Section 16.03.10.727 - SERVICE COORDINATION: COVERAGE AND LIMITATIONSService coordination consists of services provided to assist individuals in gaining access to needed services, and includes the following.
01.Plan Assessment and Periodic Reassessment. Activities that are required to determine the participant's needs by development of a plan assessment and periodic reassessment as described in Section 730 of these rules. These activities include:a. Taking a participant's history;b. Identifying the participant's needs and completing related documentation; andc. Gathering information from other sources such as family members, medical providers, social workers, and educators to form a complete assessment of the participant.02.Development of the Plan. Development and revision of a specific plan, described in Section 731 of these rules that includes information collected through the assessment and specifies goals and actions needed by the participant. The plan must be updated at least annually and as needed to meet the needs of the participant.03.Referral and Related Activities. Activities that help link the participant with service providers able to provide services to address identified needs and achieve goals specified in the service coordination plan.04.Monitoring and Follow-Up Activities. Monitoring and follow-up contacts that are necessary to ensure the plan is implemented and adequately address the participant's needs. These activities may be with the participant, family members, providers, or other entities or individuals and conducted as frequently as necessary. These activities must include at least one (1) face-to-face contact with the participant at least every ninety (90) days. The face-to-face encounter may occur via synchronous interaction virtual care, as defined in Title 54, Chapter 57, Idaho Code, to determine whether the following conditions are met: a. Services are being provided according to the participant's plan;b. Services in the plan are adequate; andc. Whether there are changes in the needs or status of the participant, and if so, making necessary adjustments in the plan and service arrangements with providers.05.Crisis Assistance. Crisis service coordination used to assist a participant to access community resources to resolve a crisis; it does not include crisis counseling, transportation to emergency service providers, or direct skill-building services. The need for all crisis assistance hours must meet the definition of "crisis" in Section 721 of these rules. a. Crisis Assistance for Children's Service Coordination. Crisis hours are unavailable until all available hours of service coordination have already been provided in the month. Crisis hours for children's service coordination must be authorized by the Department.b. Crisis Assistance for Adults With a Developmental Disability. Crisis hours are unavailable until all available hours of service coordination have already been provided in the month. Crisis assistance for adults with a developmental disability must be authorized by the Department and is based on community crisis supports under Section 646 through 648 of these rules.c. Authorization for crisis assistance hours may be requested retroactively because of a crisis under Section 721 of these rules when a participant's service coordination benefits have been exhausted and no other means of support is available to the participant. In retroactive authorizations, the service coordinator must complete a crisis resolution plan and submit a request for crisis services to the Department within five (5) business days of the last day of providing the service.06.Contacts for Assistance. Service coordination may include contacts with non-eligible individuals only when the contact is directly related to identifying the needs and supports to help the participant access services.07.Exclusions. Service coordination does not include activities that are: a. An integral component of another covered Medicaid service;b. Integral to the administration of foster care programs;c. Integral to the administration of another non-medical program for which a participant may be eligible. This exclusion does not apply to case management provided as part of the individualized education program or individualized family service plan required by the Individuals with Disabilities Education Act.08.Limitations on the Provision of Direct Services. Providers of service coordination services may only provide both service coordination and direct services to the same Medicaid participant when the participant is receiving children's service coordination. The service coordination provider must document that the participant has made a free choice of service coordinators and direct service providers.09.Limitations on Service Coordination. Service coordination is limited to four and a half (4.5) hours per month, except when utilizing unused hours in the individual's current plan of service from previous months.10.Limitations on Service Coordination Plan Assessment and Plan Development. Reimbursement for the annual assessment and plan development cannot exceed twelve (12) hours per year.Idaho Admin. Code r. 16.03.10.727