Current through September 2, 2024
Section 16.03.13.312 - FISCAL EMPLOYER AGENT DUTIES AND RESPONSIBILITIES: PAYMENT REQUIREMENTS01.Requirement to Accept a Per Member Per Month (PMPM) Payment. The Department will pay, and the provider must accept a per member per month (PMPM) payment that covers a comprehensive set of fiscal employer agent services. The Department will set allowable reimbursement rates for PMPM based on a methodology approved by CMS in the DD HCBS Waiver. The provider can only bill the PMPM rate for the months services are actually provided for participants, The provider must provide transition, training, and closeout services during the active agreement, at no additional cost to the Department.02.PMPM Payment Process Requirements. The payment (PMPM) must include all administrative costs, travel, transition, training, and closeout services. The Department will not pay for participants who do not have a support and spending plan. For the purposes of PMPM payment, one (1) month must include all payroll batch dates within that specific calendar month.03.Requirement to Complete a Readiness Review. The provider must complete a readiness review prior to billing for services.Idaho Admin. Code r. 16.03.13.312