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Public Notice and Redline Children's DD 1915i RenewalPage 1 of 2 NOTICE OF INTENT TO SEEK RENEWAL OF IDAHO’S STATE PLAN OPTION HCBS BENEFIT FOR CHILDREN WITH DEVELOPMENTAL DISABILITIES AND SOLICITATION OF PUBLIC INPUT Pursuant to 42 C.F.R. § 441.304, the Idaho Department of Health and Welfare Division of Medicaid (Department) provides public notice of its intent to submit a State Plan Amendment (SPA) to the Centers for Medicare and Medicaid Services (CMS) to renew Idaho’s 1915(i) State Plan Option Home and Community-Based Services (HCBS) Benefit for Children with Developmental Disabilities (Children’s DD State Plan HCBS Benefit). PURPOSE CMS requires states to renew their State Plan HCBS Benefits every five years. Idaho’s Children’s DD State Plan HCBS Benefit is set to expire on June 30, 2021. To ensure timely renewal and continuation of services,the Department requests public input regarding the proposed SPA to renew Idaho’s Children’s DD State Plan HCBS Benefit. The proposed SPA is expected to include the following changes: ·Updates to the operational and administrative functions; ·Updates to the projected number of participants based on historical trends; ·Updates to the process for performing evaluation/reevaluation; ·Updates to the status of the HCBS settings Statewide Transition Plan (STP); ·Updates regarding authorized assessment tools; ·Addition of provider qualifications for independent Respite, Community-Based Supports, and Family Education services; ·Revisions to the quality improvement strategy; ·Updates to the CMS form; and ·Other minor revisions to correct language and grammar. AVAILABILITY FOR PUBLIC REVIEW A copy of the proposed SPA to renew Idaho’s Children’s DD State Plan HCBS Benefit is available in the “Public Notices and Meetings” section on the Department’s website at: https://healthandwelfare.idaho.gov/.Unless otherwise specified, copies of the proposed SPA are also available for public review during regular business hours at any of the Department’s Regional Medicaid Services (RMS) offices. PUBLIC COMMENT The Department is accepting written and recorded comments regarding the proposed SPA for a period of at least 30 calendar days. Any persons wishing to provide input may submit comments regarding the proposed SPA.Comments must be received by the Department on or before Page 2 of 2 Wednesday, December 16, 2020 at 11:59 p.m.and must be sent using one of the following methods: ·Send Email Comments To:HCBSWaivers@dhw.idaho.gov ·Call Toll Free Voicemail and Comment At:1-855-249-5024 ·Send Fax Comments To:1-208-332-7286 ·Comment at Public Hearing:On the Day and Time Scheduled Below ·Mail Comments To:Medicaid Central Office, Idaho Department of Health and Welfare, PO Box 83720, Boise, ID 83720-0036, Attn: Amanda Morales ·Hand Deliver Comments To:Medicaid Central Office, Idaho Department of Health and Welfare, 3232 Elder Street, Boise, ID 83705, Attn: Amanda Morales The Department will review all comments received prior to submitting the proposed SPA to CMS. A summary document of the comments received in addition to the Department’s response will be posted online once they have been reviewed and compiled. PUBLIC HEARINGS The Department will hold public hearing concerning the proposed SPA as follows: WEBEX EVENT INFORMATION: Tuesday, December 1, 2020 at 3:00 p.m. (Mountain Local Time) Event address for attendees: https://idhw.webex.com/idhw/onstage/g.php?MTID=ec4b71fe38f708f78ed1339ad92f4c502 Event number:177 569 1988 Event password: 1234 WEBEX AUDIO CONFERENCE INFORMATION: +1-415-655-0003 US Toll Access Code: 177 569 1988 The hearing site will be accessible to persons with disabilities. Requests for accommodation must be made not later than five (5) days prior to the hearing, to the agency address above. QUESTIONS For assistance on technical questions concerning the changes in the proposed SPA, contact Amanda Morales, Medicaid Program Policy Analyst for Children’s Developmental Disability Services, at HCBSWaivers@dhw.idaho.gov. 1915(i) State plan Home and Community-Based Services For Children with Developmental Disabilities This document is a draft of the proposed State Plan Amendment (SPA) to renew Idaho’s State Plan Home and Community-Based Services (HCBS) Benefit for Children with Developmental Disabilities. As you review this proposed renewal please be aware of the following: • The proposed effective date for this renewal application is 7/1/2021, this date is reflected in the “Effective Date” section in the header of each page. • The tracked changes (underlined or strikethrough) reflect the substantive changes being recommended for this 1915(i) HCBS Benefit, but may not reflect all formatting, template, capitalization, or punctuation changes. • Because this is a renewal application, this application will supersede/replace the existing State Plan Attachment 3.1-A: Supplement 1 in its entirety (previously submitted as SPA’s 16-0003, 19-0025, and 19-0025-A). • The “Home and Community-Based Settings” section in this renewal application only reflects the current approved status of Idaho’s HCBS Statewide Transition Plan. It does not reflect the previous status that was deleted. • Item 3 related to additional limitations on waiver services under the “Services” section of this renewal application has been deleted because the information is no longer required by CMS. However, it is important to note that individuals receiving services under this 1915(i) Benefit will still be subject to individualized budgets in accordance with IDAPA 16.03.10.522.03. State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 1 Effective: 07/01/2021 Approved: Supersedes: 1915(i) State plan Home and Community-Based Services Administration and Operation The state implements the optional 1915(i) State plan Home and Community-Based Services (HCBS) benefit for elderly and disabled individuals as set forth below. 1. Services. (Specify the state’s service title(s) for the HCBS defined under “Services” and listed in Attachment 4.19-B): Respite Community-Based Supports Family Education Family-Directed Community Support Services Financial Management Services Support Broker 2. Concurrent Operation with Other Programs. (Indicate whether this benefit will operate concurrently with another Medicaid authority): Select one:  Not applicable  Applicable Check the applicable authority or authorities:  Services furnished under the provisions of §1915(a)(1)(a) of the Act. The State contracts with a Managed Care Organization(s) (MCOs) and/or prepaid inpatient health plan(s) (PIHP) or prepaid ambulatory health plan(s) (PAHP) under the provisions of §1915(a)(1) of the Act for the delivery of 1915(i) State plan HCBS. Participants may voluntarily elect to receive waiver and other services through such MCOs or prepaid health plans. Contracts with these health plans are on file at the State Medicaid agency. Specify: (a) the MCOs and/or health plans that furnish services under the provisions of §1915(a)(1); (b) the geographic areas served by these plans; (c) the specific 1915(i) State plan HCBS furnished by these plans; (d) how payments are made to the health plans; and (e) whether the 1915(a) contract has been submitted or previously approved.  Waiver(s) authorized under §1915(b) of the Act. Specify the §1915(b) waiver program and indicate whether a §1915(b) waiver application has been submitted or previously approved: Specify the §1915(b) authorities under which this program operates (check each that applies):  §1915(b)(1) (mandated enrollment to managed care)  §1915(b)(3) (employ cost savings to furnish additional services)  §1915(b)(2) (central broker)  §1915(b)(4) (selective contracting/limit number of providers) State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 2 Effective: 07/01/2021 Approved: Supersedes:  A program operated under §1932(a) of the Act. Specify the nature of the State Plan benefit and indicate whether the State Plan Amendment has been submitted or previously approved:  A program authorized under §1115 of the Act. Specify the program: 3. State Medicaid Agency (SMA) Line of Authority for Operating the State plan HCBS Benefit. (Select one):  The State plan HCBS benefit is operated by the SMA. Specify the SMA division/unit that has line authority for the operation of the program (select one):  The Medical Assistance Unit (name of unit):  Another division/unit within the SMA that is separate from the Medical Assistance Unit (name of division/unit) This includes administrations/divisions under the umbrella agency that have been identified as the Single State Medicaid Agency. Division of Family and Community Services (FACS), within the Idaho Department of Health and Welfare (Department)  The State plan HCBS benefit is operated by (name of agency) a separate agency of the state that is not a division/unit of the Medicaid agency. In accordance with 42 CFR §431.10, the Medicaid agency exercises administrative discretion in the administration and supervision of the State plan HCBS benefit and issues policies, rules and regulations related to the State plan HCBS benefit. The interagency agreement or memorandum of understanding that sets forth the authority and arrangements for this delegation of authority is available through the Medicaid agency to CMS upon request. State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 3 Effective: 07/01/2021 Approved: Supersedes: 4. Distribution of State plan HCBS Operational and Administrative Functions.  (By checking this box the state assures that): When the Medicaid agency does not directly conduct an administrative function, it supervises the performance of the function and establishes and/or approves policies that affect the function. All functions not performed directly by the Medicaid agency must be delegated in writing and monitored by the Medicaid Agency. When a function is performed by an agency/entity other than the Medicaid agency, the agency/entity performing that function does not substitute its own judgment for that of the Medicaid agency with respect to the application of policies, rules and regulations. Furthermore, the Medicaid Agency assures that it maintains accountability for the performance of any operational, contractual, or local regional entities. In the following table, specify the entity or entities that have responsibility for conducting each of the operational and administrative functions listed (check each that applies): (Check all agencies and/or entities that perform each function): Function Medicaid Agency Other State Operating Agency Contracted Entity Local Non- State Entity 1 Individual State plan HCBS enrollment     2 Eligibility evaluation     3 Review of participant service plans     4 Prior authorization of State plan HCBS     5 Utilization management     6 Qualified provider enrollment     7 Execution of Medicaid provider agreement     8 Establishment of a consistent rate methodology for each State plan HCBS     9 Rules, policies, procedures, and information development governing the State plan HCBS benefit     10 Quality assurance and quality improvement activities     (Specify, as numbered above, the agencies/entities (other than the SMA) that perform each function): Eligibility evaluation: Contracted Independent Assessment ProviderThe Department contracts with an Independent Assessment Provider (IAP) to complete needs-based eligibility determinations and assign individualized budgets. The IAP is not a provider of 1915(i) State plan home and community-based services (HCBS), nor does the IAP serve under the authority of a provider of 1915(i) State plan HCBS. Review of participant service plans: Case management contractor(s) State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 4 Effective: 07/01/2021 Approved: Supersedes: (By checking the following boxes the State assures that): 5.  Conflict of Interest Standards. The state assures the independence of persons performing evaluations, assessments, and plans of care. Written conflict of interest standards ensure, at a minimum, that persons performing these functions are not: • related by blood or marriage to the individual, or any paid caregiver of the individual • financially responsible for the individual • empowered to make financial or health-related decisions on behalf of the individual • providers of State plan HCBS for the individual, or those who have interest in or are employed by a provider of State plan HCBS; except, at the option of the state, when providers are given responsibility to perform assessments and plans of care because such individuals are the only willing and qualified entity in a geographic area, and the state devises conflict of interest protections. (If the state chooses this option, specify the conflict of interest protections the state will implement): 6.  Fair Hearings and Appeals. The state assures that individuals have opportunities for fair hearings and appeals in accordance with 42 CFR 431 Subpart E. 7.  No FFP for Room and Board. The state has methodology to prevent claims for Federal financial participation for room and board in State plan HCBS. 8.  Non-duplication of services. State plan HCBS will not be provided to an individual at the same time as another service that is the same in nature and scope regardless of source, including Federal, state, local, and private entities. For habilitation services, the state includes within the record of each individual an explanation that these services do not include special education and related services defined in the Individuals with Disabilities Education Improvement Act of 2004 that otherwise are available to the individual through a local education agency, or vocational rehabilitation services that otherwise are available to the individual through a program funded under §110 of the Rehabilitation Act of 1973. Number Served 1. Projected Number of Unduplicated Individuals To Be Served Annually. (Specify for year one. Years 2-5 optional): Annual Period From To Projected Number of Participants Year 1 July 1, 2021 June 30, 2022 1,002 Year 2 Year 3 Year 4 Year 5 2.  Annual Reporting. (By checking this box the state agrees to): annually report the actual number of unduplicated individuals served and the estimated number of individuals for the following year. N/A State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 5 Effective: 07/01/2021 Approved: Supersedes: Financial Eligibility 1.  Medicaid Eligible. (By checking this box the state assures that): Individuals receiving State plan HCBS are included in an eligibility group that is covered under the State’s Medicaid Plan and have income that does not exceed 150% of the Federal Poverty Line (FPL). (This election does not include the optional categorically needy eligibility group specified at §1902(a)(10)(A)(ii)(XXII) of the Social Security Act. States that want to adopt the §1902(a)(10)(A)(ii)(XXII) eligibility category make the election in Attachment 2.2-A of the state Medicaid plan.) 2. Medically Needy (Select one):  The State does not provide State plan HCBS to the medically needy.  The State provides State plan HCBS to the medically needy. (Select one):  The state elects to disregard the requirements section of 1902(a)(10)(C)(i)(III) of the Social Security Act relating to community income and resource rules for the medically needy. When a state makes this election, individuals who qualify as medically needy on the basis of this election receive only 1915(i) services.  The state does not elect to disregard the requirements at section 1902(a)(10)(C)(i)(III) of the Social Security Act. Evaluation/Reevaluation of Eligibility 1. Responsibility for Performing Evaluations / Reevaluations. Eligibility for the State plan HCBS benefit must be determined through an independent evaluation of each individual. Independent evaluations/reevaluations to determine whether applicants are eligible for the State plan HCBS benefit are performed (Select one):  Directly by the Medicaid agency  By Other (specify State agency or entity under contract with the State Medicaid agency): Contracted Independent Assessment provider(s) will be determined according to state purchasing requirements. 2. Qualifications of Individuals Performing Evaluation/Reevaluation. The independent evaluation is performed by an agent that is independent and qualified. There are qualifications (that are reasonably related to performing evaluations) for the individual responsible for evaluation/reevaluation of needs- based eligibility for State plan HCBS. (Specify qualifications): Per contract requirements, contractor staff must comply, at a minimum, with Qualified Intellectual Disabilities Professional (QIDP) requirements in accordance with 42 CFR 483.430a. Independent Assessment Providers who provide level of care determinations must be a Qualified Intellectual Disability Professional (QIDP) who meets qualifications specified in the Code of Federal Regulations, Title 42 Section 483.430. At a minimum, a QIDP must: a. Have at least (1) year experience working directly with persons with intellectual disabilities or other developmental disabilities; State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 6 Effective: 07/01/2021 Approved: Supersedes: b. Be one of the following: • Licensed as a doctor of medicine or osteopathy, or as a nurse; or • Have at least a bachelor’s degree in one of the following professional categories: psychology, social work, occupational therapy, speech pathology, professional recreation therapy or other related human services professions; and c. Have training and experience in completing and interpreting assessments. 3. Process for Performing Evaluation/Reevaluation. Describe the process for evaluating whether individuals meet the needs-based State plan HCBS eligibility criteria and any instrument(s) used to make this determination. If the reevaluation process differs from the evaluation process, describe the differences: Participants applying for 1915(i) state plan option services will be referred to the independent assessment provider (IAP) for initial eligibility determination. Individuals applying for Children’s 1915(i) State Plan HCBS Benefit services must submit an Application for Medicaid Services for Children with Developmental Disabilities to the Division of Family and Community Services (FACS) within the Idaho Department of Health and Welfare. Applications are completed in paper format and may be submitted to FACS by hand delivery, U.S. mail, fax, or email. Upon receipt of the application, FACS verifies if the individual is financially eligible for Medicaid. After verifying an individual’s financial eligibility, the application is forwarded to the Independent Assessment Provider (IAP) to determine if the individual meets the Needs-based HCBS Eligibility Criteria for this HCBS benefit. The IAP conducts and/or collects a variety of assessments and determines the participant’s individual budget at the time of initial application and on an annual basis, for both the traditional and the family- directed services options. The IAP will evaluate the participant through face-to-face consultation with the Participant, and if applicable, the participant’s decision-making authority. Functional assessment evaluations are conducted using the Scales of Independent Behavior-Revised (SIB-R) and a Department-developed inventory of individual needs to determine if the participant meets the needs- based criteria. The inventory of individual needs includes a summary of medical, social and developmental status and helps to determine categorical eligibility. This summary process includes an evaluation of existing participant documentation of medical assessments, diagnostic assessment, and psychometric testing. If there is no current testing, diagnostic testing may be completed by the IAP if necessary. Eligibility determinations must be completed within thirty (30) days of the new referral. The IAP is responsible for completing the eligibility determination process within thirty (30) days of receiving an application. This eligibility determination process includes the following: a. The IAP requests medical records/assessments, diagnostic assessments, and/or psychometric testing, which are necessary to make an eligibility determination, from the individual/decision-making authority; b. The IAP contacts the individual/decision-making authority to identify who will serve as a respondent for the assessment. The individual/decision-making authority is responsible for identifying a respondent who has knowledge about the individual’s current level of functioning. The individual is required to be present with the respondent for a meeting with the IAP to complete the assessment. c. During the meeting with the IAP, the respondent will assist the IAP in completing the individual’s functional assessment (using an assessment instrument approved by the Department), and the individual’s medical, social, and developmental assessment summary. State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 7 Effective: 07/01/2021 Approved: Supersedes: d. The IAP communicates eligibility determinations (including set budget amounts) to the individual/decision-making authority through a written Notice of Decision. Individuals/decision- making authorities who do not agree with a decision regarding eligibility or the set budget amount may appeal and request a fair hearing. Reevaluations of eligibility must be completed annually and require either a full reassessment or a focused review. A full assessment is required at least every three (3) calendar years. An independent needs-based inventory must be conducted at least every twelve (12) months to assess a participant’s support needs and determine the participant’s eligibility for HCBS State plan services. Eligibility determination is made by using the needs-based eligibility criteria that has been established by the State. PROCESS FOR ANNUAL REEVALUATION The annual reevaluation process is the same as the initial evaluation process, except for the following differences: a. A new Application for Medicaid Services for Children with Developmental Disabilities does not have to be submitted by the individual on an annual basis. b. If a change in income results in the termination of Medicaid financial eligibility, the individual/decision-making authority may appeal the Department’s decision. To assure the health and safety of the individual, the Department will extend eligibility and the existing plan of service during the administrative appeals process. Claims submitted for reimbursement by providers will continue to be paid until all administrative appeal rights are exhausted. If termination is upheld on administrative appeal, claims will not be paid after the date of the final administrative appeal decision. Medicaid providers are required to verify participant eligibility prior to providing services as approved on the annual Plan of Service. c. The IAP is required to complete a new functional assessment every three years. For intervening years, the IAP is only required to complete a new functional assessment or update the medical, social, and developmental assessment summary when it is determined that the existing documentation does not accurately describe the current status of the individual. The IAP will make a clinical determination regarding the need for a new/updated assessment based on information provided by the respondent (someone the participant/decision making authority have identified as the person who is most qualified to provide current information regarding the participant’s medical, functional, and behavioral needs) during the annual eligibility re-determination meeting. d. Unless contra-indicated, the participant is required to attend the annual re-determination meeting. Any comments or questions voiced by the individual/decision making authority during this meeting will be addressed and considered by the IAP completing the annual eligibility assessment. e. Information from the assessments that are completed with the respondent is included with the Notice of Decision sent to the participant regarding their annual eligibility determination. 4.  Reevaluation Schedule. (By checking this box the state assures that): Needs-based eligibility reevaluations are conducted at least every twelve months. State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 8 Effective: 07/01/2021 Approved: Supersedes: 5.  Needs-based HCBS Eligibility Criteria. (By checking this box the state assures that): Needs-based criteria are used to evaluate and reevaluate whether an individual is eligible for State plan HCBS. The criteria take into account the individual’s support needs, and may include other risk factors: (Specify the needs-based criteria): An eligible participant must: The individual Require must require assistance due to substantial limitations in three (3) or more of the following major life activities – self-care, receptive and expressive language, learning, mobility, self-direction, capacity for independent living or economic self-sufficiency; and The individual must have Reflect the need for a combination and sequence of special, interdisciplinary or generic care, treatment or other services, which are of life-long or extended duration and individually planned and coordinated, due to a delay in developing age appropriate skills occurring before the age of twenty-two (22). 6.  Needs-based Institutional and Waiver Criteria. (By checking this box the state assures that): There are needs-based criteria for receipt of institutional services and participation in certain waivers that are more stringent than the criteria above for receipt of State plan HCBS. If the state has revised institutional level of care to reflect more stringent needs-based criteria, individuals receiving institutional services and participating in certain waivers on the date that more stringent criteria become effective are exempt from the new criteria until such time as they no longer require that level of care. (Complete chart below to summarize the needs-based criteria for State Plan HCBS and corresponding more-stringent criteria for each of the following institutions): State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 9 Effective: 07/01/2021 Approved: Supersedes: State plan HCBS needs- based eligibility criteria NF (& NF LOC** waivers) ICF/IID (& ICF/IID LOC waivers) Applicable Hospital* (& Hospital LOC waivers) The individual Requiremust require assistance due to substantial limitations in three or more of the following major life activities – self-care, receptive and expressive language, learning, mobility, self-direction, capacity for independent living or economic self- sufficiency; and The individual must have Reflect the need for a combination and sequence of special, interdisciplinary or generic care, treatment or other services, which are of life-long or extended duration and individually planned and coordinated, due to a delay in developing age appropriate skills occurring before the age of 22. (end) The participant requires nursing facility level of care when a child meets one (1) or more of the following criteria: 01. Supervision Required for Children. Where the inherent complexity of a service prescribed by the physician is such that it can be safely and effectively performed only by or under the supervision of a licensed nurse or licensed physical or occupational therapist. 02. Preventing Deterioration for Children. Skilled care is needed to prevent, to the extent possible, deterioration of the child's condition or to sustain current capacities, regardless of the restoration potential of a child, even where full recovery or medical improvement is not possible. 03. Specific Needs for Children. When the plan of care, risk factors, and aggregate of health care needs is such that the assessments, interventions, or supervision of the child necessitates the skills of a licensed nurse or a licensed physical therapist or licensed occupational therapist. In such cases, the specific needs or activities must be documented by the physician’s orders, progress notes, plan of care, and nursing and therapy notes. (con’t) 01. Diagnosis. Persons must be financially eligible for Medicaid; must have a primary diagnosis of being intellectually disabled or have a related condition defined in Section 66-402, Idaho Code and Section 500 through 506 of these rules; and persons must qualify based on functional assessment, maladaptive behavior, a combination of both, or medical condition; and 02. Must Require Certain Level of Care. Persons living in the community must require the level of care provided in an ICF/ID, including active treatment, and in the absence of available intensive alternative services in the community, would require institutionalization, other than services in an institution for mental disease, in the near future; and 03. Functional Limitations. a. Persons Sixteen Years of Age or Older. Persons (sixteen (16) years of age or older) may qualify based on their functional skills. Persons with an age equivalency composite score of eight (8) years and zero (0) months or less on a full scale functional assessment (Woodcock Johnson Scales of Independent Behavior, or SIB-R, or subsequent revisions)using a Department-approved (con’t) The state uses criteria defined in 42 CFR 440.10 for inpatient hospital services. (end) State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 10 Effective: 07/01/2021 Approved: Supersedes: 04. Nursing Facility Level of Care for Children. Using the above criteria, plus consideration of the developmental milestones, based on the age of the child, the Department’s will determine nursing facility level of care. (end) assessment tool would qualify; or b. Persons Under Sixteen Years of Age. Persons (under sixteen (16) years of age) qualify if their composite full scale functional age equivalency is less than fifty percent (50%) of their chronological age; or 04. Maladaptive Behavior. a. A Minus Twenty-Two (-22) or Below Score. Individuals may qualify for ICF/ID level of care based on maladaptive behavior. Persons will be eligible if their General Maladaptive Index on the Woodcock Johnson Scales of Independent Behavior (SIB-R) or subsequent revision a Department- approved assessment tool is minus twenty-two (-22) or less; or b. Above a Minus Twenty-Two (-22) Score. Individuals who score above minus twenty-two (-22) may qualify for ICF/ID level of care if they engage in aggressive or self-injurious behaviors of such intensity that the behavior seriously endangers the safety of the individual or others, the behavior is directly related to developmental disability, and the person requires active treatment to control or decrease the behavior; or 05. Combination Functional and Maladaptive Behaviors. Persons may qualify for ICF/ID level of care if they display a combination of criteria as described in Subsections 585.05 and 585.06 of (con’t) State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 11 Effective: 07/01/2021 Approved: Supersedes: these rules above at a level that is significant and it can been determined they are in need of the level of care services provided in an ICF/ID, including active treatment services. Significance would be defined as: (3-19-07) a. Persons Sixteen Years of Age or Older. For persons sixteen (16) years of age or older, an overall age equivalency up to eight and one-half (8 1/2) years is significant in the area of functionality when combined with a General Maladaptive Index on the Woodcock Johnson SIB-R up to a Department- approved assessment tool between minus seventeen (-17), minus twenty-two (- 22) inclusive; or b. Persons Under Sixteen Years of Age. For persons under sixteen (16) years of age, an overall age equivalency up to fifty- three percent (53%) of their chronological age is considered significant when combined with a General Maladaptive Index on the Woodcock Johnson SIB-R between a Department-approved assessment tool between minus seventeen (-17), and minus twenty-one (- 21) inclusive; or 06. Medical Condition. Individuals may meet ICF/ID level of care based on their medical condition if the medical condition significantly affects their functional level/capabilities and it can be determined that they are in need of the level of services provided in an ICF/ID, including active treatment services. (end) State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 12 Effective: 07/01/2021 Approved: Supersedes: *Long Term Care/Chronic Care Hospital **LOC= level of care 7.  Target Group(s). The state elects to target this 1915(i) State plan HCBS benefit to a specific population based on age, disability, diagnosis, and/or eligibility group. With this election, the state will operate this program for a period of 5 years. At least 90 days prior to the end of this 5 year period, the state may request CMS renewal of this benefit for additional 5-year terms in accordance with 1915(i)(7)(C) and 42 CFR 441.710(e)(2). (Specify target group(s)): Children, birth through age seventeen (17), who are determined to have a developmental disability in accordance with Sections 500 through 506 under IDAPA 16.03.10 “Medicaid Enhanced Plan Benefits” and Section 66-402, Idaho Code.  Option for Phase-in of Services and Eligibility. If the state elects to target this 1915(i) State plan HCBS benefit, it may limit the enrollment of individuals or the provision of services to enrolled individuals in accordance with 1915(i)(7)(B)(ii) and 42 CFR 441.745(a)(2)(ii) based upon criteria described in a phase-in plan, subject to CMS approval. At a minimum, the phase-in plan must describe: (1) the criteria used to limit enrollment or service delivery; (2) the rationale for phasing-in services and/or eligibility; and (3) timelines and benchmarks to ensure that the benefit is available statewide to all eligible individuals within the initial 5-year approval. (Specify the phase-in plan): (By checking the following box the State assures that): 8.  Adjustment Authority. The state will notify CMS and the public at least 60 days before exercising the option to modify needs-based eligibility criteria in accord with 1915(i)(1)(D)(ii). 9. Reasonable Indication of Need for Services. In order for an individual to be determined to need the 1915(i) State plan HCBS benefit, an individual must require: (a) the provision of at least one 1915(i) service, as documented in the person-centered service plan, and (b) the provision of 1915(i) services at least monthly or, if the need for services is less than monthly, the participant requires regular monthly monitoring which must be documented in the person-centered service plan. Specify the state’s policies concerning the reasonable indication of the need for 1915(i) State plan HCBS: i. Minimum number of services. The minimum number of 1915(i) State plan services (one or more) that an individual must require in order to be determined to need the 1915(i) State plan HCBS benefit is: 1 ii. Frequency of services. The state requires (select one):  The provision of 1915(i) services at least monthly  Monthly monitoring of the individual when services are furnished on a less than monthly basis If the state also requires a minimum frequency for the provision of 1915(i) services other than monthly (e.g., quarterly), specify the frequency: State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 13 Effective: 07/01/2021 Approved: Supersedes: Home and Community-Based Settings (By checking the following box the State assures that): 1.  Home and Community-Based Settings. The State plan HCBS benefit will be furnished to individuals who reside and receive HCBS in their home or in the community, not in an institution. (Explain how residential and non-residential settings in this SPA comply with Federal home and community-based settings requirements at 42 CFR 441.710(a)(1)-(2) and associated CMS guidance. Include a description of the settings where individuals will reside and where individuals will receive HCBS, and how these settings meet the Federal home and community-based settings requirements, at the time of submission and in the future): (Note: In the Quality Improvement Strategy (QIS) portion of this SPA, the state will be prompted to include how the state Medicaid agency will monitor to ensure that all settings meet federal home and community-based settings requirements, at the time of this submission and ongoing.) The state assures that this 1915(i) State plan HCBS Benefit renewal will be subject to any provisions or requirements included in the state's approved home and community-based settings Statewide Transition Plan. The state will implement any required changes by the end of the transition period as outlined in the home and community-based settings Statewide Transition Plan. Person-Centered Planning & Service Delivery (By checking the following boxes the state assures that): 1.  There is an independent assessment of individuals determined to be eligible for the State plan HCBS benefit. The assessment meets federal requirements at 42 CFR §441.720. 2.  Based on the independent assessment, there is a person-centered service plan for each individual determined to be eligible for the State plan HCBS benefit. The person-centered service plan is developed using a person-centered service planning process in accordance with 42 CFR §441.725(a), and the written person-centered service plan meets federal requirements at 42 CFR §441.725(b). 3.  The person-centered service plan is reviewed, and revised upon reassessment of functional need as required under 42 CFR §441.720, at least every 12 months, when the individual’s circumstances or needs change significantly, and at the request of the individual. 4. Responsibility for Face-to-Face Assessment of an Individual’s Support Needs and Capabilities. There are educational/professional qualifications (that are reasonably related to performing assessments) of the individuals who will be responsible for conducting the independent assessment, including specific training in assessment of individuals with need for HCBS. (Specify qualifications): At a minimum, individuals Individuals conducting the independent assessment must meet the requirements for a Qualified Intellectual Disability Professional (QIDP) in accordance with 42 CFR 483.430. State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 14 Effective: 07/01/2021 Approved: Supersedes: At a minimum, a QIDP requirements includemust: a. Having Have at least one (1) year experience working directly with persons with intellectual disabilities or other developmental disabilities or; b. Being one of the following: • licensed as a doctor of medicine or osteopathy, or as a nurse or;: • Having at least a bachelor’s degree in one of the following professional categories: psychology, social work, occupational therapy, speech pathology, professional recreational therapy, or other related human services professions.; and c. Have training and experience in completing and interpreting assessments. 5. Responsibility for Development of Person-Centered Service Plan. There are qualifications (that are reasonably related to developing service plans) for persons responsible for the development of the individualized, person-centered service plan. (Specify qualifications): State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 15 Effective: 07/01/2021 Approved: Supersedes: In accordance with regulations contained in Idaho Administrative Code – IDAPA 16.03.10, Home and Community-Based Services (HCBS) rules, a paid or non-paid person who, under the direction of the participant or their decision-making authority, is responsible for developing a single plan of service and subsequent addenda. The service plan must cover all services and supports identified during the family-centered planning process and must meet the HCBS person-centered plan requirements as described in the IDAPA rules previously identified. The responsibility for service plan development and qualifications differ slightly based on the participant's selection of either traditional services or family-directed services. Traditional Services: Paid plan development under the traditional services option must be provided by the Department or its contractor in accordance with the noted HCBS rules. Neither a provider of direct services to the participant nor the assessor may be chosen to develop the plan of service. Paid plan developers are called Case Managers. Case Management Qualifications: Case Manager - Minimum of a Bachelor's Degree in a human services field from a nationally accredited university or college and have 24 months supervised experience working with children with disabilities, and pass a Department criminal history background check. Clinical Case Management Supervisor - Minimum of a Master's Degree in a human services field from a nationally accredited university or college and have 12 months supervised experience working with children with disabilities, and pass a Department criminal history background check. Family-Directed Services: Non-paid plan development is allowed under the Family-Directed Services option and may be provided by the family, or a person of their choosing, in accordance with the stated HCBS rules, when this person is not a paid provider of services identified on the child’s plan of service. Alternatively, the family may choose to hire a Department approved Support Broker to assist with plan development and purchase specific duties as needed. Plan developers under the Family- Directed Services option are called Support Brokers. Specific qualifications for support brokers are outlined in Idaho Administrative Code - IDAPA 16.03.13. The qualification requirements include review of the individual’s education and experience. Support Brokers must demonstrate successful completion of the Department’s Support Broker training and of the required ongoing education. 6. Supporting the Participant in Development of Person-Centered Service Plan. Supports and information are made available to the participant (and/or the additional parties specified, as appropriate) to direct and be actively engaged in the person-centered service plan development process. (Specify: (a) the supports and information made available, and (b) the participant’s authority to determine who is included in the process): Participants who are eligible for and select State plan HCBS are given an orientation to the available developmental disability services by the Independent Assessment Provider (IAP) and their case manager or support broker. Participants and their decision-making authority that chose traditional services may develop their own plan or use a case manager from the Department. If the participant and the participant’s decision-making authority choose to develop their own plan or use State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 16 Effective: 07/01/2021 Approved: Supersedes: an unpaid natural support, the Department’s Case Manager is available to assist in completing all required components. The family-centered planning team must include people chosen by the participant the family and the participant’s decision-making authority, if applicable. Participants and their decision-making authority that choose the Family-Directed Services option receive an orientation on family-direction and program training from the Department. Families may select a qualified Support Broker to assist with writing of the Support and Spending Plan, or they may choose to become a qualified support broker approved by the Department. As outlined in IDAPA 16.03.13, "Consumer-Directed Services," the participant and the participant’s decision – making authority decide who will participate in the planning sessions in order to ensure the participant's choices are honored and promoted. The family may direct the family-centered planning meetings, or these meetings may be facilitated by a chosen Support Broker. In addition, the participant and the participant’s decision-making authority select a circle of support. Members of the circle of support attend the family-centered planning meetings and commit to work within the group to help promote and improve the life of the participant in accordance with the participant's choices and preferences. They also agree to meet on a regular basis to assist the participant and participant’s decision-making authority to accomplish their expressed goals. In developing the plan of service, the family-centered planning team must identify any services and supports available outside of Medicaid-funded services that can help the participant meet desired goals. Plan developers and Support Brokers are responsible for the documentation of the developed plan and any subsequent plan changes as determined by the family-centered planning team. Individuals responsible for facilitating the person-centered planning meeting and developing the plan of service cannot be providers of direct services to the participant. 7. Informed Choice of Providers. (Describe how participants are assisted in obtaining information about and selecting from among qualified providers of the 1915(i) services in the person-centered service plan): Once participants are determined eligible for services, they and their families are given an opportunity to participate in orientation training about developmental disability services in Idaho. During family orientation, participants and their families are provided with a list of all approved providers in the state of Idaho, which is organized by geographic area. The printed materials provided to families include the website link for the Idaho State children’s DD website at https://healthandwelfare.idaho.gov/services-programs/medicaid-health/about-childrens- developmental-disabilities www.redesignforchildren.medicaid.idaho.gov where electronic versions of documents are available. Both the orientation materials and the provider list include a statement that the family may choose any willing and available provider in the state. Families are also informed of how to navigate the website to access the list of providers as well as how to access other helpful resources available to them. Families are also provided with resources on interviewing potential providers and are encouraged to contact multiple providers to identify the provider that can best meet their needs. In addition, families are informed that who they select is their choice and they may change their choice of providers if they want. Families are encouraged to access the Department Case Manager if needed to assist families in selecting or changing service providers. at the participant’s or the participant’s decision making authority’s request. State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 17 Effective: 07/01/2021 Approved: Supersedes: 8. Process for Making Person-Centered Service Plan Subject to the Approval of the Medicaid Agency. (Describe the process by which the person-centered service plan is made subject to the approval of the Medicaid agency): In both the traditional and family-directed options, the plan is developed by the participant, the participant’s decision-making authority and the family-centered planning team as selected by the participant and family. The plan of service must identify all services and supports that were determined through a family-centered planning process. This plan development is required in order to provide DD services to children from birth through seventeen (17) years of age. A plan of service must identify, at a minimum, the type of service to be delivered, goals and desired outcomes to be addressed within the plan year, strengths and preferences of the participant, including the participant’s safety and the safety of those around the participant, target dates, and methods of collaboration. The independent assessment meets the federal requirements at 42 CFR §441.720 and is used to develop the individual plan of service. Additionally, the person-centered service plan is developed using a person-centered service planning process in accordance with 42 CFR §441.725(a), and the written person-centered service plan meets federal requirements at 42 CFR §441.725(b). The plan of service must be developed in accordance with the Home and Community-Based Services (HCBS) regulations as stated in IDAPA 16.03.10. The plan developer is responsible for the documentation of the developed plan and any subsequent plan changes as determined by the family-centered planning team. In the traditional services model, the plan developer submits the plan of service to the Department. The Department has 10 business days to review and authorize the plan. When the family-directed service model is chosen, the participant and the participant’s decision- making authority, and their circle of supports are in charge of how long the plan development process takes. The process may take from a few days to much longer, depending on the needs and wants of the participant, their family and decision-making authority and the participant’s family-centered planning team. Once the family-planning process has been completed, the support broker is responsible to submit the participant’s Support and Spending Plan directly to the Department for review and authorization. The Department has ten (10) business days to review and authorize the plan. The participant and parent/decision-making authority and their circle of supports are in charge of how long the plan development process takes. The process may take from a few days to much longer, depending on the needs and wants of the participant, their family, and the support team. The IAP conducts and/or collects a variety of assessments and determined the participant’s individual budget at the time of initial application and on an annual basis, for both the traditional and the family directed option. The IAP conducts the following assessments at the time of the initial application for children’s DD services: • Scales of Independent Behavior- Revised (SIB-R)Department-approved functional assessment; and • Medical, Social and Developmental Assessment Summary. At the time of annual re-determination, the IAP conducts and/or reviews the following: • Reviews and updates the Medical, Social, and Developmental Assessment Summary; and is reviewed and updated. • Reviews the SIB-RDepartment-approved functional assessment results are reviewed, and performs another assessment is performed if there are significant changes in the participant’s situation or the reassessment criteria are met. State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 18 Effective: 07/01/2021 Approved: Supersedes: All service plans must be finalized and agreed to, by the participant, or the participant’s decision- making authority, in writing, indicating informed consent. Plans must also be signed by all individuals and providers responsible for its implementation indicating they will deliver services according to the authorized plan of service and consistent with home and community-based requirements as described in IDAPA 16.03.10. Individual service plans are distributed to the participant and the participant’s decision-making authority, if applicable, and other people involved in the family-centered planning and implementation of the plan. Medicaid has operational processes that optimize participant independence, community integration and choices in daily living. These processes include the requirement for HCBS benefits to be requested through a participant’s plan. Once plans are developed through the family-centered planning process, the plans are submitted to Medicaid the Division of Family and Community Services, within the Idaho Department of Health and Welfare for prior authorization. The prior authorization process is used to ensure the provision of services that enhance health and safety, promote participant rights, self-determination and independence according to IDAPA 16.03.10.526525. The following assessments are gathered on an as-needed basis or may be used as historical information at the time of both initial and annual re-determinations: • Psychological evaluations, including evaluations regarding cognitive abilities, mental health issues and issues related to traumatic brain injury. • Neuropsychological evaluations. • Physical, occupational and speech-language pathology evaluations. • Developmental and specific skill assessments. The results of a physical examination by the participant’s primary care physician are provided to the Case Manager on an annual basis. Participants using traditional State plan HCBS, and their support team, must be assessed for health and safety issues. Participants using the Family-Directed Services option, and their support team, must complete safety plans related to any identified health and safety risks and submit them to the Department. In the traditional option, the participant and parent/decision-making authority needs, goals, preferences and health status are summarized on the plan of service. This document is a result of the family-centered planning meeting listing a review of all assessed needs and participant and parent/legal guardiandecision-making authority preferences. In addition, the Case Manager is responsible to collect data status reviews from all paid providers, synthesize all of the information and include it on the plan of service. The participant's parent/decision-making authority sign the plan of service to indicate it is correct, complete, and represents the participant and parent/decision- making authority’s needs and wants. Family-directed participant needs, goals, preferences, health status, and safety risks are summarized on the Support and Spending Plan and in the Family-Direction workbook. The circle of supports, using family-centered planning, develops these documents and submits them to the Department at the time of initial/annual plan review. Participants and their parent/decision-making authority, along with other members of the support State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 19 Effective: 07/01/2021 Approved: Supersedes: team can receive information regarding State plan HCBS through several methods: • The Department of Health and Welfare web site has a page specific for Children's DD Services that includes FAQ's, provider forms, rules, services, list of available providers, and other important resources. The website is found at www.redesignforchildren.medicaid.idaho.govhttps://healthandwelfare.idaho.gov/services- programs/medicaid-health/about-childrens-developmental-disabilities. • The Department of Health and Welfare’s web site also has a page specific for family-directed services found at www.familydirected.dhw.idaho.gov https://healthandwelfare.idaho.gov/services- programs/medicaid-health/family-directed-services. • The IAP provides each new applicant with an informational packet which includes a listing of providers in the local area that provide developmental disabilities services for children, as well as a list of the services available under the children's DD program. • The Case Manager is charged with verbally explaining the various programs and options to the participant and parent/decision-making authority during the family-centered planning process, under the traditional option. • The Support Broker is charged with assisting the participant and parent/decision-making authority to assess what services meet their needs, under the Family-Direction Services option. Idaho requires that a family-centered planning process be utilized in plan development to ensure that participant goals, needs and preferences are reflected on the plan of service or on the Support and Spending Plan. Case Managers are trained in family-centered planning, and possess the education and experience needed to assist families in making decisions about their child’s course of treatment and Medicaid services. The child’s goals, needs, and resources are identified through a comprehensive review process that includes review of assessments and history of services, and family-centered planning. Parents/decision-making authorities who choose to family-direct must attend training offered by the Department prior to submitting a Support and Spending Plan. Completion of this training is documented in the family-direction quality assurance database. The training covers participant and parent/decision-making authority responsibilities in family-direction and the process of developing a Support and Spending Plan. The family-directed option utilizes a workbook and a Support Broker to ensure that the participant’s individual goals, needs and preferences are thoroughly explored and prioritized during the plan development process. Children's State plan HCBS participants may receive a variety of services and other supports to address their needs and wants. The family-centered planning team works to ensure that the plan of service adequately reflects the necessary services. The plan of service is a single plan that includes the goals, objectives and assessment results from all of a child’s services and supports in the child’s system of care. The plan of service will demonstrate collaboration is taking place among providers and that objectives are directly related to the goals of the family. State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 20 Effective: 07/01/2021 Approved: Supersedes: Under the Traditional option, the responsibility is placed on the Case Manager, IAP, and Department to complete the plan development process. - The IAP is responsible to submit the assessment and individual budget to the Department. - The Department assigns either a contracted Case Manager or Department staff to deliver case management and is responsible to: • Ensure that services are not duplicative, and are complementary and appropriate; • Work with the members of the family-centered planning team and providers to ensure that the service needs of the participant are reflected on the plan of service; • Act as the primary contact for the family and providers; • Link the family to training and education to promote the family's ability to competently choose from existing benefits; • Complete a comprehensive review of the child’s needs, interests, and goals; • Assist the family to allocate funding from their child’s individual budget; • Monitor the progress of the plan of service; • Ensure that changes to the plan of service are completed when needed; and • Facilitate communication between the providers in a child’s system of care. 9. Maintenance of Person-Centered Service Plan Forms. Written copies or electronic facsimiles of service plans are maintained for a minimum period of 3 years as required by 45 CFR §74.53. Service plans are maintained by the following (check each that applies):  Medicaid agency  Operating agency  Case manager  Other (specify): Services 1. State plan HCBS. (Complete the following table for each service. Copy table as needed): Service Specifications (Specify a service title for the HCBS listed in Attachment 4.19-B that the state plans to cover): Service Title: Respite Service Definition (Scope): Respite provides supervision to a participant on an intermittent or short-term basis because of the need for relief of the primary unpaid caregiver or in response to a family emergency or crisis. Respite may be delivered as an individual or group service. When respite is provided in a group, the following applies: 1. When group respite is center-based, there must be a minimum of one (1) qualified staff providing direct services for two (2) to six (6) participants. As the number and severity of the participants with functional impairments or behavioral issues increases, the participant ratio must be adjusted accordingly. State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 21 Effective: 07/01/2021 Approved: Supersedes: 2. When group respite is community-based, there must be a minimum of one (1) qualified staff providing direct services for two (2) to three (3) participants. As the number and severity of participants with functional impairments or behavioral issues increases, the participant ratio must be adjusted from three (3) to two (2). 3. When group respite is provided by an independent provider, the independent respite provider must be a relative. May provide direct services for two (2) to three (3) siblings and must be delivered in the home of the participants or the independent respite provider. Respite may be provided by a qualified agency provider (Developmental Disability Agency – DDA) or by an independent respite provider. An independent provider may be a relative of the child. Respite may be provided in the participant’s home, the private home of an independent respite provider, in a DDA, or in community settings. Limitations: • The amount of respite services available are based on an individual’s approved plan of service that is subject to the maximum funding allowed for 1915(i) services. • Not to be provided during the same time other Medicaid services are being provided to a participant with the exception of when an unpaid caregiver is receiving family education; • Not to be used to pay for room and board; • Not to be provided on a continuous, long-term basis as a daily service to enable an unpaid caregiver to work; • Not to be provided by an independent respite provider as center-based respite; or • Not to exceed fourteen (14) days • The respite provider must not use restraints on participants, other than physical restraints in the case of an emergency to prevent injury to the participant or others and must be documents in the participant’s record. Additional needs-based criteria for receiving the service, if applicable (specify): N/A Specify limits (if any) on the amount, duration, or scope of this service. Per 42 CFR Section 440.240, services available to any categorically needy recipient cannot be less in amount, duration and scope than those services available to a medically needy recipient, and services must be equal for any individual within a group. States must also separately address standard state plan service questions related to sufficiency of services. (Choose each that applies):  Categorically needy (specify limits): Subject to individual budget maximums.  Medically needy (specify limits): Provider Qualifications (For each type of provider. Copy rows as needed): Provider Type (Specify): License (Specify): Certification (Specify): Other Standard (Specify): Developmental Disability Agency (DDA) Developmental Disabilities Agency (DDA) certificate as Individuals must meet the minimum general training requirements defined in IDAPA rule "Developmental Disabilities Agencies", and in addition must meet the State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 22 Effective: 07/01/2021 Approved: Supersedes: described in Idaho Administrative Code. following qualifications to provide respite through a DDA: • Must have received instructions in the needs of the participant who will be provided the service; • Must demonstrate the ability to provide services according to a plan of service; • Must pass a criminal history and background check; • Must be certified in CPR and first aid and must maintain current certification thereafter. • Must be at least sixteen (16) years of age and employed by a DDA if serving ages three (3) to eighteen (18); or • Must be at least eighteen (18) years of age and be a high school graduate or have a GED if serving ages birth to three (3). Independent Respite Care Provider Individuals must meet the following qualifications to provide independent respite: • Be at least eighteen (18) years of age and be a high school graduate, or have a GED; • Be enrolled as an Idaho Medicaid Provider; • Have received instructions in the needs of the participant who will be provided the service; • Demonstrate the ability to provide services according to a plan of service; • Pass a criminal background check; and Be certified in CPR and first aid and must maintain current certification thereafter. Verification of Provider Qualifications (For each provider type listed above. Copy rows as needed): Provider Type (Specify): Entity Responsible for Verification (Specify): Frequency of Verification (Specify): Developmental Disability Agency (DDA) Department of Health and Welfare - At initial provider agreement approval or renewal State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 23 Effective: 07/01/2021 Approved: Supersedes: - At least every three years, and as needed based on service monitoring concerns Independent Respite Care Provider Department of Health and Welfare - At initial provider agreement approval or renewal - At least every two years, and as needed based on service monitoring concerns Service Delivery Method. (Check each that applies):  Participant-directed  Provider managed Service Specifications (Specify a service title for the HCBS listed in Attachment 4.19-B that the state plans to cover): Service Title: Community-Based Supports Service Definition (Scope): Community-Based Supports provide assistance to participants with disabilities by facilitating the participant’s independence and integration into the community. This service provides an opportunity for participants to explore their interests, practice skills learned in other therapeutic environments, and learn through interactions in typical community activities. Integration into the community enables participants to expand their skills related to activities of daily living and reinforces skills to achieve or maintain mobility, sensory-motor, communication, socialization, personal care, relationship building, and participation in leisure and community activities. Services include individual or group supports. Group services must be provided by one (1) qualified staff providing direct services for two (2) or three (3) participants. As the number and needs of the participants increase, the participant ratio in the group must be adjusted from three (3) to two (2) Limitations: • Community-Based Supports are not intended to supplant services provided in school or therapy, or to supplant the role of the primary caregiver. • Participant must be involved in age-appropriate activities in environments typical peers access according to the ability of the participant Additional needs-based criteria for receiving the service, if applicable (specify): N/A Specify limits (if any) on the amount, duration, or scope of this service. Per 42 CFR Section 440.240, services available to any categorically needy recipient cannot be less in amount, duration and scope than those services available to a medically needy recipient, and services must be equal for any individual within a group. States must also separately address standard state plan service questions related to sufficiency of services. (Choose each that applies):  Categorically needy (specify limits): Subject to individual budget maximums.  Medically needy (specify limits): State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 24 Effective: 07/01/2021 Approved: Supersedes: Provider Qualifications (For each type of provider. Copy rows as needed): Provider Type (Specify): License (Specify): Certification (Specify): Other Standard (Specify): Developmental Disability Agency (DDA) Developmental Disabilities Agency (DDA) certificate as described in Idaho Administrative Code. Individuals must meet the minimum general training requirements defined in IDAPA rule "Developmental Disabilities Agencies", and in addition must meet the following qualifications to provide Community-Based Supports when provided by a DDA: • Must be at least 18 years of age; • Demonstrate the ability to provide services according to a plan of service; • Have received instructions in the needs of the participant who will be provided the service; • Pass a criminal background check; • Complete a competency course approved by the Department related to the support staff job requirements; and • Have 1,040 hours supervised experience working with children with developmental disabilities. Experience can be achieved by having previous work experience gained through paid employment, university practicum experience, or internship; or have on- the-job supervised experience gained through employment at a DDA with increased supervision. Community-Based Support staff serving infants and toddlers from birth to three (3) years of age must have 1,040 hours of documented experience with infants, toddlers or children birth through five (5) years of age with developmental delays or disabilities. Independent Community- Based Supports Provider Individuals must meet the following qualifications to provide independent Community-Based Supports: • Be enrolled as an Idaho Medicaid Provider; • Have received instructions in the needs of the participant who will be provided State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 25 Effective: 07/01/2021 Approved: Supersedes: the service; • Demonstrate the ability to provide services according to a plan of service; • Have six (6) months supervised experience working with children with developmental disabilities. This can be achieved in the following ways: o Have previous work experience gained through paid employment, university practicum experience, or internship; or o Have on-the-job supervised experience gained through employment with increased supervision. Experience is gained by completing at least six (6) hours of job shadowing prior to the delivery of direct support services, and a minimum of weekly face-to- face supervision with the supervisor for a period of six (6) months while delivering services; o For individuals providing community-based supports to children birth to age three (3), the six (6) months of documented experience must be with infants, toddlers, or children birth to age three (3) years of age with developmental delays or disabilities. • Complete competency coursework approved by the Department to demonstrate competencies related to the requirements to provide community-based supports; • Pass a criminal background check; and • Be certified in CPR and first aid and must maintain current certification thereafter. Verification of Provider Qualifications (For each provider type listed above. Copy rows as needed): Provider Type (Specify): Entity Responsible for Verification (Specify): Frequency of Verification (Specify): DDA Department of Health and Welfare - At initial provider agreement approval or State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 26 Effective: 07/01/2021 Approved: Supersedes: renewal - At least every three years, and as needed based on service monitoring concerns Independent Community- Based Supports Provider Department of Health and Welfare - At initial provider agreement approval or renewal - At least every two years, and as needed based on service monitoring concerns Service Delivery Method. (Check each that applies):  Participant-directed  Provider managed Service Specifications (Specify a service title for the HCBS listed in Attachment 4.19-B that the state plans to cover): Service Title: Family Education Service Definition (Scope): Family education is professional assistance to family members, or others who participate in caring for the eligible participant, to help them better meet the needs of the participant by providing an orientation to developmental disabilities and to educate families on generalized strategies for behavioral modification and intervention techniques specific to the participant’s diagnosis. It offers education that is specific to the family and participant as identified on the plan of service. This service is not intended to instruct paid staff on the competencies relative to their field they are required to have or to provide training required to meet provider qualifications, but rather to support staff in meeting the individualized and specific needs of the waiver participant. Family education providers must maintain documentation of the training in the participant’s record including the provision of activities outlined in the plan of service. Family Education may be provided in a group setting not to exceed five (5) participants’ families. Additional needs-based criteria for receiving the service, if applicable (specify): N/A Specify limits (if any) on the amount, duration, or scope of this service. Per 42 CFR Section 440.240, services available to any categorically needy recipient cannot be less in amount, duration and scope than those services available to a medically needy recipient, and services must be equal for any individual within a group. States must also separately address standard state plan service questions related to sufficiency of services. (Choose each that applies):  Categorically needy (specify limits): Subject to individual budget maximums.  Medically needy (specify limits): Provider Qualifications (For each type of provider. Copy rows as needed): Provider Type (Specify): License (Specify): Certification (Specify): Other Standard (Specify): State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 27 Effective: 07/01/2021 Approved: Supersedes: Developmental Disability Agency Developmental Disabilities Agency (DDA) certificate as described in Idaho Administrative Code. Family education can be provided by an employee of an agency certified as a DDA or an individual who meets the independent provider requirements. Individuals must meet the minimum general training requirements defined in IDAPA rule "Developmental Disabilities Agencies", and in addition must meet the following minimum qualifications to provide family education when provided by a DDA: • Must hold at least a bachelor’s degree in a human services field from a nationally accredited university or college; • Must meet competency as approved by the Department to demonstrate competencies related to the requirements to provide family education; • Must pass a criminal history and background check; • Must complete at least twelve (12) hours of yearly training; and • Must have 1,040 experience providing care to children with developmental disabilities if serving ages three (3) to eighteen (18); or • Must have 1,040 hours of professionally-supervised experience providing assessment/evaluation, curriculum development, and service provision in the areas of communication, cognition, motor, adaptive (self-help), and social- emotional development with infants and toddlers birth to five (5) with developmental delays or disabilities if serving ages birth to three (3). Independent Family Education Provider Individuals must meet the following qualifications to provide independent Family Education: • Holds an independent habilitation intervention provider agreement with the Department; and • Meet the intervention specialist or professional qualifications as outlined State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 28 Effective: 07/01/2021 Approved: Supersedes: in IDAPA 16.03.09, “Medicaid Basic Plan Benefits.” Verification of Provider Qualifications (For each provider type listed above. Copy rows as needed): Provider Type (Specify): Entity Responsible for Verification (Specify): Frequency of Verification (Specify): Developmental Disability Agency Department of Health and Welfare - At initial provider agreement approval or renewal - At least every three years, and as needed based on service monitoring concerns Independent Family Education Provider Department of Health and Welfare - At initial provider agreement approval or renewal - At least every two years, and as needed based on service monitoring concerns Service Delivery Method. (Check each that applies):  Participant-directed  Provider managed Service Specifications (Specify a service title for the HCBS listed in Attachment 4.19-B that the state plans to cover): Service Title: Family Directed Community Support Services Service Definition (Scope): Family-Directed Community Support Services provide goods and supports that are medically necessary and/or minimize the participant’s need for institutionalization and address the participant’s preferences for: • Personal support to help the participant maintain health, safety, and basic quality of life. • Relationship support to help the participant establish and maintain positive relationships with immediate family members, friends, or others in order to build a natural support network and community. • Emotional support to help the participant learn and practice behaviors consistent with their goals and wishes while minimizing interfering behaviors. • Learning support to help a child to learn new adaptive skills or improve and expand their existing skills that relate to his identified goals • Non-Medical Transportation support to help the participant accomplish their identified goals. o Adaptive and therapeutic equipment address an identified medical or accessibility need in the service plan (improving and maintaining the participant’s opportunities for full membership in the community) and meet the following requirements: • A safe and effective treatment that meets acceptable standards of medical practice • Items needed to optimize the health, safety and welfare of the participant • The least costly alternative that reasonably meets the participant’s need • For the sole benefit of the participant • The participant does not have the funds to purchase the item or the item is not available through another source. o Adaptive and therapeutic equipment must also meet at least one of the following: State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 29 Effective: 07/01/2021 Approved: Supersedes: • maintain the ability of the participant to remain in the community, • enhance community inclusion and family involvement, • decrease dependency on formal support services and thus increase independence of the participant OR provide unpaid family members and friends training in the use of the equipment to provide support to the participant. Adaptive and therapeutic equipment are not otherwise covered under Durable Medical Equipment (DME). Services and equipment that are available through the Medicaid State plan as 1905(a) services for children per Early Periodic Screening, Diagnosis, and Treatment (EPSDT) requirements are not allowed as payable under family-directed community support services. Experimental or prohibited treatments are excluded. Additional needs-based criteria for receiving the service, if applicable (specify): N/A Specify limits (if any) on the amount, duration, or scope of this service. Per 42 CFR Section 440.240, services available to any categorically needy recipient cannot be less in amount, duration and scope than those services available to a medically needy recipient, and services must be equal for any individual within a group. States must also separately address standard state plan service questions related to sufficiency of services. (Choose each that applies):  Categorically needy (specify limits): Subject to individual budget maximums.  Medically needy (specify limits): Provider Qualifications (For each type of provider. Copy rows as needed): Provider Type (Specify): License (Specify): Certification (Specify): Other Standard (Specify): Community Support Agency If required to identify goods or supports. For example, a Community Support providing speech-language pathology must have a current speech-language pathology licensure. If required to identify goods or supports. Must have completed employment/vendor agreement specifying goods or supports to be provided, qualifications to provi8de identified supports, and statement of qualification to provide identified supports. Community Support Provider If required for identified goods or supports. For example, a Community Support If required for identified goods and supports. Must have completed employment/vendor agreement specifying goods or supports to be provided, qualifications to provide identified supports, and statement of qualification to provide identified State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 30 Effective: 07/01/2021 Approved: Supersedes: providing speech-language pathology must have current speech-language pathology license. supports. Verification of Provider Qualifications (For each provider type listed above. Copy rows as needed): Provider Type (Specify): Entity Responsible for Verification (Specify): Frequency of Verification (Specify): Community Support Agency Participant and parent/decision- making authority Paid Support Broker (if applicable) Department of Health and Welfare (during retrospective quality assurance reviews) Initially and annually, with review of employment/vendor agreement Community Support Provider Participant and parent/ decision- making authority Paid Support Broker (if applicable) Department of Health and Welfare (during retrospective quality assurance reviews) Initially and annually, with review of employment/vendor agreement Service Delivery Method. (Check each that applies):  Participant-directed  Provider managed Service Specifications (Specify a service title for the HCBS listed in Attachment 4.19-B that the state plans to cover): Service Title: Financial Management Services Service Definition (Scope): The Department will offer financial management services through any qualified fiscal employer agent (FEA) provider through a provider agreement. FEA providers will complete financial consultation and services for a participant who has chosen to family-direct their services in order to assure that the financial information and budgeting information is accurate and available to them as is necessary in order for successful family-direction to occur. Once the participant or the participant’s decision making-authority have entered into a written agreement, the FEA performs the following: • Payroll and Accounting. Provides payroll and accounting supports to the participant that has chosen the family-directed community supports option; • Financial Reporting. Perform financial reporting for employees of the participant; • Financial Information Packet. Prepare and distribute a packet of information, including department approved forms for agreements, in order for the participant and family to hire their own staff; • Time Sheets and Invoices. Process and pay timesheets for community support workers and State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 31 Effective: 07/01/2021 Approved: Supersedes: support brokers, as authorized by the participant and parent/decision-making authority according to the participant’s Department authorized support and spending plan; • Taxes. Manages and processes payment of required state and federal employment taxes for the participant’s community support worker and support broker. • Payments for goods and services. Processes and pay invoices for goods and services, as authorized by the participant and parent/decision-making authority according to the participant’s support and spending plan; • Spending information. Provides participant and parent/decision-making authority with reporting information and data that will assist the participant and parent/decision-making authority with managing the individual budget; • Quality assurance and improvement. Participant in department quality assurance activities. FEA qualifications and requirements and responsibilities as well as allowable activities are described in Idaho Administrative Rules. Additional needs-based criteria for receiving the service, if applicable (specify): N/A Specify limits (if any) on the amount, duration, or scope of this service. Per 42 CFR Section 440.240, services available to any categorically needy recipient cannot be less in amount, duration and scope than those services available to a medically needy recipient, and services must be equal for any individual within a group. States must also separately address standard state plan service questions related to sufficiency of services. (Choose each that applies):  Categorically needy (specify limits): Only participants who select the family-directed option may access these services. The FEA must not either provider any other direct services (including support brokerage) to the participant to ensure there is no conflict of interest; or employ the parent/decision-making authority of the participant or have direct control over the participant’s choice. The FEA providers may only provide financial consultation, financial information and financial data to the participant and their parent/decision-making authority, and may not provide counseling or information to the participant and parent/decision-making authority about other goods and services.  Medically needy (specify limits): Provider Qualifications (For each type of provider. Copy rows as needed): Provider Type (Specify): License (Specify): Certification (Specify): Other Standard (Specify): Fiscal Employer/Agent Agencies that provide financial management services as a FEA must be qualified to provide such services as indicated in section 3504 of the Internal Revenue Code and in accordance with the requirements outlined in the signed provider agreement with the Department. State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 32 Effective: 07/01/2021 Approved: Supersedes: Verification of Provider Qualifications (For each provider type listed above. Copy rows as needed): Provider Type (Specify): Entity Responsible for Verification (Specify): Frequency of Verification (Specify): Fiscal Employer/Agent Department of Health and Welfare At the time of application, as indicated by a readiness review to be conducted by the Department for all FEA providers and thereafter at least every three years by Department review. Fiscal Employer/Agent Department of Health and Welfare At the time of application, as indicated by a readiness review to be conducted by the Department for all FEA providers and thereafter at least every three years by Department review. Service Delivery Method. (Check each that applies):  Participant-directed  Provider managed Service Specifications (Specify a service title for the HCBS listed in Attachment 4.19-B that the state plans to cover): Service Title: Support Broker Service Definition (Scope): Support Brokers provide counseling and assistance for participants and their parent/ or decision- making authority with arranging, directing, and managing services. They serve as the agent or representative of the participant to assist in identifying immediate and long-term needs, developing options to meet those needs, and accessing identified supports and services. This includes providing participants and their parent/decision-making authority with any assistance they need for gathering and reviewing their budget and financial data and reports prepared and issued to them by the FEA. Practical skills training is offered to enable families to remain independent. Examples of skills training include helping families understand the responsibilities involved with directing services, providing information on recruiting and hiring community support workers, managing workers and providing information on effective communication and problem-solving. The extent of Support Broker services furnished to the participant and parent or decision-making authority must be specified on the support and spending plan. Support Broker qualifications, requirements and responsibilities as well as allowable activities are described in IDAPA 16.03.13.135-136. Support Broker services may include only a few required tasks or may be provided as a comprehensive service package depending on the participant and parent or decision-making authority’s needs and preferences. At a minimum, the Support Broker must: • Participate in the family-centered planning process. • Develop a written Support and Spending plan with the participant and family that includes the State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 33 Effective: 07/01/2021 Approved: Supersedes: supports the participant needs and wants, related risks identified with the participant’s wants and preferences, and a comprehensive risk plan for each potential risk that includes at least three backup plans should a support fall out. • Assist the participant and family to monitor and review their budget through data and financial information provided by the FEA. • Submit documentation regarding the participant and parent/decision-making authority’s satisfaction with identified supports as requested by the Department. • Participate with Department quality assurance measures, as requested. • Assist the participant and parent/decision-making authority with scheduling required assessments to complete the Department’s annual re-determination process as needed, including assisting the participant and parent/decision-making authority to update the support and spending plan and submit it to the Department for authorization. In addition to the required minimum Support Broker duties, the Support Broker must be able to provide the following services when reque4sted by the participant and parent/decision-making authority: o Assist the participant and parent/decision-making authority to develop and maintain a circle of support. o Help the participant and family learn and implement the skills needed to recruit, hire, and monitor community supports. o Assist the participant and parent/decision-making authority to negotiate rates for paid Community Support Workers. o Maintain documentation of supports provided by each Community Support Worker and participant and parent/decision-making authority’s satisfaction with these supports. o Assist the participant and parent/decision-making authority to monitor community supports. o Assist the participant and parent/decision-making authority to resolve employment-related problems. o Assist the participant and parent/decision-making authority to identify and develop community resources to meet specific needs. Additional needs-based criteria for receiving the service, if applicable (specify): N/A Specify limits (if any) on the amount, duration, or scope of this service. Per 42 CFR Section 440.240, services available to any categorically needy recipient cannot be less in amount, duration and scope than those services available to a medically needy recipient, and services must be equal for any individual within a group. States must also separately address standard state plan service questions related to sufficiency of services. (Choose each that applies):  Categorically needy (specify limits): Only participants who select the Family-Directed Option may access this service. Support Brokers may not act as a Fiscal Employer Agent, instead Support Brokers work together with the participant and parent/decision-making authority to review participant financial information that is produced and maintained by the Fiscal Employer Agent.  Medically needy (specify limits): State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 34 Effective: 07/01/2021 Approved: Supersedes: Provider Qualifications (For each type of provider. Copy rows as needed): Provider Type (Specify): License (Specify): Certification (Specify): Other Standard (Specify): Support Broker Specific requirements outlined in Idaho Administrative Code – IDAPA 16.03.13 include review of education, experience, successful completion of Support Broker training and ongoing education. The parent/decision-making authority can be an unpaid support broker for the participant and are subject to the same qualification requirements as paid support brokers. Verification of Provider Qualifications (For each provider type listed above. Copy rows as needed): Provider Type (Specify): Entity Responsible for Verification (Specify): Frequency of Verification (Specify): Support Broker Department of Health and Welfare At the time of application, annual review of ongoing education requirement, and by participant and parent/decision-making authority when entering into employment agreement. Service Delivery Method. (Check each that applies):  Participant-directed  Provider managed 2.  Policies Concerning Payment for State plan HCBS Furnished by Relatives, Legally Responsible Individuals, and Legal Guardians. (By checking this box the state assures that): There are policies pertaining to payment the state makes to qualified persons furnishing State plan HCBS, who are relatives of the individual. There are additional policies and controls if the state makes payment to qualified legally responsible individuals or legal guardians who provide State Plan HCBS. (Specify (a) who may be paid to provide State plan HCBS; (b) the specific State plan HCBS that can be provided; (c) how the state ensures that the provision of services by such persons is in the best interest of the individual; (d) the state’s strategies for ongoing monitoring of services provided by such persons; (e) the controls to ensure that payments are made only for services rendered; and (f) if legally responsible individuals may provide personal care or similar services, the policies to determine and ensure that the services are extraordinary (over and above that which would ordinarily be provided by a legally responsible individual): Respite is the only State plan HCBS that may be reimbursed when provided by relatives of a participant. A parent/decision-making authority cannot furnish State plan HCBS, but other relatives may be paid to provide respite services whenever the relative is qualified to provide respite as defined in this application. There are numerous safeguards in place to ensure that payments are only made for services rendered including oversight by provider agencies, family-centered planning teams, circles of supports, fiscal/employer agent, and by the Department through review and approval of plan of services and retrospective quality assurance reviews. State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 35 Effective: 07/01/2021 Approved: Supersedes: All providers are precluded from being in a position to both influence a participant and parent/decision-making authority’s decision making and benefit financially from these decisions. Payments for family-directed services rendered are made only after review and approval by the participant and parent/decision-making authority and review by the Fiscal Employer Agent. Additionally, the participant’s Support Broker and Circle of Supports are available to address any conflicts of interest. Participant-Direction of Services Definition: Participant-direction means self-direction of services per §1915(i)(1)(G)(iii). Election of Participant-Direction. (Select one):  The state does not offer opportunity for participant-direction of State plan HCBS.  Every participant in State plan HCBS (or the participant’s representative) is afforded the opportunity to elect to direct services. Alternate service delivery methods are available for participants who decide not to direct their services.  Participants in State plan HCBS (or the participant’s representative) are afforded the opportunity to direct some or all of their services, subject to criteria specified by the state. (Specify criteria): 1. Description of Participant-Direction. (Provide an overview of the opportunities for participant-direction under the State plan HCBS, including: (a) the nature of the opportunities afforded; (b) how participants may take advantage of these opportunities; (c) the entities that support individuals who direct their services and the supports that they provide; and, (d) other relevant information about the approach to participant- direction): Idaho’s family-direction option provides a more flexible system, enabling participants and their parent/decision-making authority to exercise more choice and control over the services they receive which helps them live more productive and participatory lives within their home communities. This option is provided within the existing system so that it is sustainable and reflects the value of this option for all participants and their parents/decision-making authorities who choose to direct their own services and supports. The process supports participant and parent/decision-making authority preferences and honors their desire to family-direct their own services; how and when supports and services are provided; and who will assist them in developing and monitoring a realistic support and spending plan that accurately reflects their individual wants and needs. Once participants are determined eligible for State plan HCBS, an individualized budget is developed for each participant. The budget model provides participants with an individual budget and a maximum level of funding that varies according to individual needs, and allows for spending flexibility within the set budgeted dollars. The support need is determined from an evaluation completed using a uniform assessment tool. Upon completion of the assessment, the individualized budget is reviewed with the participant and parent/decision-making authority by the Department or its contractor. Participant s then have the option to choose Family-Directed Services (FDS). The FDS option allows eligible participants and their parent/decision-making authority to choose the type and frequency of State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 36 Effective: 07/01/2021 Approved: Supersedes: supports they want, to negotiate the rate of payment, and to hire the person or agency they prefer to provide those supports. Participants and the parent/decision-making authority must use a support broker to assist them with the family-directed process. This can be accomplished on one of two ways: • The family may choose to hire an approved Support Broker to perform specific duties as needed, • or the parent/decision-making authority may choose to act as an unpaid Support Broker with the ability to perform the full range of support broker duties. If a parent/decision-making authority wishes to act as an unpaid Support Broker for the participant, they must complete the Support Broker training and be approved by the Department. Paid Support Broker services are included as part of the community support services that participants and their parent/decision-making authority may purchase out of their allotted budget dollars Support Broker duties include planning, accessing, negotiating, and monitoring the family’s chosen services to their satisfaction. They can assist families to make informed choices, participate in a family-centered planning process, and become skilled at managing their own supports. The Support Broker possesses skills and knowledge that go beyond typical service coordination. The Support Broker assists participants and parents/decision-making authorities to convene a circle of supports team and engages in a family-centered planning process. The circle of supports team assists participants and parents/decision-making authorities in planning for and accessing needed services and supports based on their wants and needs within their established budget. The FDS option gives participants and their parent/decision-making authority the freedom to make choices and plan their own lives, authority to control the resources allocated to them to acquire needed supports, the opportunity to choose their own supports and the responsibility to make choices and take responsibility for those choices. Families and Support Brokers are responsible for the following: • Accepting and honoring the guiding principles of family-direction to the best of their ability. • Directing the family-centered planning process in order to identify and document support and service needs, wants, and preferences. • Negotiating payment rates for all paid community supports they want to purchase. • Developing and implementing employment/service agreements. Families, with the help of their Support Broker, must develop a comprehensive Support and Spending Plan based on the information gathered during the family-centered planning. The Support and Spending Plan is reviewed and authorized by the Department and includes participant’s preferences and interests by identifying all the supports and services, both paid and non-paid, and the participant’s wants and needs to live successfully in their community. Participants and their parent/decision-making authority choose support services, categorized as “family-directed community supports,” that will provide greater flexibility to meet the participant’s needs in the following areas: My Personal Needs – focuses on identifying supports and services needed to assure the person’s health, safety, and basic quality of life. My Relationship Needs – identifies strategies in assisting an individual to establish and maintain relationships with immediate family members, friends, spouse, or other persons and build their natural support network. My Emotional Needs – addresses strategies in assisting an individual to learn and increasingly practice behaviors consistent with the person’s identified goals and wishes while minimizing interfering behaviors. My Learning Needs – identifies activities that support an individual in acquiring new skills or improving established skills that relate to a goal that the person has identified. State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 37 Effective: 07/01/2021 Approved: Supersedes: Participants and their parent/decision-making authority choosing the Family-Directed Services option in Idaho are required to choose a qualified financial management services provider to provide Financial Management Services (FMS). The FMS provider is utilized to process and make payments to community support workers for the community support services contained in their support and spending plan. FMS providers have primary responsibility for the monitoring the dollars spending in accordance with the itemized spending plan and for ensuring payment itemization and accuracy. Financial management services providers also manage payroll expenses including required tax withholding, unemployment/workers compensation insurance; ensuring completion of criminal history checks and providing monthly reports to the participant, parent/decision-making authority and support broker if applicable. Financial Management services providers offer services on behalf of the participant in accordance with Section 3504 of the IRS code and the IRS Revenue Procedure 70-6, which outlines requirements of financial management service providers who are Fiscal Employer Agents. 2. Limited Implementation of Participant-Direction. (Participant direction is a mode of service delivery, not a Medicaid service, and so is not subject to statewideness requirements. Select one):  Participant direction is available in all geographic areas in which State plan HCBS are available.  Participant-direction is available only to individuals who reside in the following geographic areas or political subdivisions of the state. Individuals who reside in these areas may elect self- directed service delivery options offered by the state, or may choose instead to receive comparable services through the benefit’s standard service delivery methods that are in effect in all geographic areas in which State plan HCBS are available. (Specify the areas of the state affected by this option): 3. Participant-Directed Services. (Indicate the State plan HCBS that may be participant-directed and the authority offered for each. Add lines as required): Participant-Directed Service Employer Authority Budget Authority Community-Based Support Services   Support Broker Services   Financial Management Services   4. Financial Management. (Select one) :   Financial Management is not furnished. Standard Medicaid payment mechanisms are used.  Financial Management is furnished as a Medicaid administrative activity necessary for administration of the Medicaid State plan. 5.  Participant–Directed Person-Centered Service Plan. (By checking this box the state assures that): Based on the independent assessment required under 42 CFR §441.720, the individualized person-centered service plan is developed jointly with the individual, meets federal requirements at 42 CFR §441.725, and: Specifies the State plan HCBS that the individual will be responsible for directing; Identifies the methods by which the individual will plan, direct or control services, including whether the individual will exercise authority over the employment of service providers and/or authority over expenditures from the State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 38 Effective: 07/01/2021 Approved: Supersedes: individualized budget; Includes appropriate risk management techniques that explicitly recognize the roles and sharing of responsibilities in obtaining services in a self-directed manner and assures the appropriateness of this plan based upon the resources and support needs of the individual; Describes the process for facilitating voluntary and involuntary transition from self-direction including any circumstances under which transition out of self-direction is involuntary. There must be state procedures to ensure the continuity of services during the transition from self-direction to other service delivery methods; and Specifies the financial management supports to be provided. State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 39 Effective: 07/01/2021 Approved: Supersedes: 6. Voluntary and Involuntary Termination of Participant-Direction. (Describe how the state facilitates an individual’s transition from participant-direction, and specify any circumstances when transition is involuntary): The Department assists participants and the parent/decision-making authority with this transition and assures that authorization for services under family-direction do not expire until new services are in place. The Department provides technical assistance and guidance as requested by participants and their parent/decision-making authority, Support Brokers, and circles of support. Transition from Family- Directed Services option to Traditional services will not take more than 120 days and in most cases will be accomplished in 60 to 90 days. This transition time is spent re-determining the LOC needs, development of a new plan, and review and authorization of the new plan. The participant remains in Family-Directed Services option until this process is completed so that there is no interruption in services. If at any time there are health and safety issues, the Department works closely with the participant and parent/decision-making authority to ensure that the participant’s health and safety is protected. This may include utilizing the Crisis Network Team to address any immediate crises and/or authorizing an emergency 120-day transition plan to assure a smooth transition from Family-Directed Services option to Traditional services. Only demonstrated danger to the participant’s health and safety would result in the involuntary termination of the participant’s use of Family-Directed Services option. In these cases, the Department will work closely with the parent/decision-making authority and Support Broker to identify necessary changes to the plan of service, authorize emergency services if necessary, and facilitate any other activities necessary to assure continuity of services during this transition. 7. Opportunities for Participant-Direction a. Participant–Employer Authority (individual can select, manage, and dismiss State plan HCBS providers). (Select one):  The state does not offer opportunity for participant-employer authority.  Participants may elect participant-employer Authority (Check each that applies):  Participant/Co-Employer. The participant (or the participant’s representative) functions as the co-employer (managing employer) of workers who provide waiver services. An agency is the common law employer of participant-selected/recruited staff and performs necessary payroll and human resources functions. Supports are available to assist the participant in conducting employer-related functions.  Participant/Common Law Employer. The participant (or the participant’s representative) is the common law employer of workers who provide waiver services. An IRS-approved Fiscal/Employer Agent functions as the participant’s agent in performing payroll and other employer responsibilities that are required by federal and state law. Supports are available to assist the participant in conducting employer-related functions. b. Participant–Budget Authority (individual directs a budget that does not result in payment for medical assistance to the individual). (Select one):  The state does not offer opportunity for participants to direct a budget.  Participants may elect Participant–Budget Authority. Participant-Directed Budget. (Describe in detail the method(s) that are used to establish the amount of the budget over which the participant has authority, including the method for calculating the dollar values in the budget based on reliable costs and service utilization, is applied consistently to each participant, and is adjusted to reflect changes in individual assessments and service plans. Information about these method(s) must be made publicly available and included in the person-centered service plan.): State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 40 Effective: 07/01/2021 Approved: Supersedes: The same budget methodology used for the traditional option is applied for the Family-Directed Services option. See page 33 of this Supplement 1 to Attachment 3.1-A for the complete description. Expenditure Safeguards. (Describe the safeguards that have been established for the timely prevention of the premature depletion of the participant-directed budget or to address potential service delivery problems that may be associated with budget underutilization and the entity (or entities) responsible for implementing these safeguards. The participant and parent/decision-making authority’s selected Fiscal Employer Agent will have the individual budget and the approved supports and services from the Support and Spending Plan. They will send monthly statements to participants and their parent/decision-making authority on a monthly basis to inform them on the status of expenditures. The Support Broker will assist the family to review these statements to assure spending is on track. Employment agreements are developed for each Community Support Worker that describe what is expected and how the support worker will be paid. As a part of the QA process, Medicaid staff monitors FEAs to assure that processes are in place to monitor these expenditures. Each fiscal agent is required to: 1) Have a system in place to perform a quarterly quality management (QM) analysis activity on a statistically significant sample of overall participant records; 2) Have documented, approved policies and procedures with stated timeframes for preforming a quarterly quality management analysis activity on a statistically significant sample of overall participant records; 3) Have internal controls documented and in place for preforming a quarterly QM analysis activity on a statistically significant sample of overall participant records; 4) Forward QM reports to the Department within thirty (30) working days from the end of each quarter. In addition to reviewing these quarterly reports, the Department also conducts a full-service performance check on each fiscal agent provider at least every 3 years (all policies and procedures, and all the task and services as agreed upon in the provider agreement). State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 41 Effective: 07/01/2021 Approved: Supersedes: Quality Improvement Strategy Quality Measures (Describe the state’s quality improvement strategy. For each requirement, and lettered sub-requirement, complete the table below): 1. Service plans (a) address assessed needs of 1915(i) participants; (b) are updated annually; and (c) document choice of services and providers. 2. Eligibility Requirements: (a) an evaluation for 1915(i) State plan HCBS eligibility is provided to all applicants for whom there is reasonable indication that 1915(i) services may be needed in the future; (b) the processes and instruments described in the approved state plan for determining 1915(i) eligibility are applied appropriately; and (c) the 1915(i) benefit eligibility of enrolled individuals is reevaluated at least annually or if more frequent, as specified in the approved state plan for 1915(i) HCBS. 3. Providers meet required qualifications. 4. Settings meet the home and community-based setting requirements as specified in this SPA and in accordance with 42 CFR 441.710(a)(1) and (2). 5. The SMA retains authority and responsibility for program operations and oversight. 6. The SMA maintains financial accountability through payment of claims for services that are authorized and furnished to 1915(i) participants by qualified providers. 7. The state identifies, addresses, and seeks to prevent incidents of abuse, neglect, and exploitation, including the use of restraints. (Table repeats for each measure for each requirement and lettered sub-requirement above.) Requirement 1 (Service Plans) Sub-Requirement 1-a Service plans address all members’ assessed needs (including health and safety risk factors) and personal goals either by the State Plan HCBS service or through other means.Service plans address assessed needs of 1915(i) participants. Discovery Discovery Evidence (Performance Measure) Performance Measure 1 (PM1) Number and percent of service plans reviewed that document address 1915(i) participants’s needs, goals, and risk factors as identified in the individual’stheir assessment(s). a. Numerator: Number of service plans reviewed that document address 1915(i) participants’s needs, goals, and risk factors as identified in the their assessment(s). State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 42 Effective: 07/01/2021 Approved: Supersedes: b. Denominator: Number of service plans reviewed in the representative sample. Discovery Activity (Source of Data & sample size) Data Source: Reports to State Medicaid Agency on delegated administrative functions. Sampling Approach: Representative sample of child participants receiving 1915(i) HCBS services. Confidence interval = 95% with -/+ 5% margin of error. Monitoring Responsibilities (Agency or entity that conducts discovery activities) The State Medicaid Agency is responsible for data collection/generation. Frequency Quarterly and Annually Remediation Remediation Responsibilities (Who corrects, analyzes, and aggregates remediation activities; required timeframes for remediation) The State Medicaid Agency is responsible for data aggregation and analysis. Frequency (of Analysis and Aggregation) Quarterly and Annually Requirement 1 (Service Plans) Sub-Requirement 1-b Service plans are updated annually. Discovery Discovery Evidence (Performance Measure) Performance Measure 2 (PM2) Number and percent of service plans reviewed that were updated/revised at least annually. a. Numerator: Number of service plans reviewed that were updated/revised at least annually. b. Denominator: Number of service plans in the representative sample requiring annual updates. Discovery Activity (Source of Data & sample size) Data Source: Reports to State Medicaid Agency on delegated administrative functions. Sampling Approach: Representative sample of child participants receiving 1915(i) HCBS services. Confidence interval = 95% with -/+ 5% margin of error. Monitoring Responsibilities (Agency or entity that conducts discovery activities) The State Medicaid Agency is responsible for data collection/generation. Frequency Quarterly and Annually State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 43 Effective: 07/01/2021 Approved: Supersedes: Remediation Remediation Responsibilities (Who corrects, analyzes, and aggregates remediation activities; required timeframes for remediation) The State Medicaid Agency is responsible for data aggregation and analysis. Frequency (of Analysis and Aggregation) Quarterly and Annually Requirement 1 (Service Plans) Sub-Requirement 1-b Service plans are updated or revised at least annually or when warranted by changes in the HCBS participant’s needs. Discovery Discovery Evidence (Performance Measure) Performance Measure 3 (PM3) Number and percent of service plans reviewed that are were updated/ revised when requested and warranted by changes in the 1915(i) participant’s needs/goals. a. Numerator: Number of service plans reviewed that are were updated/ revised when requested and warranted by changes in the 1915(i) participant’s needs/ goals. b. Denominator: Number of service plans reviewed in the representative sample that identified the need for changes requiring revision(s) requested and warranted by changes in the 1915(i) participant’s needs. Discovery Activity (Source of Data & sample size) Data Source: Reports to State Medicaid Agency on delegated administrative functions. Sampling Approach: Representative sample of child 1915(i) participants receiving HCBS services. Confidence interval = 95% with -/+ 5% margin of error. Monitoring Responsibilities (Agency or entity that conducts discovery activities) The State Medicaid Agency is responsible for data collection/generation. Frequency Quarterly and Annually Remediation Remediation Responsibilities (Who corrects, analyzes, and aggregates remediation activities; required timeframes for remediation) The State Medicaid Agency is responsible for data aggregation and analysis. Frequency (of Analysis and Aggregation) Quarterly and Annually State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 44 Effective: 07/01/2021 Approved: Supersedes: Requirement 1 (Service Plans) Sub-Requirement 1-c Service plans document the 1915(i) participant’s Participants are afforded choice between/among of services and providers. Discovery Discovery Evidence (Performance Measure) Performance Measure 4 (PM4) Number and percent of 1915(i) participants records reviewed who reported that indicated they 1915(i) participants were given a choice when selecting service providers. a. Numerator: Number of 1915(i) participants records reviewed who reportedthat indicated they 1915(i) participants were given a choice when selecting service providers. b. Denominator: Number of 1915(i) participants records reviewed in the representative sample. Discovery Activity (Source of Data & sample size) Data Source: Analyzed collected data Sampling Approach: Representative sample of child 1915(i) participants receiving HCBS services. Confidence interval = 95% with -/+ 5% margin of error. Monitoring Responsibilities (Agency or entity that conducts discovery activities) The State Medicaid Agency is responsible for data collection. Frequency Quarterly and Annually Remediation Remediation Responsibilities (Who corrects, analyzes, and aggregates remediation activities; required timeframes for remediation) The State Medicaid Agency is responsible for data aggregation and analysis. Frequency (of Analysis and Aggregation) Quarterly and Annually Requirement 1 (Service Plans) Sub-Requirement 1-c Service plans document the 1915(i) participant’s Participants are afforded choice between/among of services and providers. Discovery Discovery Evidence (Performance Measure) Performance Measure 5 (PM5) Number and percent of 1915(i) participants records reviewed who reported they that indicated 1915(i) participants were given a choice when selecting services. a. Numerator: Number of 1915(i) participants records reviewed who indicated State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 45 Effective: 07/01/2021 Approved: Supersedes: they that indicated 1915(i) participants were given a choice between serviceswhen selecting services. b. Denominator: Number of 1915(i) participants records reviewed in the representative sample. Discovery Activity (Source of Data & sample size) Data Source: Reports to State Medicaid Agency on delegated administrative functions. Sampling Approach: Representative sample of child 1915(i) participants receiving HCBS services. Confidence interval = 95% with -/+ 5% margin of error. Monitoring Responsibilities (Agency or entity that conducts discovery activities) The State Medicaid Agency is responsible for data collection/generation. Frequency Quarterly and Annually Remediation Remediation Responsibilities (Who corrects, analyzes, and aggregates remediation activities; required timeframes for remediation) The State Medicaid Agency is responsible for data aggregation and analysis. Frequency (of Analysis and Aggregation) Quarterly and Annually Requirement (Service Plans) The state monitors service plan development in accordance with its policies and procedures. Discovery Discovery Evidence (Performance Measure) Number and percent of service plans reviewed and authorized by the Department prior to the expiration of the current plan of service. a. Numerator: number of service plans that were reviewed and authorized by the Department prior to the expiration of the current plan of service. b. Denominator: number of service plans reviewed and authorized by the Department. Discovery Activity (Source of Data & sample size) Data Source: Reports to State Medicaid Agency on delegated administrative functions. Sampling Approach: Representative sample of child participants receiving HCBS services. Confidence interval = 95% with -/+ 5% margin of error. MonitoringResponsibilities (Agency or entity that conducts discovery activities) The State Medicaid Agency is responsible for data collection/generation. Frequency Quarterly, Annual State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 46 Effective: 07/01/2021 Approved: Supersedes: Remediation Remediation Responsibilities (Who corrects, analyzes, and aggregates remediation activities; required timeframes for remediation) The State Medicaid Agency is responsible for data aggregation and analysis. Frequency (of Analysis and Aggregation) Quarterly, Annual (Service Plans) Services are delivered in accordance with the service plan, including the type, scope, amount, duration, and frequency specified in the service plan. Discovery Discovery Evidence (Performance Measure) Number and percent of service plans that indicate services were delivered consistent with the service type, scope, amount, duration and frequency approved on service plans. a. Numerator: number of plans reviewed that indicate services were delivered consistent with the approved service plans. b. Denominator: number of service plans reviewed. Discovery Activity (Source of Data & sample size) Data Source: Reports to State Medicaid Agency on delegated administrative functions. Sampling Approach: Representative sample of child participants receiving HCBS services. Confidence interval = 95% with -/+ 5% margin of error. MonitoringResponsibilities (Agency or entity that conducts discovery activities) The State Medicaid Agency is responsible for data collection/generation. Frequency Annual Remediation Remediation Responsibilities (Who corrects, analyzes, and aggregates remediation activities; required timeframes for remediation) The State Medicaid Agency is responsible for data aggregation and analysis. Frequency (of Analysis and Aggregation) Annual Requirement 2 (Eligibility) Sub-Requirement 2-a An evaluation for 1915(i) State plan HCBS eligibility is provided to all applicants for whom there is reasonable indication that 1915(i) services may be needed in the future. Discovery State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 47 Effective: 07/01/2021 Approved: Supersedes: Discovery Evidence (Performance Measure) Performance Measure 6 (PM6) Number and percent of initial 1915(i) applicants for whom an evaluation of the needs-based eligibility criteria was completed HCBS services who receive an eligibility assessment prior to receiving 1915(i) services. a. Numerator: Number of initial 1915(i) applicants for whom an evaluation of the needs-based eligibility criteria was completed prior to receiving 1915(i) services HCBS services who received an eligibility assessment. b. Denominator: Number of initial 1915(i) applicants for receiving HCBS 1915(i) services. Discovery Activity (Source of Data & sample size) Data Source: Reports to State Medicaid Agency on delegated administrative functions. Sampling Approach: 100% Review. Monitoring Responsibilities (Agency or entity that conducts discovery activities) The State Medicaid Agency is responsible for data collection/generation. Frequency Quarterly, and Annually Remediation Remediation Responsibilities (Who corrects, analyzes, and aggregates remediation activities; required timeframes for remediation) The State Medicaid Agency is responsible for data aggregation and analysis. Frequency (of Analysis and Aggregation) Quarterly, and Annually Requirement 2 (Eligibility) Sub-Requirement 2-b The processes and instruments described in the approved State plan for determining 1915(i) eligibility are applied appropriately. Discovery Discovery Evidence (Performance Measure) Performance Measure 7 (PM7) Number and percent of reviewed 1915(i) eligibility determinations that were made according to criteria was determined according to policy the processes and instruments for determining eligibility described in this 1915(i) HCBS Benefit. a. Numerator: Number of reviewed 1915(i) eligibility determinations that were determined made according to policy the processes and instruments for determining eligibility described in this 1915(i) HCBS Benefit. b. Denominator: Number of 1915(i) eligibility determinations in the State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 48 Effective: 07/01/2021 Approved: Supersedes: representative sample. Discovery Activity (Source of Data & sample size) Data Source: Reports to State Medicaid Agency on delegated administrative functions. Sampling Approach: Representative sample of child 1915(i) participants receiving HCBS services. Confidence interval = 95% with -/+ 5% margin of error. Monitoring Responsibilities (Agency or entity that conducts discovery activities) The State Medicaid Agency is responsible for data collection/generation. Frequency Quarterly and Annually Remediation Remediation Responsibilities (Who corrects, analyzes, and aggregates remediation activities; required timeframes for remediation) The State Medicaid Agency is responsible for data aggregation and analysis. Frequency (of Analysis and Aggregation) Quarterly and Annually Requirement 2 (Eligibility) Sub-Requirement 2-c An evaluation for state plan HCBS eligibility is provided to all applicants for whom there is reasonable indication that services may be needed in the future. The 1915(i) Benefit eligibility of enrolled individuals is reevaluated at least annually or, if more frequent, as specified in the approved state plan for 1915(i) HCBS. Discovery Discovery Evidence (Performance Measure) The SMA is required to conduct annual re-evaluations, however, per the CMS March 2014 guidance the state is not required to report on the number and percent of participants who received an annual redetermination of eligibility within 364 days of their previous eligibility assessment. Number and percent of participants who received an annual redetermination of eligibility within 364 days of their previous eligibility assessment. a. Numerator: Number of participants who received an annual redetermination within 364 days of their previous eligibility assessment. Denominator: Number of participants who received an annual redetermination. Discovery Activity (Source of Data & sample size) N/A Data Source: Reports to State Medicaid Agency on delegated administrative functions. Sampling Approach: 100% Review of annual redetermination of eligibility. State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 49 Effective: 07/01/2021 Approved: Supersedes: Monitoring Responsibilities (Agency or entity that conducts discovery activities) N/A The State Medicaid Agency is responsible for data collection/generation. Frequency N/AQuarterly, Annual Remediation Remediation Responsibilities (Who corrects, analyzes, and aggregates remediation activities; required timeframes for remediation) N/A The State Medicaid Agency is responsible for data aggregation and analysis. Frequency (of Analysis and Aggregation) N/AQuarterly, Annual Requirement 3 (Qualified Providers) The state verifies that providers initially and continually meet required licensure and/or certification standards and adhere to the approved State Plan standards prior to furnishing services.Providers meet required qualifications. Discovery Discovery Evidence (Performance Measure) Performance Measure 8 (PM8) Number and percent of initial certified HCBS new 1915(i) providers, which are required by the State to be licensed/certified, who that meet the State’s certification standards prior to providing 1915(i) services. a. Numerator: Number of initial new 1915(i) providers, which are required by the State to be licensed/certified, who that meet the State’s required licensure or certification standards prior to providing 1915(i) services. b. Denominator: Number of initialnew 1915(i) providers, which are required by the State to be certified. Discovery Activity (Source of Data & sample size) Data Source: Reports to State Medicaid Agency on delegated administrative functions. Sampling Approach: 100% Review Monitoring Responsibilities (Agency or entity that conducts discovery activities) The State Medicaid Agency is responsible for data collection/generation. Frequency Quarterly, and Annually Remediation State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 50 Effective: 07/01/2021 Approved: Supersedes: Remediation Responsibilities (Who corrects, analyzes, and aggregates remediation activities; required timeframes for remediation) The State Medicaid Agency is responsible for data aggregation and analysis. Frequency (of Analysis and Aggregation) Quarterly, and Annually Requirement 3 (Qualified Providers) The state verifies that providers initially and continually meet required licensure and/or certification standards and adhere to the approved State Plan standards prior to furnishing services.Providers meet required qualifications. Discovery Discovery Evidence (Performance Measure) Performance Measure 9 (PM9) Number and percent of ongoing 1915(i) certified providers, which are required by the State to be licensed/certified, who that continue to meet the State’s licensure/certification standards. a. Numerator: Number of reviewed ongoing 1915(i) providers, which are required by the State to be licensed/certified, who that continue to meet the State’s licensure/certification standards. b. Denominator: Number of ongoing 1915(i) providers, which are required by the State to be licensed/certified, in the sample specified below surveyed. Discovery Activity (Source of Data & sample size) Data Source: Reports to State Medicaid Agency on delegated administrative functions. Sampling Approach: 100% Review of 1915(i) providers who are surveyed in the yearthat were required to be surveyed during the relevant annual period. Monitoring Responsibilities (Agency or entity that conducts discovery activities) The State Medicaid Agency is responsible for data collection/generation. Frequency Quarterly, and Annually Remediation Remediation Responsibilities (Who corrects, analyzes, and aggregates remediation activities; required timeframes for remediation) The State Medicaid Agency is responsible for data aggregation and analysis. Frequency (of Analysis and Aggregation) Quarterly, and Annually Requirement 3 The State monitors non-licensed/non-certified providers to assure adherence to State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 51 Effective: 07/01/2021 Approved: Supersedes: (Qualified Providers) provider standards.Providers meet required qualifications. Discovery Discovery Evidence (Performance Measure) Performance Measure 10 (PM10) Number and percent of new 1915(i) providers, which are not required by the State to be licensed/certified, that have received an initial provider quality review within 6 months of providing 1915(i) services to 1915(i) participants. a. Numerator: Number of initial new 1915(i) providers, which are not required by the State to be licensed/certified, who that have received an initial provider quality review within 6 months of providing 1915(i) services to 1915(i) participants. b. Denominator: Number of initial new 1915(i) providers, which are not required by the State to be licensed/certified providing services. Discovery Activity (Source of Data & sample size) Data Source: Reports to State Medicaid Agency on delegated administrative functions. Sampling Approach: 100% Review Monitoring Responsibilities (Agency or entity that conducts discovery activities) The State Medicaid Agency is responsible for data collection/generation. Frequency Quarterly, and Annually Remediation Remediation Responsibilities (Who corrects, analyzes, and aggregates remediation activities; required timeframes for remediation) The State Medicaid Agency is responsible for data aggregation and analysis. Frequency (of Analysis and Aggregation) Quarterly, and Annually Requirement 3 (Qualified Providers) The State monitors non-licensed/non-certified providers to assure adherence to provider standards.Providers meet required qualifications. Discovery Discovery Evidence (Performance Measure) Performance Measure 11 (PM11) Number and percent of ongoing 1915(i)HCBS providers, which are not required by the State to be licensed/certified, who that received a provider quality review every two years. State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 52 Effective: 07/01/2021 Approved: Supersedes: a. Numerator: Number of reviewed ongoing 1915(i) providers, which were not required by the State to be licensed /certified, reviewed in the year that received at least one quality review during the preceding two years. b. Denominator: Number of ongoing 1915(i) providers, which were not required by the State to be licensed /certified, in the sample specified below who were required to receive a review in the year. Discovery Activity (Source of Data & sample size) Data Source: Reports to State Medicaid Agency on delegated administrative functions. Sampling Approach: 100% Review of 1915(i) providers that were required to receive a review be reviewed in the year during the relevant annual period. Monitoring Responsibilities (Agency or entity that conducts discovery activities) The State Medicaid Agency is responsible for data collection/generation. Frequency Quarterly, and Annually Remediation Remediation Responsibilities (Who corrects, analyzes, and aggregates remediation activities; required timeframes for remediation) The State Medicaid Agency is responsible for data aggregation and analysis. Frequency (of Analysis and Aggregation) Quarterly, and Annually Requirement 3 (Qualified Providers) The state implements its policies and procedures for verifying that training is conducted in accordance with state requirements and the approved State Plan. Providers meet required qualifications. Discovery Discovery Evidence (Performance Measure) Performance Measure 12 (PM12) Number and percent of HCBS 1915(i) providers that meet the State’s requirements for training. a. Numerator: Number of HCBS 1915(i) providers reviewed that meet State’s requirements for training. b. Denominator: Number of HCBS 1915(i) providers reviewed in the sample specified below. Discovery Activity (Source of Data & sample size) Data Source: Reports to State Medicaid Agency on delegated administrative functions. Sampling Approach: 100% Review of 1915(i) providers who were reviewed within State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 53 Effective: 07/01/2021 Approved: Supersedes: the year during the relevant annual period. Monitoring Responsibilities (Agency or entity that conducts discovery activities) The State Medicaid Agency is responsible for data collection/generation. Frequency Quarterly, and Annually Remediation Remediation Responsibilities (Who corrects, analyzes, and aggregates remediation activities; required timeframes for remediation) The State Medicaid Agency is responsible for data aggregation and analysis. Frequency (of Analysis and Aggregation) Quarterly, and Annually Requirement 4 (HCBS Settings) Settings meet the home and community-based setting requirements as specified in this 1915(i) Benefit and in accordance with 42 CFR 441.701705(a)(1) and (2). Discovery Discovery Evidence (Performance Measure) Performance Measure 13 (PM13) Number and percent of HCBS settings reviewed that meet the HCBS setting requirements as specified in this 1915(i) Benefit and who are in compliance accordance with HCBS regulations42 CFR 441.705(a)(1) and (2). a. Numerator: Number of 1915(i) HCBS settings providers reviewed who meet compliance standards that meet the HCBS setting requirements as specified in this 1915(i) Benefit and in accordance with 42 CFR 441.705(a)(1) and (2). b. Denominator: Number of 1915(i) HCBS settings providers sampled to determine compliancein the representative sample. Discovery Activity (Source of Data & sample size) Data Source: Reports to the State Medicaid Agency on delegated administrative functions. Sampling Approach: 100% of reviewed HCBS providers. Representative sample of 1915(i) HCBS settings. Confidence interval = 95% with -/+ 5% margin of error. Monitoring Responsibilities (Agency or entity that conducts discovery activities) The State Medicaid Agency is responsible for data collection/generation. Frequency Annually Remediation Remediation Responsibilities (Who corrects, analyzes, and aggregates remediation The State Medicaid Agency is responsible for data aggregation and analysis. State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 54 Effective: 07/01/2021 Approved: Supersedes: activities; required timeframes for remediation) Frequency (of Analysis and Aggregation) Annually Requirement 5 (Administrative Authority) The State Medicaid Agency (SMA) retains ultimate administrative authority and responsibility for the operation of the program operations and by exercising oversight of the performance of State Plan HCBS1915(i) Benefit functions by other state and local/regional non-state agencies (if appropriate) and contracted entities. Discovery Discovery Evidence (Performance Measure) Performance Measure 14 (PM14) The number and percent of remediation issues requiring remediation identified that the state followed up on that were identified in the IAP contract monitoring reports that were addressed by the State. a. Numerator: Number of remediation issues requiring remediation followed up on identified in the IAP contract monitoring reports that were addressed by the State. b. Denominator: Number of issues requiring remediation identified in the IAP contract monitoring reports. Discovery Activity (Source of Data & sample size) Data Source: Reports to State Medicaid Agency on delegated administrative functions. Provider performance monitoring. Sampling Approach: 100% Review of remediation issues. Monitoring Responsibilities (Agency or entity that conducts discovery activities) The State Medicaid Agency is responsible for data collection/generation. Frequency Quarterly, and Annually Remediation Remediation Responsibilities (Who corrects, analyzes, and aggregates remediation activities; required timeframes for remediation) The State Medicaid Agency is responsible for data aggregation and analysis. Frequency (of Analysis and Aggregation) Quarterly, and Annually Requirement 6 The State Medicaid Agency (SMA) maintains financial accountability through State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 55 Effective: 07/01/2021 Approved: Supersedes: (Financial Accountability) payment of claims for services that are authorized and furnished to 1915(i) participants by qualified providers. Discovery Discovery Evidence (Performance Measure) Performance Measure 15 (PM15) Number and percent of claims paid for 1915(i) services according to the posted fee schedule for 1915(i) services. a. Numerator: Number of reviewed claims paid for 1915(i) services (by procedure code) according to the posted fee schedule for 1915(i) services. b. Denominator: Number of claims Paid paid claims for 1915(i) services (by procedure code) for one-week of each calendar quarter in the sample specified below. Discovery Activity (Source of Data & sample size) Data Source: Reports to State Medicaid Agency on delegated administrative functionsOther – MMIS Claims Paid Report. Sampling Approach: Representative sample of child participants receiving HCBS services. Confidence interval = 95% with +/- 5% margin of error.100% Review of claims paid for 1915(i) services (by procedure code) for a one-week period each calendar quarter. Monitoring Responsibilities (Agency or entity that conducts discovery activities) The State Medicaid Agency is responsible for data collection/generation. Frequency Quarterly, and Annually Remediation Remediation Responsibilities (Who corrects, analyzes, and aggregates remediation activities; required timeframes for remediation) The State Medicaid Agency is responsible for data aggregation and analysis. Frequency (of Analysis and Aggregation) Quarterly, and Annually Requirement 6 (Financial Accountability) The State Medicaid Agency (SMA) maintains financial accountability through payment of claims for services that are authorized and furnished to 1915(i) participants by qualified providers. Discovery Discovery Evidence (Performance Measure) Performance Measure 16 (PM16) Number and percent of posted rates for 1915(i) services on the posted fee schedule that are compared to consistent with the approved rate methodology in Attachment 4.19-B of the state plan. State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 56 Effective: 07/01/2021 Approved: Supersedes: a. Numerator: Posted rates compared to the rate methodology. Number of rates for 1915(i) services (by procedure code) on the posted fee schedule that are consistent with the approved rate methodology in Attachment 4.19-B of the state plan. b. Denominator: Approved rate methodology.Number of rates for 1915(i) services (by procedure code) on the posted fee schedule. Discovery Activity (Source of Data & sample size) Data Source: Reports to State Medicaid Agency on delegated administrative functionsOnsite record reviews. Sampling Approach: 100% review of billing for a week period on an annual basis. Monitoring Responsibilities (Agency or entity that conducts discovery activities) The State Medicaid Agency is responsible for data collection/generation. Frequency Annually Remediation Remediation Responsibilities (Who corrects, analyzes, and aggregates remediation activities; required timeframes for remediation) The State Medicaid Agency is responsible for data aggregation and analysis. Frequency (of Analysis and Aggregation) Annually Requirement 6 (Financial Accountability) The State Medicaid Agency (SMA) maintains financial accountability through payment of claims for services that are authorized and furnished to 1915(i) participants by qualified providers. Discovery Discovery Evidence (Performance Measure) Performance Measure 17 (PM17) Number and percent of unduplicated participants utilizing Children’s 1915(i) services.Number and percent of claims paid for 1915(i) services on behalf of eligible 1915(i) participants. a. Numerator: Number of unduplicated participants with a paid claim for 1915(i) services.Number of reviewed claims paid for 1915(i) services (by procedure code) on behalf of eligible 1915(i) participants. b. Denominator: Number of unduplicated participants eligible for 1915(i) services. Number of claims paid for 1915(i) services (by procedure code) in the sample specified below. Discovery Activity (Source of Data & Data Source: Reports to State Medicaid Agency on delegated administrative functions. State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 57 Effective: 07/01/2021 Approved: Supersedes: sample size) Sampling Approach: Representative sample of child participants receiving HCBS services. Confidence interval = 95% with +/- 5% margin of error.100% Review of claims paid for 1915(i) services (by procedure code) for a one-week period each annual period. Monitoring Responsibilities (Agency or entity that conducts discovery activities) The State Medicaid Agency is responsible for data collection/generation. Frequency Quarterly, Annually Remediation Remediation Responsibilities (Who corrects, analyzes, and aggregates remediation activities; required timeframes for remediation) The State Medicaid Agency is responsible for data aggregation and analysis. Frequency (of Analysis and Aggregation) Quarterly, Annually Requirement 6 (Financial Accountability) The State Medicaid Agency (SMA) maintains financial accountability through payment of claims for services that are authorized and furnished to 1915(i) participants by qualified providers. Discovery Discovery Evidence (Performance Measure) Performance Measure 18 (PM18) Number and percent of 1915(i) claims paid to 1915(i) providers of that are qualified to furnish Children’s 1915(i) services. a. Numerator: Number of reviewed 1915(i) claims paid Paid claims to 1915(i) providers that are qualified enrolled to furnish Children’s 1915(i) services. b. Denominator: Number of Paid claims paid to 1915(i) providers of 1915(i) services in the sample specified below. Discovery Activity (Source of Data & sample size) Data Source: Reports to State Medicaid Agency on delegated administrative functions. Sampling Approach: 100% review of billing claims paid to 1915(i) providers for a one-week period on an annual basiseach annual period. Monitoring Responsibilities (Agency or entity that conducts discovery activities) The State Medicaid Agency is responsible for data collection/generation. Frequency Quarterly, Annually Remediation Remediation Responsibilities The State Medicaid Agency is responsible for data State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 58 Effective: 07/01/2021 Approved: Supersedes: (Who corrects, analyzes, and aggregates remediation activities; required timeframes for remediation) aggregation and analysis. Frequency (of Analysis and Aggregation) Quarterly, Annually Requirement 7 (Health and Welfare) The state identifies, addresses, and seeks to prevent incidents of abuse, neglect, and exploitation, including the use of restraints. Discovery Discovery Evidence (Performance Measure) Performance Measure 19 (PM19) Number and percent of reported critical incidents (of related to abuse, neglect, or and/or exploitation) requiring referral to child protection or law enforcement that follow up was completed were referred within policy timelines. a. Numerator: Number of reported critical incidents (related to abuse, neglect, and/or or exploitation) where action/resolution was completed within policy requiring referral to child protection or law enforcement that were referred within policy timelines. b. Denominator: Number of reported critical incidents (related to abuse, neglect, and/or or exploitation) requiring referral to child protection or law enforcement. Discovery Activity (Source of Data & sample size) Data Source: Reports to State Medicaid Agency on delegated administrative functions. Sampling Approach: 100% Review of critical reports Monitoring Responsibilities (Agency or entity that conducts discovery activities) The State Medicaid Agency is responsible for data collection/generation. Frequency Monthly, Quarterly, Annual, Continuously and Ongoing Remediation Remediation Responsibilities (Who corrects, analyzes, and aggregates remediation activities; required timeframes for remediation) The State Medicaid Agency is responsible for data aggregation and analysis. Frequency (of Analysis and Aggregation) Quarterly and Annually Requirement 7 The state identifies, addresses, and seeks to prevent incidents of abuse, neglect, State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 59 Effective: 07/01/2021 Approved: Supersedes: (Health and Welfare) and exploitation, including the use of restraints. Discovery Discovery Evidence (Performance Measure) Performance Measure 20 (PM20) Number and percent of 1915(i) participants and/or family legal guardians who received information/education about how to report abuse, neglect, exploitation, and other critical incidents. a. Numerator: Number of 1915(i) participants and/or family legal guardians who received information/education about how to report abuse, neglect, exploitation, and other critical incidents. b. Denominator: Number of 1915(i) participants receiving 1915(i) services. Discovery Activity (Source of Data & sample size) Data Source: Reports to State Medicaid Agency on delegated administrative functions. Sampling Approach: 100% review Monitoring Responsibilities (Agency or entity that conducts discovery activities) The State Medicaid Agency is responsible for data collection/generation. Frequency Quarterly, Annually Remediation Remediation Responsibilities (Who corrects, analyzes, and aggregates remediation activities; required timeframes for remediation) The State Medicaid Agency is responsible for data aggregation and analysis. Frequency (of Analysis and Aggregation) Quarterly, Annually Requirement 7 (Health and Welfare) The state identifies, addresses, and seeks to prevent incidents of abuse, neglect, and exploitation, including the use of restraints. Discovery Discovery Evidence (Performance Measure) Performance Measure 21 (PM21) Number and percent of 1915(i) service plans with restrictive interventions (including restraints and seclusion) that were approved according to criteria in the approved 1915(i) Benefit. a. Numerator: Number of reviewed 1915(i) service plans with restrictive interventions (including restraints and seclusion) that were approved according to criteria in the approved 195(i) Benefit. State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 60 Effective: 07/01/2021 Approved: Supersedes: b. Denominator: Number of 1915(i) service plans reviewed with restrictive interventions (including restraints and seclusion). Discovery Activity (Source of Data & sample size) Data Source: Reports to State Medicaid Agency on delegated administrative functions. Sampling Approach: 100% Reviewof service plans reviewed with restrictive interventions. Monitoring Responsibilities (Agency or entity that conducts discovery activities) The State Medicaid Agency is responsible for data collection/generation. Frequency Quarterly, Annually Remediation Remediation Responsibilities (Who corrects, analyzes, and aggregates remediation activities; required timeframes for remediation) The State Medicaid Agency is responsible for data aggregation and analysis. Frequency (of Analysis and Aggregation) Quarterly, Annually System Improvement (Describe the process for systems improvement as a result of aggregated discovery and remediation activities.) 1. Methods for Analyzing Data and Prioritizing Need for System Improvement CSOR results are gathered; Regional complaints and incident reports are investigated Individual plans of service are reviewed by the Department Results of CSOR are reviewed and analyzed, and tabulated; Complaints and Critical Incidents are reviewed analyzed, and tabulated Plan of service information is analyzed Quarterly meetings: Quarterly the committee reviews analyzed data to develop recommendations for program improvements, and reviews actions taken and progress made toward implementing previous approved system improvements. Annual meeting: Meets annually to prioritize findings and develop recommendations for specific system improvements for the coming year. This recommendation will be submitted to administration for approval and assignment. Quarterly QM Report Annual QM Report The State Medicaid Authority (SMA) has developed the following process/method for prioritizing, and State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 61 Effective: 07/01/2021 Approved: Supersedes: implementing system improvements prompted as a result of an analysis of discovery and remediation information: Division of Family and Community Services (FACS) Quality Management (QM) staff perform discovery and remediation quality improvement activities, including gathering children’s service outcome reviews, investigating regional complaints and incident reports and reviewing plans of service and remediating identified issues. The results of these quality improvement activities are submitted to the FACS QM Data Analyst for review, analysis, tabulation, and reporting. The Quality Management Committee reviews analyzed data in each quarterly quality management report to develops and prioritizes recommendations for system improvements. Recommendations are prioritizes based on need, available resources, and SMA overall operational strategies. System Improvement recommendations for the coming year are compiled into an annual quality management report that is submitted to SMA administration for review and final approval. 2. Roles and Responsibilities Quality Management Staff Team: This is a group of Team of FACS Quality Assurance (QA) staff persons across the seven regions of Idaho, with knowledge of quality improvement interventions, and who are responsible for collecting and reporting data to the Department SMA. Department Data Analyst: This is department staff identified that FACS staff person who is responsible for leading statewide data collection activities, analysis, and reporting activities related to quality management. This staff person is also responsible for creating and implementing data collection tools. Quality Management Team Committee: The QM team Committee is responsible for steering the quality assessment and improvement process, and issues related to parallel data collection. It is responsible for formally recommending specific program improvements to Department SMA administration. FACS DD Policy Program Manager: FACS DD policy program manager takes overall responsibility for leading team members, finalizing quarterly and yearly QM reports, leading the process of prioritizing needs for system improvements, and implementing approved system improvements. 3. Frequency Ongoing monitoring, remediation and analysis activities with quarterly oversight and quarterly and annual reporting. State: Idaho §1915(i) State plan HCBS State plan Attachment 3.1–A: Supplement 1 TN: Page 62 Effective: 07/01/2021 Approved: Supersedes: 4. Method for Evaluating Effectiveness of System Changes Data is gathered and submitted to the Department’s analyst. The analyzed data is presented to the QA team for review and prioritization. Annual QM report is submitted to administration. Overall data findings and recommendations are submitted to the QM Team for review prior to finalization. The Quality Management Committee is responsible for evaluating the effectiveness of system change. During each quarterly meeting, the Quality Management Committee review actions taken by the Quality Management Team and reviews progress made toward implementing previous approved system improvements. When necessary, the Quality Management Committee seeks evaluation and feedback from impacted stakeholders and recommends changes to the implementation process to ensure approved system improvements are fully implemented. State: Idaho §1915(i) State plan HCBS State plan Attachment 4.19–B TN: Page 63 Effective: 07/01/2021 Approved: Supersedes: Methods and Standards for Establishing Payment Rates 1. Services Provided Under Section 1915(i) of the Social Security Act. For each optional service, describe the methods and standards used to set the associated payment rate. (Check each that applies, and describe methods and standards to set rates):  HCBS Case Management  HCBS Homemaker  HCBS Home Health Aide  HCBS Personal Care  HCBS Adult Day Health  HCBS Habilitation (Community-Based Supports) Individual and Group - The reimbursement methodology adds many cost components together to arrive at a 15 min unit rate for the Community-Based Supports Individual and Group, we use the (BLS) mean wage (Idaho) for all others (BLS code 31-1011) which uses reasonable payroll rate studies. Then, this hourly wage is inflated by using (GI) index. In SFY 2010 (2 months) it was .5% and SFY 2011 it is .8%. Using the Survey results we use direct care staff multipliers for employer related, program related, and general & administrative percentages. These multipliers are decreased to accommodate the average payroll rate currently paid for these services along with the BLS cost for employer related payroll expenses. Lastly, we add costs for paid leave time for direct care staff based on BLS (MWD) report. The dollar figure arriving from the calculations is divided by the ratio provided. The hourly rate then is brought into a quarterly unit rate, or the target rate. The final unit rate is 85.5% of the target rate. We are using the most current DD/MH rates dictated by Idaho code 56-118 and used to calculate the 85.5% adjusted target rate.  HCBS Respite Care Individual and Group - The reimbursement methodology adds many cost components together to arrive at a 15 min unit rate for the Respite Individual and Group, we use the Bureau of Labor statistics (BLS) mean wage (Idaho) for all others (BLS code 39-9099) which uses reasonable payroll rate studies. Then, this hourly wage is inflated by using Global Insights Mountain States Market Basket (GI) inflation index. In SFY 2010 (2 months) it was .5% and SFY 2011 it is .8%. Using the Survey results we use direct care staff multipliers for employer related, program related, and general & administrative percentages. These multipliers are decreased to accommodate the average payroll rate currently paid for these services along with the BLS cost for employer related payroll expenses. Lastly, we add costs for paid leave time for direct care staff based on BLS Mountain West Division's (MWD) report. The dollar figure arriving from the calculations is divided by the ratio provided. The hourly State: Idaho §1915(i) State plan HCBS State plan Attachment 4.19–B TN: Page 64 Effective: 07/01/2021 Approved: Supersedes: rate then is brought into a quarterly unit rate, or the target rate. The final unit rate for Respite Individual is 77% of the target rate. The final unit rate for Respite group is 100% of the target rate. We are using the most current DD/MH rates dictated by Idaho code 56-118 and used to calculate the 77% and the 100% respectfully for the adjusted target rate. For Individuals with Chronic Mental Illness, the following services:  HCBS Day Treatment or Other Partial Hospitalization Services  HCBS Psychosocial Rehabilitation  HCBS Clinic Services (whether or not furnished in a facility for CMI)  Other Services (specify below)  Family Education: The reimbursement methodology adds many cost components together to arrive at a 15 min unit rate for Family Education Individual and Group, we use the (BLS) mean wage (Idaho) for all others (BLS code 29-1129) which uses reasonable payroll rate studies. Then, this hourly wage is inflated by using (01) index. In SFY 2010 (2 months) it was .5% and SFY 2011 it is .8%, Using the Survey results we use direct care staff multipliers for employer related, program related, and general & administrative percentages. These multipliers are decreased to accommodate the average payroll rate currently paid for these services along with the BLS cost for employer related payroll expenses. Lastly, we add costs for paid leave time for direct care staff based on BLS (MWO) report. The dollar figure arriving from the calculations is divided by the ratio provided. The hourly rate then is brought into a quarterly unit rare, or the target rate. The final unit rate is 76.6% of the target rate. We are using the most current OO/MH rates dictated by Idaho code 56-118 and used to calculate the 76.6% adjusted target rate.  Supports for Participant Direction – Community Support Services: The participant and parent/legal guardian negotiates the rate with community support staff, ensuring the rates negotiated do not exceed the prevailing market rate.  Supports for Participant Direction – Support Broker: The participant and parent/legal guardian negotiates the rate with the support broker, ensuring the negotiated rate does not exceed the maximum hourly rate for support broker services established by the Department.  Supports for Participant Direction – Financial Management Services: Financial Management Services -Reimbursement methodology for FMS is based on a market study of other state Medicaid program rates for FMS to gather a range which allows the Department to accept a Per Member Per Month (PMPM) rate within the range determined from the market study. The established PMPM payment rates for each department approved qualified FMS provider will be published on a fee schedule by the Department. This fee schedule will be updated at least yearly, and when new providers are approved. This information will be published for consumer convenience to the IDHW Medicaid website, and by request. State: Idaho §1915(i) State plan HCBS State plan Attachment 2.2-A: TN: Page 65 Effective: 07/01/2021 Approved: Supersedes: Groups Covered CMS now requires states to enter information regarding optional coverage groups directly into the electronic Medicaid and CHIP Program (MACPro) system. The following electronic submission is the most recently approved information for the optional coverage groups previously identified in Attachment 2.2-A of the Idaho Medicaid state plan. The Department does not anticipate making any changes to this approved submission. PRA Disclosure Statement According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-1188. The time required to complete this information collection is estimated to average 114 hours per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850. ___________________________________________________________________________________ Table of Contents State/Territory Name: Idaho State Plan Amendment (SPA) #: 19-0025-A This file contains the following documents in the order listed: 1)Approval Letter2)CMS 179 Form / Summary Form (with 179 like data) 3)Approved SPA Pages Records /Submission PackagesID - Submission Package - ID2019MS0005O - (ID-19-0025-A) - Eligibility CMS-10434 OMB 0938-1188 Package Information Package ID ID2019MS0005O Program Name N/A SPA ID ID-19-0025-A Version Number 4 Submitted By Robin Butrick Package Disposition Priority Code P2 Submission Type Official State ID Region Seattle, WA Package Status Approved Submission Date 9/30/2019 Approval Date 12/13/2019 5:44 PM EST Summary Reviewable Units Versions Correspondence Log Analyst Notes Review Assessment Report Approval Letter Transaction Logs News Related Actions Records /Submission PackagesID - Submission Package - ID2019MS0005O - (ID-19-0025-A) - Eligibility CMS-10434 OMB 0938-1188 DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services Seattle Regional Office 701 Fifth Avenue, Suite 1600, MS/RX-200 Seattle, WA 98104 Division of Medicaid and Children's Health Operations December 13, 2019 Dave Jeppesen Director Idaho Department of Health and Welfare P.O. Box 83720 Boise, ID 83720 Re: Approval of State Plan Amendment ID-19-0025-A Dear Dave Jeppesen: On September 30, 2019, the Centers for Medicare and Medicaid Services (CMS) received Idaho State Plan Amendment (SPA) ID-19-0025-A to treat individuals with and without community spouses comparably for the purpose of determining the personal needs allowance under the Adult Developmental Disability waiver (ID.0076), in accordance with Idaho Administrative Code (IDAPA) 16.03.18.400.06 and current practice. The State applies a personal needs allowance for both populations that is three times the federal SSI benefit amount.. We approve Idaho State Plan Amendment (SPA) ID-19-0025-A on December 13, 2019 with an effective date(s) of July 01, 2019. Name Date Created No items available If you have any questions regarding this amendment, please contact MARIA GARZA at maria.garza@cms.hhs.gov. Sincerely, David L. Meacham Deputy Director Division of Medicaid and Children's Health Operations Submission - Summary MEDICAID | Medicaid State Plan | Eligibility | ID2019MS0005O | ID-19-0025-A Package Header Package ID ID2019MS0005O Submission Type Official SPA ID ID-19-0025-A Initial Submission Date 9/30/2019 Summary Reviewable Units Versions Correspondence Log Analyst Notes Review Assessment Report Approval Letter Transaction Logs News Related Actions Approval Date 12/13/2019 Superseded SPA ID N/A Effective Date N/A State Information State/Territory Name:Idaho Medicaid Agency Name:Idaho Department of Health and Welfare Submission Component State Plan Amendment Medicaid CHIP Submission - Summary MEDICAID | Medicaid State Plan | Eligibility | ID2019MS0005O | ID-19-0025-A Package Header Package ID ID2019MS0005O Submission Type Official Approval Date 12/13/2019 Superseded SPA ID N/A SPA ID ID-19-0025-A Initial Submission Date 9/30/2019 Effective Date N/A SPA ID and Effective Date SPA ID ID-19-0025-A Reviewable Unit Proposed Effective Date Superseded SPA ID Optional Eligibility Groups 7/1/2019 ID-19-0001-A Individuals Receiving State Plan Home and Community-Based Services 7/1/2019 ID-17-0013 Individuals Receiving State Plan Home and Community-Based Services Who Are Otherwise Eligible for HCBS Waivers 7/1/2019 ID-17-0013 Page Number of the Superseded Plan Section or Attachment (If Applicable): Submission - Summary MEDICAID | Medicaid State Plan | Eligibility | ID2019MS0005O | ID-19-0025-A Package Header Package ID ID2019MS0005O Submission Type Official Approval Date 12/13/2019 Superseded SPA ID N/A SPA ID ID-19-0025-A Initial Submission Date 9/30/2019 Effective Date N/A Executive Summary Summary Description Including Goals and Objectives The purpose of this SPA is to revise eligibility criteria to ensure children who were receiving support services under Idaho’s expired 1915(c) waivers (ID-0887 and ID 0859) can continue to receive support services under Idaho’s 1915(i) benefit for Children with Developmental Disabilities (Supplement 1 to Attachment 3.1-A). Federal Budget Impact and Statute/Regulation Citation Federal Budget Impact Federal Fiscal Year Amount First 2019 $0 Second 2020 $0 Federal Statute / Regulation Citation 1902(a)(10)(A)(iii)(XXII) 42 CFR 435.219 Supporting documentation of budget impact is uploaded (optional). Name Date Created No items available Submission - Summary MEDICAID | Medicaid State Plan | Eligibility | ID2019MS0005O | ID-19-0025-A Package Header Package ID ID2019MS0005O Submission Type Official Approval Date 12/13/2019 Superseded SPA ID N/A SPA ID ID-19-0025-A Initial Submission Date 9/30/2019 Effective Date N/A Governor's Office Review No comment Comments received No response within 45 days Other Medicaid State Plan Eligibility Optional Eligibility Groups MEDICAID | Medicaid State Plan | Eligibility | ID2019MS0005O | ID-19-0025-A Package Header Package ID ID2019MS0005O Submission Type Official Approval Date 12/13/2019 Superseded SPA ID ID-19-0001-A User-Entered SPA ID ID-19-0025-A Initial Submission Date 9/30/2019 Effective Date 7/1/2019 A.Options for Coverage The state provides Medicaid to specified optional groups of individuals. Yes No The optional eligibility groups covered in the state plan are (elections made in this screen may not be comprehensive during the transition period from the paper-based state plan to MACPro): Families and Adults Eligibility Group Name Covered In State Plan Include RU In Package ? Included in Another Submission Package Source Type ? Optional Coverage of Parents and Other Caretaker Relatives NEW Reasonable Classifications of Individuals under Age 21 CONVERTED Children with Non- IV-E Adoption Assistance CONVERTED Independent Foster Care Adolescents NEW Optional Targeted Low Income Children NEW Individuals above 133% FPL under Age 65 NEW Individuals Needing Treatment for Breast or Cervical Cancer NEW Individuals Eligible for Family Planning Services NEW Individuals with Tuberculosis NEW Individuals Electing COBRA Continuation Coverage NEW Aged, Blind and Disabled    Eligibility Group Name Covered In State Plan Include RU In Package ? Included in Another Submission Package Source Type ? Individuals Eligible for but Not Receiving Cash Assistance NEW Individuals Eligible for Cash Except for Institutionalization NEW Individuals Receiving Home and Community- Based Waiver Services under Institutional Rules NEW Optional State Supplement Beneficiaries NEW Individuals in Institutions Eligible under a Special Income Level APPROVED PACE Participants NEW Individuals Receiving Hospice NEW Children under Age 19 with a Disability NEW Age and Disability- Related Poverty Level NEW Work Incentives NEW Ticket to Work Basic NEW Ticket to Work Medical Improvements NEW Family Opportunity Act Children with a Disability NEW Individuals Receiving State Plan Home and Community-Based Services APPROVED Individuals Receiving State Plan Home and Community-Based Services Who Are Otherwise Eligible for HCBS Waivers APPROVED         ID-19-0025-A Supersedes TN: ID-19-0001-A Approval Date: 12/13/19 Effective Date: 7/1/19 Optional Eligibility Groups MEDICAID | Medicaid State Plan | Eligibility | ID2019MS0005O | ID-19-0025-A Package Header Package ID ID2019MS0005O Submission Type Official Approval Date 12/13/2019 Superseded SPA ID ID-19-0001-A User-Entered SPA ID ID-19-0025-A Initial Submission Date 9/30/2019 Effective Date 7/1/2019 B. Medically Needy Options for Coverage The state provides Medicaid to specified groups of individuals who are medically needy. Yes No Optional Eligibility Groups MEDICAID | Medicaid State Plan | Eligibility | ID2019MS0005O | ID-19-0025-A Package Header Package ID ID2019MS0005O Submission Type Official Approval Date 12/13/2019 Superseded SPA ID ID-19-0001-A User-Entered SPA ID ID-19-0025-A Initial Submission Date 9/30/2019 Effective Date 7/1/2019 C. Additional Information (optional) Effective January 1, 2019, Idaho no longer covers the Medicaid eligibility group for individuals who qualify on the basis of receiving optional state supplement payments (1902(a)(10)(A)(ii)(XI)) 42 CFR 435.232 and 435.434). Eligibility Groups Deselected from Coverage The following eligibility groups were previously covered in the source approved version of the state plan and deselected from coverage as part of this submission package: •N/A Medicaid State Plan Eligibility Eligibility Groups - Options for Coverage Individuals Receiving State Plan Home and Community-Based Services MEDICAID | Medicaid State Plan | Eligibility | ID2019MS0005O | ID-19-0025-A Individuals receiving section 1915(i) state plan home and community-based services. Package Header Package ID ID2019MS0005O Submission Type Official Approval Date 12/13/2019 Superseded SPA ID ID-17-0013 User-Entered SPA ID ID-19-0025-A Initial Submission Date 9/30/2019 Effective Date 7/1/2019 The state covers the optional Individuals Receiving State Plan Home and Community-Based Services eligibility group in accordance with the following provisions: Individuals who are eligible under other eligibility groups receive section 1915(i) home and community-based services under the state plan. A. Characteristics Individuals qualifying under this eligibility group must meet the following criteria: 1. Meet the needs-based criteria for receiving home and community-based services specified in section 1915(i)(1) of the Act and at 42 CFR 441.715. These are defined in the benefits section of the state plan. 2. Have income that does not exceed the standard described in section D. 3. Will receive at least one state plan home and community-based service as defined at 42 CFR 440.182. Individuals Receiving State Plan Home and Community-Based Services MEDICAID | Medicaid State Plan | Eligibility | ID2019MS0005O | ID-19-0025-A Package Header Package ID ID2019MS0005O Submission Type Official Approval Date 12/13/2019 Superseded SPA ID ID-17-0013 User-Entered SPA ID ID-19-0025-A Initial Submission Date 9/30/2019 Effective Date 7/1/2019 B. Individuals Covered 1. The state covers all individuals who meet the characteristics described in section A. Yes No a. Individuals age 65 or older b. Individuals with blindness c. Individuals who have a disability d. All children under a specified age limit: e. Reasonable classifications of children Name Age Covered Children with DD Under age 18 Children with SED Under age 18 f. Parents and other caretaker relatives g. Pregnant women h. Other individuals who qualify for home and community-based services under 1915(i) Individuals Receiving State Plan Home and Community-Based Services MEDICAID | Medicaid State Plan | Eligibility | ID2019MS0005O | ID-19-0025-A Package Header Package ID ID2019MS0005O Submission Type Official Approval Date 12/13/2019 Superseded SPA ID ID-17-0013 User-Entered SPA ID ID-19-0025-A Initial Submission Date 9/30/2019 Effective Date 7/1/2019 C. Financial Methodologies 1. The state uses the same financial methodology for all individuals covered. Yes No 2. The financial methodology used is: a. SSI methodologies. Please refer as necessary to Non-MAGI Methodologies, completed by the state. c. MAGI-like methodologies. Please refer as necessary to Non-MAGI Methodologies, completed by the state. Less restrictive methodologies are used in calculating countable income. Yes No The less restrictive income methodologies are: General income disregard: Name of disregard:Description: Children with Developmental Disabilities or SED The State will disregard the difference in income between 150% FPL and 300% FPL d. AFDC methodologies. Please refer as necessary to Non-MAGI Methodologies, completed by the state. e. Other methodology. Individuals Receiving State Plan Home and Community-Based Services MEDICAID | Medicaid State Plan | Eligibility | ID2019MS0005O | ID-19-0025-A Package Header Package ID ID2019MS0005O Submission Type Official Approval Date 12/13/2019 Superseded SPA ID ID-17-0013 User-Entered SPA ID ID-19-0025-A Initial Submission Date 9/30/2019 Effective Date 7/1/2019 D. Income Standard Used 1. The state uses the same income standard for all individuals covered. Yes No 2. The income standard for this eligibility group is: a. 150% FPL b. A lower percent of the FPL: Individuals Receiving State Plan Home and Community-Based Services MEDICAID | Medicaid State Plan | Eligibility | ID2019MS0005O | ID-19-0025-A Package Header Package ID ID2019MS0005O Submission Type Official Approval Date 12/13/2019 Superseded SPA ID ID-17-0013 User-Entered SPA ID ID-19-0025-A Initial Submission Date 9/30/2019 Effective Date 7/1/2019 E. Resource Standard Used There is no resource test for this group. F. Additional Information (optional) Medicaid State Plan Eligibility Eligibility Groups - Options for Coverage Individuals Receiving State Plan Home and Community-Based Services Who Are Otherwise Eligible for HCBS Waivers MEDICAID | Medicaid State Plan | Eligibility | ID2019MS0005O | ID-19-0025-A Individuals receiving section 1915(i) state plan home and community-based services who are otherwise eligible for 1915 HCBS waivers. Package Header Package ID ID2019MS0005O Submission Type Official Approval Date 12/13/2019 Superseded SPA ID ID-17-0013 User-Entered SPA ID ID-19-0025-A Initial Submission Date 9/30/2019 Effective Date 7/1/2019 The state covers the optional Individuals Receiving State Plan Home and Community-Based Services Who Are Otherwise Eligible for HCBS Waivers eligibility group in accordance with the following provisions: Individuals who are eligible under other eligibility groups receive section 1915(i) home and community-based services under the state plan. A. Characteristics Individuals qualifying under this eligibility group must meet the following criteria: 1. Are eligible for home and community-based services under an existing 1915 waiver or 1115 demonstration, even if they are not receiving services under such waivers or demonstrations. 2. Have income that does not exceed 300% of the supplemental security income (SSI) federal benefit rate (FBR). 3. Will receive at least one state plan home and community-based service as defined at 42 CFR 440.182. Individuals Receiving State Plan Home and Community-Based Services Who Are Otherwise Eligible for HCBS Waivers MEDICAID | Medicaid State Plan | Eligibility | ID2019MS0005O | ID-19-0025-A Package Header Package ID ID2019MS0005O Submission Type Official Approval Date 12/13/2019 Superseded SPA ID ID-17-0013 User-Entered SPA ID ID-19-0025-A Initial Submission Date 9/30/2019 Effective Date 7/1/2019 B. Individuals Covered 1. The state covers all individuals who meet the characteristics described in section A. Yes No Individuals Receiving State Plan Home and Community-Based Services Who Are Otherwise Eligible for HCBS Waivers MEDICAID | Medicaid State Plan | Eligibility | ID2019MS0005O | ID-19-0025-A Package Header Package ID ID2019MS0005O Submission Type Official Approval Date 12/13/2019 Superseded SPA ID ID-17-0013 User-Entered SPA ID ID-19-0025-A Initial Submission Date 9/30/2019 Effective Date 7/1/2019 C. Financial Methodologies The income and resource methodologies that would be used to determine eligibility for individuals under the special income level group described in 42 C.F.R. §435.236 are used to determine eligibility for this group. D. Income Standard Used The state applies the income standard used to determine eligibility for the relevant 1915 waiver or 1115 demonstration under which the individual is eligible, up to a maximum of 300% of the SSI FBR. E. Resource Standard Used The resource standard used for this group is the resource standard used to determine eligibility for the relevant 1915 waiver or 1115 demonstration under which the individual is eligible. Individuals Receiving State Plan Home and Community-Based Services Who Are Otherwise Eligible for HCBS Waivers MEDICAID | Medicaid State Plan | Eligibility | ID2019MS0005O | ID-19-0025-A Package Header Package ID ID2019MS0005O Submission Type Official Approval Date 12/13/2019 Superseded SPA ID ID-17-0013 User-Entered SPA ID ID-19-0025-A Initial Submission Date 9/30/2019 Effective Date 7/1/2019 F. Additional Information (optional) Individuals qualifying under this eligibility group are limited to those that would be eligible for the Idaho Developmental Disabilities Waiver ID.0076 PRA Disclosure Statement: According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-1188. The time required to complete this information collection is estimated to average 40 hours per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850. This view was generated on 12/13/2019 6:37 PM EST ID-19-0025-A Supersedes TN: ID-17-0013 Approval Date: 12/13/19 Effective Date: 7/1/19