Idaho Admin. Code r. 16.03.09.574

Current through September 2, 2024

Section 16.03.09.574 - CHIS: PROCEDURAL REQUIREMENTS

All CHIS identified on a participant's ACTP must be prior authorized by the Department, or its contractor, and must be maintained in each participant's file. The CHIS provider is responsible for documenting and submitting the participant's ACTP to obtain prior authorization before delivering any CHIS.

01.Prior Authorization Request. The request must be submitted to the Department, or its contractor, who will review and approve or deny prior authorization requests and notify the provider and the parent or legal guardian of the decision. Prior authorization is intended to help ensure the provision of medically necessary services and will be approved according to the timeframes established by the Department and as described in the Medicaid Provider Handbook.

a. Once the initial request for prior authorization is submitted, CHIS may be delivered for a maximum of twenty-four (24) total hours for up to thirty (30) calendar days or until the prior authorization is approved. Initial prior authorization requests must include:

i. A recommendation from a physician or other practitioner of the healing arts;

ii. The ACTP; and

iii. Implementation plan(s).

b. Ongoing prior authorization requests must include:

i. A list of the participant's objectives;

ii. Graphs showing change lines;

iii. A brief analysis of data regarding progress or lack of progress to meeting each objective;

iv. A list of all CHIS hours being requested and the qualification of the individual(s) who will provide them;

v. Request for the annual ACTP, if applicable;

vi. New implementation plans, if applicable;

vii. An updated annual ACTP, if applicable; and

viii. An annual written summary with an analysis of data regarding the participant's progress or lack of progress, justification for any changes made to implementation of programming for new objectives, discontinuation of objectives, if applicable, and a summary of parent(s) or caregiver(s) response to teaching of coordinated methods.

c. The following services may be requested retroactively:

i. The initial ATCP;

ii. The screening tool; and

iii. Crisis intervention within seventy-two (72) hours of the service initiation.

02.Implementation Plan(s). An implementation plan will provide details on how intervention will be implemented and must be completed by a qualified provider. All implementation plan objectives must be related to a need identified on the ATCP. The provider must document that a copy of the participant's implementation plan(s) was offered to the participant's parent or legal guardian. The implementation plan(s) must include the following requirements:

a. Participant's name;

b. Measurable, behaviorally-stated objectives including criteria for successful achievement, and a baseline statement;

c. Location(s) where objectives will be implemented;

d. Precursor behaviors for participants receiving behavioral intervention;

e. Description of the treatment modality to be utilized;

f. Discriminative stimulus or direction;

g. Targets, steps, task analysis or prompt level;

h. Correction procedure;

i. Data collection;

j. Reinforcement, including type and frequency;

k. A plan for generalization and a plan for family training;

l. A behavior response plan for participants receiving behavioral intervention;

m. Any restrictive or aversive interventions being implemented must be reviewed and approved by a licensed individual working within the scope of their practice; and

n. A signature of the qualified provider who completed the document(s), date signed, and credential.

03.Requirements for Program Documentation. Providers must maintain records for each participant served. Failure to maintain such documentation may result in the recoupment of funds paid for undocumented services. For each participant, the following program documentation is required for each visit made or service provided to the participant, including at a minimum the following information:

a. Date, time, and duration;

b. Summary of session or service provided, and if interdisciplinary training is provided, documentation must include who the service was delivered to and the content covered;

c. Data documentation that corresponds to the implementation plans for habilitative skill building or behavioral intervention;

d. Location of service delivery; and

e. Signature of the individual providing the service, date signed, and credential.

04.Supervision. Supervision includes both face-to-face observation and direction to the staff regarding developmental and behavioral techniques, progress measurement, data collection, function of behaviors, and generalization of acquired skills for a participant. Supervision is provided to ensure staff demonstrate the necessary skills to correctly provide the services as defined in this rule and informs of any modification needed to the methods implemented to support the accomplishment of outcomes identified in the ACTP. Supervision must be provided in accordance with the requirements of the evidence-based model or in accordance with each individual provider qualification. Intervention specialists providing services to children birth to three (3) years old must be supervised by an intervention specialist or intervention professional who also meets the birth to three (3) years old requirements.

Idaho Admin. Code r. 16.03.09.574

Effective March 17, 2022