access to emergency assistance and care. This plan should reflect the wants, preferences, and needs of the whole person, regardless of payment source, if any.

d. Risks or safety concerns in relation to the identified support needs on the participant's plan. The plan must specify the supports or services needed to address the risks for each issue listed, with at least three (3) backup plans for each identified risk to implement in case the need arises;

e. Sources of payment for the listed supports and services, including the frequency, duration, and main task of the listed supports and services;

f. The budgeted amounts planned in relation to the participant's needed supports. Community support worker employment agreements submitted to the fiscal employer agent must identify the negotiated rates agreed upon with each community support worker along with the specific support being purchased, the frequency and duration that the support will be provided, and the payment increment; that is, hourly or daily. The fiscal employer agent will compare and match the employment agreements to the appropriate support categories identified on the initial spending plan prior to processing time sheets or invoices for payment; and

g. Additional HCBS person-centered plan requirements as defined in IDAPA 16.03.10, "Medicaid Enhanced Plan Benefits," Sections 313, 316, and 317.

02.Support and Spending Plan Limitations. Support and spending plan limitations include:

a. Traditional Medicaid waiver and traditional rehabilitative or habilitative services must not be purchased under the CDCS option. Because a participant cannot receive these traditional services and consumer-directed services at the same time, the participant, the support broker, and the Department must all work together to ensure that there is no interruption of required services when moving between traditional services and the CDCS option;

b. Paid community supports must not be provided in a group setting with recipients of traditional Medicaid waiver, rehabilitative or habilitative services. This limitation does not preclude a participant who has selected the consumer-directed option from choosing to live with recipients of traditional Medicaid services;

c. All paid community supports must fit into one (1) or more types of community supports described in Section 110 of these rules. The support and spending plan must not include supports or services that are illegal, that adversely affect the health and safety of the participant, that do harm, or that violate or infringe on the rights of others;

d. Support and spending plans that exceed the approved budget amount will not be authorized; and

e. Time sheets or invoices that are submitted to the fiscal employer agent for payment that exceed the authorized support and spending plan amount will not be paid by the fiscal employer agent.

Idaho Admin. Code r. 16.03.13.160

Effective March 17, 2022