Idaho Admin. Code r. 16.03.09.854

Current through September 2, 2024

Section 16.03.09.854 - SCHOOL-BASED SERVICE: PROCEDURAL REQUIREMENTS

The following documentation must be maintained by the provider and retained for a period of five (5) years:

01.Individualized Education Program (IEP) and Other Service Plans. School districts and charter schools may bill for Medicaid services covered by a current Individualized Education Program (IEP), transitional Individualized Family Service Plan (IFSP), or Services Plan (SP) defined in the Idaho Special Education Manual on the State Department of Education website for parentally placed private school students with disabilities when designated funds are available for special education and related services. The plan must be developed within the previous three hundred sixty-five (365) days which indicates the need for one (1) or more medically-necessary health-related service, and lists all the Medicaid reimbursable services for which the school district or charter school is requesting reimbursement. The IEP and transitional IFSP must include:

a. Type, frequency, and duration of the service(s) provided;

b. Title of the provider(s), including the direct care staff delivering services under the supervision of the professional;

c. Measurable goals, when goals are required for the service; and

d. Specific place of service, if provided in a location other than school.

02.Evaluations and Assessments. Evaluations and assessments must:

a. Support services billed to Medicaid; and

b. Accurately reflect the student's current status.

03.Service Detail Reports. A service detail report that includes:

a. Name of student;

b. Name, title, and signature of the person providing the service;

c. Date, time, and duration of service;

d. Place of service, if provided in a location other than school;

e. Category of service and brief description of the specific areas addressed; and

f. Student's response to the service when required for the service.

04.One Hundred Twenty Day Review. A documented review of progress toward each service plan goal completed at least every one hundred twenty (120) days from the date of the annual plan.

05.Documentation of Qualifications of Providers.

06.Copies of Required Referrals and Recommendations. Copies of required referrals and recommendations.

a. School-based services must be recommended or referred by a physician or other licensed practitioner of the healing arts for all Medicaid services for which the school district or charter school is receiving reimbursement.

b. A recommendation or referral must be obtained within thirty (30) days of the provision of services for which the school district or charter school is seeking reimbursement. Therapy requirements for the order are identified in Section 733 of these rules.

c. A recommendation or referral must be obtained for the service at least every three hundred sixty-five (365) days.

07.Parental Notification. School districts and charter schools must document that parents were notified of the health-related services and equipment for which they will bill Medicaid. Notification must comply with the requirements in Subsection 854.08 of this rule.

08.Requirements for Cooperation with and Notification of Parents and Agencies. Each school district or charter school billing for Medicaid services must act in cooperation with students' parent or guardian, and with community and state agencies and professionals who provide like Medicaid services to the student.

a. Notification of Parents. For all students who are receiving Medicaid reimbursed services, school districts and charter schools must document that parents are notified of the Medicaid services and equipment for which they will bill Medicaid. Notification must describe the service(s), service provider(s), and state the type, location, frequency, and duration of the service(s). The school district must document that they provided the student's parent or guardian with a current copy of the child's plan and any pertinent addenda; and

b. Primary Care Provider (PCP). School districts and charter schools must request the name of the student's PCP and request a written consent to release and obtain information between the PCP and the school from the parent or guardian.

c. Other Community and State Agencies. Upon receiving a request for a copy of the evaluations or the current plan, the school district or charter school must furnish the requesting agency or professional with a copy of the plan or appropriate evaluation after obtaining consent for release of information from the student's parent or guardian.

Idaho Admin. Code r. 16.03.09.854

Effective March 17, 2022