Section 16.03.10.651 - DEVELOPMENTAL THERAPY: COVERAGE REQUIREMENTS AND LIMITATIONSDevelopmental therapy must be recommended by a physician or other practitioner of the healing arts.
01.Requirements to Deliver Developmental Therapy. Developmental therapy may be delivered in a DDA center-based program, the community, or the home of the participant. Developmental therapy includes individual developmental therapy and group developmental therapy. Developmental therapy must be delivered by Developmental Specialists or paraprofessionals qualified under these rules, based on an assessment completed prior to the delivery of developmental therapy. a. These services must be directed toward the rehabilitation or habilitation of physical or developmental disabilities in the areas of self-care, receptive and expressive language, learning, mobility, self-direction, capacity for independent living, or economic self-sufficiency.b. Developmental therapy includes instruction in daily living skills the participant has not gained at the normal developmental stages in their life or is not likely to develop without training or therapy. Developmental therapy must be age-appropriate.c. Developmental therapy does not include tutorial activities or assistance with educational tasks associated with educational needs that result from the participant's disability.d. Developmental Therapy may be provided in home and community-based settings as described in Section 312 of these rules. Developmental therapy, in both individual and group formats, must be available in both community-based and home-based settings, and be based on participant needs, interests, or choices.e. When group developmental therapy is center-based, there must be a minimum of one (1) qualified staff who may be a paraprofessional or a Developmental Specialist providing direct services for every twelve (12) participants. The community-based services must occur in integrated, inclusive settings and with no more than three (3) participants per qualified staff at each session. Additional staff must be added, as necessary, to meet the needs of each individual served.02.Excluded Services. The following services are excluded for Medicaid payments: b. Educational services; andc. Recreational services.03.Limitations on Developmental Therapy. Developmental therapy may not exceed the limitations as specified below:a. Developmental therapy must not exceed twenty-two (22) hours per week.b. Developmental therapy provided in combination with supported employment services under these rules must not exceed forty (40) hours per week.c. When a participant receives adult day health as provided in these rules, the combination of adult day health and developmental therapy must not exceed thirty (30) hours per week.d. Only one (1) type of therapy will be reimbursed during a single period by the Medicaid program. Developmental therapy will not be reimbursed during periods when the participant is being transported to and from the agency.Idaho Admin. Code r. 16.03.10.651