Idaho Admin. Code r. 16.03.10.329

Current through September 2, 2024

Section 16.03.10.329 - AGED AND DISABLED WAIVER SERVICES: PROVIDER QUALIFICATIONS AND DUTIES

Each provider must have a signed provider agreement with the Department for each of the services it provides.

01.Employment Status. Unless otherwise specified by the Department, each individual service provider must be an employee of record or fact of an agency. The Department may enter into provider agreements with individuals in situations in which no agency exists, or no fiscal intermediary agency is willing to provide services. Such agreements will be reviewed annually to verify whether coverage by a personal assistance agency or fiscal intermediary agency is still not available.

02.Fiscal Intermediary Services. An agency that has responsibility for the following:

a. Directly assure compliance with legal requirements related to employment of waiver service providers;

b. Offer supportive services to enable participants or their families to perform the required employer tasks themselves;

c. Bill the Medicaid program for services approved and authorized by the Department;

d. Collect any participant participation due;

e. Pay personal assistants and other waiver service providers for service;

f. Perform all necessary withholding as required by state and federal labor and tax laws, rules, and regulations;

g. Assure that personal assistants providing services meet the standards and qualifications under in this rule;

h. Maintain liability insurance coverage;

i. Conduct, at least annually, participant satisfaction or quality control reviews that are available to the Department and the public; and

j. Obtain such background checks and health screens on new and existing employees of record and fact as required.

03.Provider Qualifications. All providers of homemaker services, respite care, adult day health, transportation, chore services, companion services, attendant care, adult residential care, and home-delivered meals must meet, either by formal training or demonstrated competency, the training requirements contained in the provider training matrix and the standards for direct care staff and allowable tasks or activities in the Department's Aged and Disabled waiver as approved by CMS.

a. A waiver provider cannot be a relative of any participant to whom the provider is supplying services except for extraordinary circumstances as defined by the Department.

b. For the purposes of Section 329 of this rule, a relative is defined as a spouse or parent of a minor child.

c. Individuals who provide direct care or services must complete a background check and receive a clearance under IDAPA 16.05.06, "Criminal History and Background Checks."

04.Quality Assurance. Providers of Aged and Disabled waiver services are responsible for ensuring that they provide quality services in compliance with applicable rules.

a. The results of a quality assurance review conducted by the Department must be transmitted to the provider within forty-five (45) days after the review is completed.

b. The provider must respond to the quality assurance review within forty-five (45) days after the results are received from the Department. If problems are identified, the provider must implement a quality improvement plan and report the results to the Department upon request.

c. The Department may take enforcement actions as described in IDAPA 16.03.09, "Medicaid Basic Plan Benefits," Section 205, if the provider fails to comply with any term or provision of the provider agreement, or any applicable state or federal regulation.

05.HCBS Setting Compliance. Providers of Aged and Disabled waiver services are responsible for ensuring that they meet the person-centered planning and setting quality requirements under Sections 311 through 318 of these rules, as applicable, and must comply with associated Department quality assurance activities.

06.Specialized Medical Equipment and Supplies. Providers of specialized medical equipment and supplies must be enrolled in the Medicaid program as participating medical vendor providers. Providers must ensure all items meet applicable standards of manufacture, design, and installation. Preference will be given to equipment and supplies that are the most cost-effective option to meet the participant's needs.

07.Skilled Nursing Service Providers. Must be licensed in Idaho as an RN or LPN in good standing, or must be practicing on a federal reservation and be licensed in another state. Skilled nursing providers who provide direct care and services must complete a background check and receive a clearance under IDAPA 16.05.06, "Criminal History and Background Checks."

08.Consultation Services. Must be provided through a Personal Assistance Agency by a person who has demonstrated skills in training participants/family members in hiring, firing, training, and supervising their own care providers.

09.Adult Residential Care Providers. Will meet all applicable state laws and regulations. In addition, the provider must ensure that adequate staff are provided to meet the needs of the participants accepted for admission. Adult residential care providers who provide direct care or services must complete a background check and receive a clearance appropriate to the setting under IDAPA 16.03.19, "Certified Family Homes," or IDAPA 16.03.22, "Residential Assisted Living Facilities."

10.Providers of Home-Delivered Meals. Must be a public agency or private business, and must exercise supervision to ensure that:

a. Each meal meets one-third (1/3) of the Recommended Daily Allowance, as defined by the Food and Nutrition Board of the National Research Council of the National Academy of Sciences;

b. Meals are delivered under the service plan, in a sanitary manner, and at the correct temperature for the specific type of food;

c. Documentation is maintained demonstrating that the meals served are made from the highest USDA grade for each specific food served;

d. The agency or business is inspected and licensed as a food establishment under IDAPA 16.02.19, "Idaho Food Code";

e. A Registered Dietitian documents the review and approval of menus, menu cycles, and any changes or substitutions; and

f. Either by formal training or demonstrated competency, the training requirements contained in the Idaho provider training matrix and the standards for direct care staff under Subsection 329.03 of this rule have been met.

11.Personal Emergency Response Systems. Must demonstrate that the devices installed in a waiver participant's home meet Federal Communications Standards, Underwriter's Laboratory Standards, or equivalent standards.

12.Adult Day Health Providers. Must meet the following requirements:

a. Services provided in a facility must be provided in a facility that meets the building and health standards identified in IDAPA 16.03.21, "Developmental Disabilities Agencies (DDA)."

b. Services provided in a home must be provided in a home that meets the standards of home certification identified in IDAPA 16.03.19, "Certified Family Homes."

c. Services provided in a RALF must be provided in a facility that meets the standards identified in IDAPA 16.03.22, "Residential Assisted Living Facilities."

d. Adult day health providers who provide direct care or services must complete a background check and receive a clearance under IDAPA 16.05.06, "Criminal History and Background Checks."

e. Providers of adult day health must notify the Department on behalf of the participant, if the adult day health is provided in a CFH other than the participant's primary residence. The adult day health provider must provide care and supervision appropriate to the participant's needs as identified on the plan.

f. Adult day health providers who provide direct care or services must be free from communicable disease.

g. All providers of adult day health services must meet, either by formal training or demonstrated competency, the training requirements contained in the Idaho provider training matrix and the standards for direct care staff under Subsection 329.03 of this rule.

13.Non-Medical Transportation Services. Providers of non-medical transportation services must:

a. Possess a valid driver's license;

b. Complete a background check and receive a clearance under IDAPA 16.05.06, "Criminal History and Background Checks."

c. Possess valid vehicle insurance; and

d. Meet, either by formal training or demonstrated competency, the training requirements contained in the Idaho provider training matrix and the standards for direct care staff under Subsection 329.03 of this rule.

14.Attendant Care Providers. Provide direct care and services and must complete a background check and receive a clearance under IDAPA 16.05.06, "Criminal History and Background Checks." All providers of attendant care must meet, either by formal training or demonstrated competency, the training requirements contained in the Idaho provider training matrix and the standards for direct care staff under Subsection 329.03 of this rule.

15.Homemaker Services Providers. Must be employees of record or fact of an agency. Homemaker service providers who provide direct care or services must complete a background check and receive a clearance under IDAPA 16.05.06, "Criminal History and Background Checks." All homemaker services providers must meet, either by formal training or demonstrated competency, the training requirements contained in the Idaho provider training matrix and the standards for direct care staff under Subsection 329.03 of this rule.

16.Environmental Accessibility Adaptations. All services must be provided under applicable state or local building codes and meet state or local building, plumbing, and electrical requirements for certification.

17.Residential Habilitation Supported Living. When residential habilitation services are provided by an agency, the agency must be certified by the Department as a residential habilitation agency under IDAPA 16.04.17, "Residential Habilitation Agencies," and supervise the direct services provided. Individuals who provide residential habilitation services in the home of the participant (supported living) must be employed by a residential habilitation agency. Providers of residential habilitation services must meet the following requirements:

a. Staff who provide direct care or services must:

i. Be at least eighteen (18) years of age;

ii. Be a high school graduate, or have a GED, or demonstrate the ability to provide services according to a plan of service;

iii. Have current CPR and First Aid certifications;

iv. Be free from communicable disease;

v. Each staff person assisting with participant medications must successfully complete and follow the "Assistance with Medications" course available through the Idaho Professional Technical Education Program approved by the Idaho State Board of Nursing or other Department-approved training.

vi. Complete a background check and receive a clearance under IDAPA 16.05.06, "Criminal History and Background Checks;"

vii. Have appropriate certification or licensure if required to perform tasks that require certification or licensure. Direct service staff must also have taken a traumatic brain injury training course approved by the Department.

b. The provider agency is responsible for providing direct service staff with a traumatic brain injury training course approved by the Department, and training specific to the needs of the participant.

c. Prior to delivering services to a participant, agency direct service staff must complete an orientation program that includes the following subjects:

i. Purpose and philosophy of services;

ii. Service rules;

iii. Policies and procedures;

iv. Proper conduct in relating to waiver participants;

v. Handling of confidential and emergency situations that involve the waiver participant;

vi. Participant rights;

vii. Methods of supervising participants;

viii. Working with individuals with traumatic brain injuries; and

ix. Training specific to the needs of the participant.

d. Additional training requirements must be completed within six (6) months of employment with the residential habilitation agency and include:

i. Methodologies for training in a systematic and effective manner;

ii. Techniques and strategies for teaching adaptive behaviors;

iii. Feeding;

iv. Communication;

v. Mobility;

vi. ADL;

vii. Body mechanics and lifting techniques;

viii. Housekeeping techniques; and

ix. Maintenance of a clean, safe, and healthy environment.

e. The provider agency will be responsible for providing on-going training specific to the needs of the participant as needed.

18.Day Habilitation Providers. Must have a minimum of two (2) years of experience working directly with persons with a traumatic brain injury, provide documentation of standard licensing specific to their discipline, and have taken a traumatic brain injury course approved by the Department. Day habilitation providers who provide direct care and services must complete a background check and receive a clearance under IDAPA 16.05.06, "Criminal History and Background Checks."

19.Respite Care Providers. Must meet the following:

a. Have received care-giving instructions in the needs of the person who will be provided the service;

b. Demonstrate the ability to provide services according to a plan of service;

c. Be free of communicable disease; and

d. Respite care service providers who provide direct care and services must complete a background check and receive a clearance under IDAPA 16.05.06, "Criminal History and Background Checks."

20.Supported Employment Services. Must be provided by an agency that supervises the direct service and is accredited by the Commission on Accreditation of Rehabilitation Facilities, other comparable standards, or meet State requirements to be a State-approved provider. Supported employment service providers who provide direct care or services must complete a background check and receive a clearance under IDAPA 16.05.06, "Criminal History and Background Checks."

21.Chore Services Providers. Must meet the following:

a. Be skilled in the type of service to be provided.

b. Demonstrate the ability to provide services according to a plan of service.

c. Chore service providers who provide direct care and services must complete a background check and receive a clearance under IDAPA 16.05.06, "Criminal History and Background Checks."

d. Meet, either by formal training or demonstrated competency, the training requirements in the Idaho provider training matrix and the standards for direct care staff under Subsection 329.03 of this rule.

22.Transition Services. Transition managers as described in Section 350.01 of these rules are responsible for administering transition services.

Idaho Admin. Code r. 16.03.10.329

Effective July 1, 2024