Idaho Admin. Code r. 16.03.09.855

Current through September 2, 2024

Section 16.03.09.855 - SCHOOL-BASED SERVICE: PROVIDER QUALIFICATIONS AND DUTIES

Medicaid will only reimburse for services provided by qualified staff. The following are the minimum qualifications for providers of covered services:

01.Behavioral Intervention. Must be provided by, or under the supervision of, an intervention specialist or professional. Individuals providing behavioral intervention must be one (1) of the following:

a. Intervention Paraprofessional. Provides direct services. The specialist or professional must observe and review the direct services performed by the paraprofessional monthly, or more often as necessary, to ensure the paraprofessional demonstrates the necessary skills to correctly provide the direct service. An intervention paraprofessional under the direction of a qualified intervention specialist or professional must:

i. Be at least eighteen (18) years of age;

ii. Demonstrate the knowledge, have the skills needed to support the program to which they are assigned; and

iii. Meet the paraprofessional requirements under IDAPA 08.02.02, "Rules Governing Uniformity."

b. Intervention Technician. A provisional position intended to allow an individual to gain the necessary degree, competency, or experience needed to qualify as an intervention specialist or higher. Provisional status is limited to a single eighteen (18) successive month period. The specialist or professional must observe and review the direct services performed by the technician monthly, or more often as necessary, to ensure the technician demonstrates the necessary skills to correctly provide the direct service. An intervention technician under the direction of a qualified intervention specialist or professional, must:

i. Be an individual who is currently enrolled and is within twenty-four (24) semester credits, or equivalent, to complete their bachelor's degree or higher from an accredited institution in a human services field and working towards meeting the experience and competency requirements; or

ii. Hold a bachelor's degree from an accredited institution in a human services field or has a bachelor's degree and a minimum of twenty-four (24) semester credits, or equivalent, in a human services field and working towards meeting the experience and competency requirements.

c. Intervention Specialist. Provides direct services, completes assessments, and develops implementation plans. Intervention specialists who will complete assessments must have documented training and experience in completing assessments and designing and implementing comprehensive therapies for students with functional or behavioral needs, or both. The qualifications for this provider type can be met by one (1) of the following:

i. An individual who holds an Idaho Standard Instructional Certificate who meets qualifications for an endorsement specific to special education as defined in State Board of Education Policy Section IV.B;

ii. An individual who holds a Habilitative Intervention Certificate of Completion in Idaho with an expiration date of July 1, 2019, or later, and does not have a gap of more than three (3) years of employment as an intervention specialist; or

iii. An individual who holds a bachelor's degree from an accredited institution in a human services field or has a bachelor's degree and a minimum of twenty-four (24) semester credits in a human services field, can demonstrate one thousand forty (1,040) hours of supervised experience working with children who demonstrate functional or behavioral needs, and meets the competency requirements by completing one (1) of the following:

(1) A Department-approved competency checklist referenced in the Medicaid Provider Handbook;

(2) A minimum of forty (40) hours of applied behavior analysis training delivered by an individual who is certified or credentialed to provide the training; or

(3) Other Department-approved competencies as defined in the Medicaid Provider Handbook.

d. Intervention Professional. Provides direct services, completes assessments, and develops implementation plans. Intervention professionals who will complete assessments must have documented training and experience in completing assessments and designing and implementing comprehensive therapies for students with functional or behavioral needs, or both. The qualifications for this provider type can be met by one (1) of the following:

i. An individual who holds a master's degree or higher from an accredited institution in psychology, education, applied behavior analysis, or have a related discipline with one thousand five hundred (1,500) hours of relevant coursework or training, or both, in principles of child development, learning theory, positive behavior support techniques, dual diagnosis psychology, education, or behavior analysis which may be documented within the individual's degree program, other coursework, or training; and

ii. Have one thousand two hundred (1,200) hours of relevant experience in completing and implementing comprehensive behavioral therapies for participants with functional or behavioral needs, which may be documented within the individual's degree program, other coursework, or training.

e. Evidence-Based Model (EBM) Intervention Paraprofessional. Provides direct services and must be supervised under the evidence-based model in which they are certified or credentialed. The EBM intervention specialist or professional must observe and review the direct services performed by the paraprofessional to ensure the paraprofessional demonstrates the necessary skills to correctly provide the direct service. An EBM intervention paraprofessional must:

i. Hold a high school diploma; and

ii. Hold a para-level certification or credential in an evidence-based model approved by the Department.

f. Evidence Based Model (EBM) Intervention Specialist. Provides direct services, completes assessments, and develops implementation plans and must be supervised under the evidence-based model in which they are certified or credentialed. The EBM intervention professional must observe and review the direct services performed by the specialist to ensure the specialist demonstrates the necessary skills to correctly provide the direct service. The specialist may supervise the EBM intervention paraprofessional working within the same evidence-based model. An EBM intervention specialist must:

i. Hold a bachelor's degree from an accredited institution in accordance with their certification or credentialing requirements; and

ii. Hold a bachelors-level certification or credential in an evidence-based model approved by the Department.

g. Evidence-Based Model (EBM) Intervention Professional. Provides direct services, completes assessments, develops implementation plans, and may supervise EBM intervention paraprofessionals or specialists working within the same evidence-based model in which they are certified or credentialed. An EBM intervention professional must:

i. Hold a master's degree or higher from an accredited institution in accordance with their certification or credentialing requirements; and

ii. Hold a masters-level certification or credential in an evidence-based model approved by the Department.

02.Behavioral Consultation. Must be provided by a professional who has a Doctoral or Master's degree in psychology, education, applied behavioral analysis, or has a related discipline with one thousand five hundred (1,500) hours of relevant coursework or training, or both, in principles of child development, learning theory, positive behavior support techniques, dual diagnosis psychology, education, or behavior analysis (may be included as part of degree program), and who meets one (1) of the following:

a. An individual who holds an Idaho Standard Instructional Certificate who meets qualifications for an endorsement specific to special education as defined in State Board of Education Policy Section IV.B;

b. An individual with a Pupil Personnel Certificate who meets the qualifications defined under IDAPA 08.02.02, "Rules Governing Uniformity," excluding an RN or audiologist;

c. An occupational therapist who is qualified and registered to practice in Idaho;

d. An intervention professional, as defined in Subsection 855.01 of this rule; or

e. An EBM intervention professional, as defined in Subsection 855.01 of this rule.

03.Crisis Intervention. Must be provided by, or under the supervision of, an intervention specialist or professional. Individuals providing crisis intervention must be one (1) of the following:

a. An intervention paraprofessional, under Subsection 855.01 of this rule;

b. An intervention technician, under Subsection 855.01 of this rule;

c. An intervention specialist, under Subsection 855.01 of this rule;

d. An intervention professional, under Subsection 855.01 of this rule;

e. An EBM intervention paraprofessional, under Subsection 855.01 of this rule;

f. An EBM intervention specialist, under Subsection 855.01 of this rule;

g. An EBM intervention professional, under Subsection 855.01 of this rule;

h. A licensed physician, licensed practitioner of the healing arts;

i. An advanced practice registered nurse;

j. A licensed psychologist;

k. A licensed clinical professional counselor or professional counselor;

l. A licensed marriage and family therapist;

m. A licensed masters social worker, licensed clinical social worker, or licensed social worker;

n. A psychologist extender registered with the Division of Occupational and Professional Licenses;

o. An RN;

p. A licensed occupational therapist; or

q. An endorsed or certified school psychologist.

04.Habilitative Skill Building. Must be provided by, or under the supervision of, an intervention specialist or professional. Individuals providing habilitative skill building must be one (1) of the following under Subsection 855.01 of this rule:

a. An intervention paraprofessional;

b. An intervention technician;

c. An intervention specialist;

d. An intervention professional;

e. An EBM intervention paraprofessional;

f. An EBM intervention specialist; or

g. An EBM intervention professional.

05.Interdisciplinary Training. Must be provided by one (1) of the following under Subsection 855.01 of this rule:

a. An intervention specialist;

b. An intervention professional;

c. An EBM intervention specialist;

d. An EBM intervention professional.

06.Medical Equipment and Supplies. See Subsection 853.03 of these rules.

07.Nursing Services. Must be provided by an RN or by a licensed practical nurse (LPN) licensed to practice in Idaho.

08.Occupational Therapy and Evaluation. For therapy-specific rules, refer to Sections 730 through 739 of these rules.

09.Personal Care Services (PCS). Must be provided by or under the direction of an RN.

a. Providers of PCS must have at least one (1) of the following qualifications:

i. Licensed Registered Nurse (RN).

ii. Licensed Practical Nurse (LPN). A person currently licensed by the Idaho State Board of Nursing as a licensed practical nurse;

iii. Certified Nursing Assistant (CNA). A person currently certified by the State of Idaho; or

iv. Personal Assistant. A person who meets the standards of Section 39-5603, Idaho Code, and receives training to ensure the quality of services. The assistant must be at least age eighteen (18) years of age.

b. The RN must review or complete, or both, the PCS assessment and develop or review, or both, the written plan of care annually. Oversight provided by the RN must include all of the following:

i. Development of the written PCS plan of care;

ii. Review of the treatment given by the personal assistant through a review of the student's PCS service detail reports as maintained by the provider; and

iii. Reevaluation of the plan of care as necessary, but at least annually.

c. The RN must conduct supervisory visits on a quarterly basis, or more frequently as determined by the IEP team and defined as part of the PCS plan of care.

10.Physical Therapy and Evaluation. For therapy-specific rules, refer to Sections 730 through 739 of these rules.

11.Psychological Evaluation. Must be provided by a:

a. Licensed psychiatrist;

b. Licensed physician;

c. Licensed psychologist;

d. Psychologist extender registered with the Division of Occupational and professional Licenses; or

e. Endorsed or certified school psychologist.

12.Psychotherapy. Provision of psychotherapy services must have, one (1) or more of the following credentials:

a. Psychiatrist, MD;

b. Physician, MD;

c. Licensed psychologist;

d. Licensed clinical social worker;

e. Licensed clinical professional counselor;

f. Licensed marriage and family therapist;

g. Certified psychiatric nurse (RN), under Subsection 707.13 of these rules;

h. Licensed professional counselor whose provision of psychotherapy is supervised under with IDAPA 24.15.01, "Rules of the Idaho Licensing Board of Professional Counselors and Marriage and Family Therapists";

i. Licensed masters social worker whose provision of psychotherapy is supervised under IDAPA 24.14.01, "Rules of the State Board of Social Work Examiners";

j. Licensed associate marriage and family therapist whose provision of psychotherapy is supervised under IDAPA 24.15.01, "Rules of the Idaho Licensing Board of Professional Counselors and Marriage and Family Therapists"; or

k. Psychologist extender, registered with the Division of Occupational and Professional Licenses, whose provision of diagnostic services is supervised under IDAPA 24.12.01, "Rules of the Idaho State Board of Psychologist Examiners."

13.Skills Building/Community-Based Rehabilitation Services (CBRS). Skills Building/CBRS must be provided by one (1) of the following. Skills Building/Community-Based Rehabilitation Services (CBRS) provider who is not required to have a PRA credential or credential required for CBRS specialists must be one (1) of the following:

a. Licensed physician, licensed practitioner of the healing arts;

b. Advanced practice registered nurse;

c. Licensed psychologist;

d. Licensed clinical professional counselor or professional counselor;

e. Licensed marriage and family therapist;

f. Licensed masters social worker, licensed clinical social worker, or licensed social worker;

g. Psychologist extender registered with the Division of Occupational and professional Licenses;

h. Licensed registered nurse (RN);

i. Licensed occupational therapist;

j. Endorsed or certified school psychologist;

k. Skills Building/Community Based Rehabilitation Services specialist who must:

i. Be an individual who has a bachelor's degree and holds a current PRA credential; or

ii. Be an individual who has a bachelor's degree or higher and is under the supervision of a licensed behavioral health professional, a physician, nurse, or an endorsed or certified school psychologist. The supervising practitioner is required to have regular one-to-one (1:1) supervision of the specialist to review treatment provided to student participants on an ongoing basis. The frequency of the one-to-one (1:1) supervision must occur at least monthly. Supervision can be conducted using synchronous virtual care when it is equally effective as direct on-site supervision; and

iii. Have a credential required for CBRS specialists.

14.Speech/Audiological Therapy and Evaluation. For therapy-specific rules, refer to Sections 730 through 739 of these rules.

15.Social History and Evaluation. Must be provided by a RN, psychologist, M.D, school psychologist, certified school social worker, or by a person who is licensed and qualified to provide social work in the state of Idaho.

16.Transportation. Must be provided by an individual who has a current Idaho driver's license and is covered under vehicle liability insurance that covers passengers for business use.

17.Therapy Paraprofessionals. The schools may use paraprofessionals to provide occupational therapy, physical therapy, and speech therapy if they are under the supervision of the appropriate professional. The services provided by paraprofessionals must be delegated and supervised by a professional therapist under the appropriate licensure and certification rules. The portions of the treatment plan that can be delegated to the paraprofessional must be identified in the IEP or transitional IFSP.

a. Occupational Therapy (OT). Refer to IDAPA 24.06.01, "Rules for the Licensure of Occupational Therapists and Occupational Therapy Assistants," for qualifications, supervision, and service requirements.

b. Physical Therapy (PT). Refer to IDAPA 24.13.01, "Rules Governing the Physical Therapy Licensure Board," for qualifications, supervision, and service requirements.

c. Speech-Language Pathology (SLP). Refer to IDAPA 24.23.01, "Rules of the Speech, Hearing and Communication Services Licensure Board," and the American Speech-Language-Hearing Association (ASHA) guidelines for qualifications, supervision, and service requirements for speech-language pathology as incorporated in Section 004 of these rules.

i. Supervision must be provided by an SLP professional in Section 734 of these rules.

ii. The professional must observe and review the direct services performed by the paraprofessional monthly, or more often as necessary, to ensure the paraprofessional demonstrates the necessary skills to correctly provide the SLP service.

Idaho Admin. Code r. 16.03.09.855

Effective July 1, 2024