Current through September 2, 2024
Section 16.03.10.001 - TITLE AND SCOPE01.Title. The title of these rules is IDAPA 16.03.10, "Medicaid Enhanced Plan Benefits."02.Scope. These rules establish the Medicaid Enhanced Plan Benefits covered under Title XIX and Title XXI. Participants who are eligible for Enhanced Plan Benefits are also eligible for benefits under IDAPA 16.03.09, "Medicaid Basic Plan Benefits." Dental benefits and outpatient behavioral health benefits are contained in IDAPA 16.03.09. "Medicaid Basic Plan Benefits."03.Scope of Reimbursement System Audits. These rules also provide for the audit of providers' claimed costs against these rules and Medicare standards. The Department reserves the right to audit financial and other records of the provider, and, when warranted, the records of entities related to the provider. Audits consist of the following types of records: a. Cost verification of actual costs for providing goods and services;b. Evaluation of provider's compliance with the provider agreement, reporting form instructions, and any applicable law, rule, or regulation;c. Effectiveness of the service to achieve desired results or benefits; andd. Reimbursement rates or settlement calculated under this chapter.04.Exception to Scope for Audits and Investigations. Audits as described in these rules do not apply to the audit processes used in conducting investigations of fraud and abuse under IDAPA 16.05.07, "Investigation and Enforcement of Fraud, Abuse, and Misconduct."Idaho Admin. Code r. 16.03.10.001