Idaho Admin. Code r. 16.03.10.728

Current through September 2, 2024

Section 16.03.10.728 - SERVICE COORDINATION: PROCEDURAL REQUIREMENTS

01.Prior Authorization for Service Coordination Services. Services must be prior authorized by the Department as provided in the Medicaid Provider Handbook available at www.idmedicaid.com.

02.Service Coordination Plan Development.

a. A written plan under Section 731 of these rules must be developed and implemented within sixty (60) days after the participant chooses a service coordinator.

b. The plan must be updated at least annually and amended as necessary.

c. The plan must address the service coordination needs of the participant as identified in the assessment under Section 730 of these rules.

d. The plan must be developed prior to ongoing service coordination being provided.

03.Documentation of Service Coordination. Agencies must maintain records that contain documentation describing the services provided, review of the continued need for service coordination, and progress toward each service coordination goal. Documentation must be completed as described in Section 56-209(h), Idaho Code. All active records must be immediately available. Documentation must include the following:

a. The name of the eligible participant.

b. The name of the provider agency and the person providing the services.

c. The date, time, duration, and place the service was provided.

d. The nature, content, units of the service coordination received, and whether goals specified in the plan have been achieved.

e. Whether the participant declined any services in the plan.

f. The need for and occurrences of coordination with any non-Medicaid case managers.

g. The timeline for obtaining needed services.

h. The timeline for re-evaluation of the plan.

i. A copy of the assessment or prior authorization from the Department that documents eligibility for service coordination services, and a dated and signed plan.

j. Agency records must contain documentation describing details of the service provided, signed by the person who delivered the service.

k. Documented review of participant's continued need for service coordination and progress toward each service coordination goal. A review must be completed at least every one hundred eighty (180) days after the plan development or update. Progress reviews must include the date of the review, and the signature of the service coordinator completing the review.

l. Documentation of the participant's, family's, or legal guardian's satisfaction with service.

m. A copy of the informed consent form signed by the participant, parent, or legal guardian that documents that the participant has been informed of the purposes of service coordination, their rights to refuse service coordination, and their right to choose their service coordinator and other service providers.

n. A plan that is signed by the participant, parent, or legal guardian, and the service coordinator. The plan must reflect person-centered planning principles and document the participant's inclusion in the development of the plan. The service coordinator must also document that a copy of the plan was given to the participant or their legal representative. The plan must be updated and authorized when required, but at least annually. Children's service coordination plans cannot be effective before the date that the child's parent or legal guardian has signed the plan.

04.Documentation Completed by a Paraprofessional. Each entry completed by a paraprofessional must be reviewed by the participant's service coordinator and include the date of review and the service coordinator's signature on the documentation.

05.Participant Freedom of Choice. A participant must have freedom of choice when selecting from the service coordinators available to them. The service coordinator cannot restrict the participant's choice of other health care or HCBS providers.

06.Service Coordinator Contact and Availability. The frequency of contact, mode of contact, and person or entity to be contacted must be identified in the plan and meet the needs of the participant. The contacts must verify the participant's well being and whether services are being provided according to the written plan. At least every ninety (90) days, service coordinators must have face-to-face contact with each participant. The face-to-face encounter may occur via synchronous interaction virtual care, as defined in Title 54, Chapter 57, Idaho Code.

a. When it is necessary for the children's service coordinator to conduct a face-to-face contact with a child participant without the parent or legal guardian present, the service coordinator must notify the parent or legal guardian prior to the face-to-face contact with the participant. Notification must be documented in the participant's file.

b. Service coordinators do not have to be available on a twenty-four (24) hour basis, but must include an individualized objective on the plan describing what the participant, families, and providers should do in an emergency situation. The individualized objective must include how the service coordinator will coordinate needed services after an emergency situation.

07.Conflict of Interest. Individuals and agency employees or contractors who develop a participant's plan of service under these rules cannot:

a. Be related by blood or marriage to the participant or to any paid caregiver or the participant;

b. Be financially responsible for the participant;

c. Be empowered to make financial or health-related decisions on behalf of the participant;

d. Hold financial interests in any entity that is paid to provide care for the participant; or

e. Be a provider of the State Plan HCBS or waiver services for the participant or have an interest in or are employed by a provider of State Plan HCBS or waiver services.

08.Service Coordinator Responsibilities Related to Conflict of Interest. The service coordinator will:

a. Be alert to, and avoid, conflicts of interest that interfere with the exercise of professional discretion and impartial judgment.

b. Inform the participant, parent, or legal guardian when a real or potential conflict of interest arises and take reasonable steps to resolve the issue in a manner that makes the participant's interests primary and protects their interests to the greatest extent possible.

09.Agency Responsibilities Related to Conflict of Interest. The agency must guard against conflicts of interest and inform all participants and guardians of any risks. The agency must:

a. Ensure its employees and contractors meet the conflict of interest standards as defined in these rules; and

b. Have a document in each participant's file that contains:

i. The definition of "conflict of interest" as defined in Section 721 of these rules;

ii. A signed statement by the agency representative verifying that the concept of conflict of interest was reviewed and explained to the participant's parent or legal guardian; and

iii. The participant's, parent's, or legal guardian's signature on the document.

Idaho Admin. Code r. 16.03.10.728

Effective July 1, 2024