Idaho Admin. Code r. 16.03.10.654

Current through September 2, 2024

Section 16.03.10.654 - DEVELOPMENTAL THERAPY: PROCEDURAL REQUIREMENTS

01.Assessment and Diagnostic Services. DDAs must obtain assessments required under Sections 507 through 515 of these rules. Four (4) hours is the maximum Medicaid reimbursable time allowed for the combination of all assessment, evaluation, or diagnostic services provided in any calendar year. The following assessment and diagnostic services are reimbursable when provided in accordance with these rules:

a. Comprehensive Developmental Assessment; and

b. Specific Skill Assessment.

02.Comprehensive Developmental Assessments. Assessments must be conducted by qualified professionals defined under Section 655 of these rules.

a. Comprehensive Assessments. A comprehensive assessment must:

i. Determine the necessity of the service;

ii. Determine the participant's needs;

iii. Guide treatment; iv. Identify the participant's current and relevant strengths, needs, and interests when these are applicable to the respective discipline; and

b. Date, Signature, and Credential Requirements. Assessments must be signed and dated by the professional completing the assessment and include the appropriate professional credential or qualification of that person.

c. Requirements for Current Assessments. Assessments must accurately reflect the current status of the participant. To be considered current, assessments must be completed or updated at least every two (2) years for service areas in which the participant is receiving services on an ongoing basis.

d. Comprehensive Developmental Assessment. A comprehensive developmental assessment must reflect a person's developmental status in the following areas:

i. Self-care;

ii. Receptive and expressive language;

iii. Learning;

iv. Gross and fine motor development;

v. Self-direction;

vi. Capacity for independent living; and

vii. Economic self-sufficiency.

03.Specific Skill Assessments. Specific skill assessments must:

a. Further assess an area of limitation or deficit identified on a comprehensive assessment.

b. Be related to a goal on the IPP or ISP.

c. Be conducted by qualified professionals.

d. Be conducted for the purposes of determining a participant's skill level within a specific domain.

e. Be used to determine baselines and develop the program implementation plan.

04.DDA Program Documentation Requirements. Each DDA must maintain records for each participant the agency serves. Each participant's record must include documentation of the participant's involvement in and response to the services provided.

a. General Requirements for Program Documentation. For each participant the following program documentation is required:

i. Daily entry of all activities conducted toward meeting participant objectives.

ii. Sufficient progress data to accurately assess the participant's progress toward each objective; and

iii. A review of the data, and, when indicated, changes in the daily activities or specific implementation procedures by the qualified professional. The review must include the qualified professional's dated initials.

iv. Documentation of six (6) month and annual reviews by the Developmental Specialist that includes a written description of the participant's progress toward the achievement of therapeutic goals, and the reason(s) why they continue to need services.

v. Signed, authorized plan as described in Section 513 of these rules.

b. DDAs must also submit provider status reviews to the plan monitor in accordance with Sections 507 through 515 of these rules.

05.DDA Program Implementation Plan Requirements. For each participant, the DDA must develop a Program Implementation Plan for each DDA objective included on the participant's required plan of service. All Program Implementation Plans must be related to a goal or objective on the participant's plan of service. The Program Implementation Plan must be developed within fourteen (14) days from the plan of service start date or receipt of the authorized plan of service and be revised whenever participant needs change. If the Program Implementation Plan is not completed within this time frame, the participant's records must contain participant-based documentation justifying the delay. If consistent with the timeframes above, a participant's annual Program Implementation Plan is completed after the start date of the annual plan of service, the provider will address goals and objectives as agreed to by the participant until the annual Program Implementation Plan is complete and must document service provision related to these interim goals and objectives consistent with Section 654 of these rules. The Program Implementation Plan must include the following requirements:

a. Name. The participant's name.

b. Baseline Statement. A baseline statement addressing the participant's skill level and abilities related to the specific skill to be learned.

c. Objectives. Measurable, behaviorally-stated objectives that correspond to those goals or objectives authorized and agreed to in the required plan of service.

d. Written Instructions to Staff. These instructions may include curriculum, interventions, task analyses, activity schedules, type and frequency of reinforcement, and data collection including probe, directed at the achievement of each objective. These instructions must be individualized and revised as necessary to promote participant progress toward the stated objective.

e. Service Environments. Identification of the type of environment(s) where services will be provided.

f. Target Date. Target date for completion.

g. Results of the Psychological or Psychiatric Assessment. When a participant has had a psychological or psychiatric assessment, the results of the psychological or psychiatric assessment must be used when developing objectives to ensure therapies provided in the DDA accommodate the participant's mental health needs and to ensure that none of the therapeutic methods are contra-indicated or delivered in a manner that presents a risk to the participant's mental health status.

h. Home and Community-Based Services Requirements. All program implementation plans must meet home and community-based setting qualities defined in Section 313 of these rules.

Idaho Admin. Code r. 16.03.10.654

Effective March 17, 2022