Idaho Admin. Code r. 16.03.10.319

Current through September 2, 2024
Section 16.03.10.319 - HCBS - TERMINATION OF PARTICIPANT ENROLLMENT
01.Federal and State Eligibility Requirements. To be enrolled in an HCBS waiver or State Plan option program as provided in 42 CFR 441 and Section 1915 of the Social Security Act, a participant must meet the following eligibility requirements that include:
a. An independent assessment;
b. A state-approved person-centered plan;
c. At least an annual redetermination of eligibility; and
d. Other state-established criteria for determining eligibility under the State Plan for medical assistance.
02.Failure to Meet Requirements. A participant who fails to meet any of the conditions of participation required by state established eligibility criteria is subject to termination of enrollment.
03.Conditions for Termination of Enrollment. The Department will terminate the enrollment of a participant who is enrolled in an HCBS waiver or State Plan option, or who has accessed Medicaid coverage through an HCBS waiver or State Plan option under any of the following conditions. The participant:
a. Does not have an identified need for a waiver or State Plan option service;
b. Elects not to use services offered under the HCBS waiver or State Plan option;
c. Declines to engage in person-centered planning;
d. Does not meet other HCBS requirements provided in Section 319.01 of this rule; or
e. Is non-responsive to three or more contact attempts by the Department or its designee to engage the participant in fulfilling requirements.
04.Continuous Eligibility for Children Under Age Nineteen. Continuous health care assistance eligibility for children under age nineteen (19), as provided in IDAPA 16.03.01, "Eligibility for Health Care Assistance for Families and Children," does not apply for a participant under the age of nineteen (19) who is enrolled in an HCBS waiver or State Plan option program or who has accessed Medicaid coverage through an HCBS waiver or State Plan option program.

Idaho Admin. Code r. 16.03.10.319

Effective March 17, 2022