Section 16.03.09.573 - CHIS: COVERAGE AND LIMITATIONS01.Excluded for Medicaid Payment.ii. Educational services; andiii. Recreational services.02.Service Delivery. The CHIS allowed under the Medicaid State Plan authority include evaluations, diagnostic and therapeutic treatment services provided on an outpatient basis. These services help improve individualized functional skills, develop replacement behaviors, and promote self-sufficiency of the participant. CHIS may be delivered in the community, the participant's home, or in a DDA under the requirements of these rules. Duplication of services is not reimbursable.03.Required Recommendation. CHIS must be recommended by a physician or other licensed practitioner of the healing arts within their scope of practice, under state law.a. The CHIS provider may not seek reimbursement for services provided more than thirty (30) calendar days prior to the signed and dated recommendation.b. The recommendation is only required to be completed once and must be received prior to submitting the initial prior authorization request. If the participant has not accessed CHIS for more than three hundred sixty-five (365) calendar days then a new recommendation must be received.04.Required Screening. Needs are determined through the current version of the Vineland Adaptive Behavior Scales or other Department-approved screening tools that are conducted by the family's chosen CHIS provider, and the Department, and are administered under the protocol of the tool. The screening tool is only required to be completed once and must be completed prior to submitting the initial prior authorization request. The following apply:a. If a screening tool has been completed by the Department a new screening is not required.b. If the participant has been determined eligible by the Department, a new screening tool is not required.c. If the participant has not accessed CHIS for more than three hundred sixty-five (365) calendar days, a new screening must be completed.d. The screening cannot be billed more than once unless an additional screening is required under guidelines as outlined in the Medicaid Provider Handbook.05.Services. All CHIS recommended on a participant's assessment and clinical treatment plan must be prior authorized by the Department. The following CHIS are available for eligible participants and are reimbursable services when provided under these rules:a. Habilitative Skill Building. This direct intervention service includes techniques used to develop, improve, and maintain, to the maximum extent possible, the developmentally appropriate functional abilities and daily living skills needed by a participant. This service may include teaching and coordinating methods of training with family members or others who regularly participate in caring for the eligible participant. Services include individual or group interventions. i. Group services must be provided by one (1) qualified staff providing direct services for two (2) or three (3) participants.ii. As the number and needs of the participants increase, the participant ratio in the group must be adjusted from three (3) to two (2).iii. Group services will only be reimbursed when the participant's objectives relate to benefiting from group interaction.b. Behavioral Intervention. This service utilizes direct intervention techniques used to produce positive meaningful changes in behavior that incorporate functional replacement behaviors and reinforcement-based strategies while also addressing any identified habilitative skill building needs. These services are provided to participants who exhibit interfering behaviors that impact the independence or abilities of the participant, such as impaired social skills and communication or destructive behaviors. Intervention services may include teaching and coordinating methods of training with family members or others who regularly participate in caring for the eligible participant. Evidence-based or evidence-informed practices are used to promote positive behaviors and learning while reducing interfering behaviors and developing behavioral self-regulation. Services include individual or group interventions. i. Group services must be provided by one (1) qualified staff providing direct services for two (2) or three (3) participants.ii. As the number and severity of the participants with behavioral issues increase, the participant ratio in the group must be adjusted from three (3) to two (2).iii. Group services should only be delivered when the participant's objectives relate to benefiting from group interaction.c. Interdisciplinary Training. This is a companion service to behavioral intervention and habilitative skill building and is used to assist with implementing a participant's health and medication monitoring, positioning and physical transferring, use of assistive equipment, and intervention techniques in a manner that meets the participant's needs. This service is to be utilized for collaboration, with the participant present, during the provision of services between the intervention specialist or professional and a Speech Language and Hearing Professional (SLP), Physical Therapist (PT), Occupational Therapist (OT), medical professional, behavioral or mental health professional.d. Crisis Intervention. This service may include providing training to staff directly involved with the participant, delivering intervention directly with the eligible participant, and developing a crisis plan that directly addresses the behavior occurring and the necessary intervention strategies to minimize the behavior and future occurrences. Crisis intervention is provided in the home or community on a short-term basis typically not to exceed thirty (30) days. Positive behavior interventions must be used prior to, and in conjunction with, the implementation of any restrictive intervention. Crisis intervention is available for participants who have an unanticipated event, circumstance, or life situation that places a participant at risk of at least one (1) of the following: ii. Out-of-home placement;iv. Physical harm to self or others, including a family altercation or psychiatric relapse.e. Assessment and Clinical Treatment Plan (ACTP). The ACTP is a comprehensive assessment that guides the formation of the implementation plan(s) that include developmentally appropriate objectives and strategies related to identified needs. The qualified provider conducts an assessment to evaluate the participant's strengths, needs, and functional abilities across environments. This process guides the development of intervention strategies and recommendations for services related to the participant's identified needs. The ACTP must be monitored and adjusted to reflect the current needs of the participant. The CHIS provider must document that a copy of the ACTP was offered to the participant's parent or legal guardian. The ACTP must be completed on a Department-approved form as referenced in the Medicaid Provider Handbook and contain the following minimum standards:i. Clinical interview(s) must be completed with the parent or legal guardian;ii. Administer or obtain an objective and validated comprehensive skills or developmental assessment approved by the Department. The most current version of the assessment must be used and the assessment must have been completed within the last three-hundred and sixty-five (365) days;iii. Review of assessments, reports, and relevant history;iv. Observations in at least one (1) environment;v. A reinforcement inventory or preference assessment;vi. A transition plan; andvii. Be signed by the individual completing the assessment and the parent or legal guardian.Idaho Admin. Code r. 16.03.09.573