Section 16.03.10.736 - SERVICE COORDINATION: PROVIDER REIMBURSEMENT01.Duplication. Participants are only eligible for one (1) type of service coordination. If they qualify for more than one (1) type, the participant must choose one (1). Service coordination payment must not duplicate payment made to public or private sector entities under other program authorities for this same purpose.02.Payment for Service Coordination. Subject to the service limitations in Subsection 736.06 of this rule, only the following services are reimbursable: a. Service coordination plan development defined in Section 721 of these rules.b. Face-to-face contact required in Subsection 728.06 of these rules.c. Two-way communication between the service coordinator and the participant, participant's service providers, family members, primary care givers, legal guardian, or other interested persons.d. Face-to-face contact between the service coordinator and the participant's family members, legal representative, primary caregivers, providers, or other interested persons.e. Referral and related activities associated with obtaining needed services as identified in the service coordination plan.03.Service Coordination During Institutionalization. Service coordination is reimbursable on the day a participant is admitted to a medical institution if the service is provided prior to admission. Service coordination is reimbursable on the day of discharge from a medical institution if the service is provided after discharge.a. Service coordination for reintegration into the community, can only be provided by and reimbursed to a service coordination agency when the following applies: i. During the last fourteen (14) days of an inpatient stay that is less than one hundred eighty (180) days in duration; orii. During the last sixty (60) days of an inpatient stay of one hundred eighty (180) days or more.b. Service coordination providers may not file claims for reimbursement until the participant is discharged and using community services;c. Service coordination must not duplicate activities provided as part of admission or discharge planning activities of the medical institution.04.Incarceration. Service coordination is not reimbursable when the participant is incarcerated.05.Services Delivered Prior to Assessment. Payment for on-going service coordination will not be made prior to the completion of the service coordination plan.06.Payment Limitations. Reimbursement is not allowed for missed appointments, attempted contacts, travel to provide the service, leaving messages, scheduling appointments with the Medicaid service coordinator, transporting participants, or documenting services. a. Service coordination providers are paid in unit increments of fifteen (15) minutes each. A service coordinator can only be reimbursed for the amount of time worked and must not bill for more than four (4) billing units per hour. The following table is an example of minutes to billing units. Services Provided Are More Than Minutes | Services Provided Are Less Than Minutes | Billing Units |
8 | 23 | 1 |
22 | 38 | 2 |
37 | 53 | 3 |
52 | 68 | 4 |
67 | 83 | 5 |
82 | 98 | 6 |
97 | 113 | 7 |
b. Direct delivery of medical, educational, psychiatric, social, early intervention, or other service to which a participant has been referred is not reimbursable as service coordination.c. Activities that are an integral component of another covered Medicaid service are not reimbursable as service coordination.d. Activities that are integral to the administration of foster care programs are not reimbursable as service coordination.e. Activities that are integral to the administration of another non-medical program are not reimbursable as service coordination. This exclusion does not apply to case management provided as part of the individualized education program or individualized family service plan required by the Individuals with Disabilities Education Act.07.Group Service Coordination. Payment is not allowed for service coordination provided to a group of participants.Idaho Admin. Code r. 16.03.10.736