Section 16.03.10.521 - CHILDREN'S DD HCBS STATE PLAN OPTION: DEFINITIONSFor the purposes of Sections 520 through 528 of these rules, the following terms are used as defined below.
01.Annual. Every three hundred sixty-five (365) days, except during a leap year which equals three hundred sixty-six (366) days.02.Community. Natural, integrated environments outside of the participant's home, outside of DDA center-based settings, or at school outside of school hours.03.Developmental Disabilities Agency (DDA). a. A type of developmental disabilities facility, as defined in Section 39-4604, Idaho Code, that is non-residential and provides services on an outpatient basis;b. Certified by the Department to provide services to participants with developmental disabilities; andc. A business entity, open for business to the general public.04.Family-Centered Planning Process. A participant-focused planning process directed by the participant or the participant's decision-making authority and facilitated by the paid or non-paid plan developer. The family-centered planning team discusses the participant's strengths, needs, and preferences, including the participant's safety and the safety of those around the participant. This discussion helps the participant or the participant's decision-making authority make informed choices about the services and supports included on the plan of service.05.Family-Centered Planning Team. The planning group who helps inform the participant about available services to develop the participant's plan of service. This group includes, at a minimum, the participant, the participant's decision-making authority, and the plan developer. The family-centered planning team must include people chosen by the participant and the family.06.HCBS State Plan Option. The federal authority under Section 1915(i) of the Social Security Act that allows a state to provide through a state plan amendment, medical assistance for home and community-based services for elderly and participants with disabilities who without the provision of services the participants would require institutional level of care.07.Integration. The process of promoting a lifestyle for participants with developmental disabilities that is as much as possible like that of other citizens of the community, including living in the community and having access to community resources. A further goal of this process is to enhance the social image and personal competence of participants with developmental disabilities.08.Level of Support. The amount of services and supports necessary to allow the participant to live independently and safely in the community.09.Medical, Social, and Developmental Assessment Summary. A form used by the Department or its contractor to gather a participant's medical, social and developmental history and other summary information. It is required for all participants receiving home and community-based services under a plan of service. The information is used in the assessment and authorization of a participant's services.10.Plan Developer. A paid or non-paid person who, under the direction of the participant or the participant's decision-making authority, is responsible for developing a single plan of service and subsequent addenda. The plan of service 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 Section 317 of these rules.11.Plan Monitor. A person who oversees the provision of services on a paid or non-paid basis and is identified on the participant's plan of service.12.Plan of Service. An initial or annual plan of service, developed by the participant, the participant's decision-making authority, and the family-centered planning team, that identifies all services that were determined through a family-centered planning process. Plan development is required in order to provide DD services to children from birth through seventeen (17) years of age. This plan must be developed in accordance with Sections 316 and 317 of these rules.13.Practitioner of the Healing Arts, Licensed. A licensed physician, physician assistant, or nurse practitioner.14.Prior Authorization (PA). A process for determining a participant's eligibility for services and medical necessity prior to the delivery or payment of services as described in Sections 520 through 528 of these rules.15.Provider Status Review. The written documentation that identifies the participant's progress toward goals defined in the plan of service, and demonstrates the continued need for the service.16.Right Care. Accepted treatment for defined diagnosis, functional needs and abilities to achieve the desired outcome. The right care is consistent with best practice and continuous quality improvement.17.Right Place. Services delivered in the most integrated setting in which they normally occur, based on the participant's choice to promote independence.18.Right Price. The most integrated and least expensive services that are sufficiently intensive to address the participant's needs. The amount is based on the individual's needs for services and supports as identified in the assessment.19.Right Outcomes. Services based on assessed need that ensure the health and safety of the participant and result in progress, maintenance, or delay or prevention of regression for the participant.20.Supervisor. An individual responsible for the supervision of DDA staff or independent providers that must meet the intervention specialist or professional qualifications as outlined in IDAPA 16.03.09, "Medicaid Basic Plan Benefits", Section 570.21.Support Services. Services that provide supervision and assistance to a participant or facilitates integration into the community.Idaho Admin. Code r. 16.03.10.521