Idaho Admin. Code r. 16.03.13.010

Current through September 2, 2024

Section 16.03.13.010 - DEFINITIONS

01.Circle of Supports. People who encourage and care about the participant and provide unpaid supports.

02.Community Support Worker. An individual, agency, or vendor selected and paid by the participant to provide community support worker services.

03.Community Support Worker Services. Community support worker services are those identified supports listed in Section 110 of these rules.

04.Consumer-Directed Community Supports (CDCS). For the purposes of this chapter, consumer-directed supports include Self-Directed Community Supports (SDCS) and Family-Directed Community Supports (FDCS).

05.Family-Directed Community Supports (FDCS). A program option for children eligible for the Children's Developmental Disabilities (DD) Waiver and the Children's Home and Community Based Services State Plan Option described in IDAPA 16.03.10, "Medicaid Enhanced Plan Benefits."

06.Financial Management Services (FMS). Services provided by a fiscal employer agent that include:

a. Financial guidance and support to the participant by tracking individual expenditures and monitoring overall budgets;

b. Performing payroll services; and

c. Handling billing and employment related documentation responsibilities.

07.Fiscal Employer Agent (FEA). An agency that provides financial management services to participants who have chosen the CDCS option. The fiscal employer agent (FEA) is selected by the participant. The duties of the FEA are defined under Section 3504 of the Internal Revenue Code (26 USC 3504).

08.Goods. Tangible products or merchandise that are authorized on the support and spending plan.

09.Guiding Principles for the CDCS Option. Consumer-Directed Community Supports is based upon the concept of self-determination and has the following guiding principles:

a. Freedom for the participant to make choices and plan their own life;

b. Authority for the participant to control resources allocated to them to acquire needed supports;

c. Opportunity for the participant to choose their own supports;

d. Responsibility for the participant to make choices and take responsibility for the result of those choices; and

e. Shared responsibility between the participant and their community to help the participant become an involved and contributing member of that community.

10.Home and Community Based Services (HCBS). HCBS are those long-term services and supports that assist eligible participants to remain in their home and community.

11.Participant. A person eligible for and enrolled in the Consumer-Directed Services Programs.

12.Readiness Review. A review conducted by the Department to ensure that each fiscal employer agent is prepared to enter into and comply with the requirements of the provider agreement and this chapter of rules.

13.Self-Directed Community Supports (SDCS). A program option for adults eligible for the Adult Developmental Disabilities (DD) Waiver described in IDAPA 16.03.10, "Medicaid Enhanced Plan Benefits."

14.Support and Spending Plan. A support and spending plan is a document that functions as a participant's plan of care when the participant is eligible for and has chosen a consumer-directed service option. This document identifies the goods or services, or both, selected by a participant, including those goods, services, and supports available outside of Medicaid-funded services that can help the participant meet desired goals, and the cost of each of the identified goods and services. The participant uses this document to manage their individualized budget.

15.Supports. Services provided for a participant, or a person who provides a support service. A support service may be a paid service provided by a community support worker, or an unpaid service provided by a natural support, such as a family member, a friend, neighbor, or other volunteer. A person who provides a support service for pay is a paid support. A person who provides a volunteer support service is a natural support.

16.Support Broker. An individual who advocates on behalf of the participant and who is hired by the participant to provide support broker Services.

17.Support Broker Services. Services provided by a support broker to assist the participant with planning, negotiating, and budgeting.

18.Traditional Adult DD Waiver Services. A program option for participants eligible for the Adult Developmental Disabilities (DD) Waiver consisting of the specific Medicaid Enhanced Plan Benefits described in IDAPA 16.03.10, "Medicaid Enhanced Plan Benefits."

19.Traditional Children's DD Waiver Services. A program option for children eligible for the Children's Developmental Disabilities (DD) Waiver consisting of the specific Medicaid Enhanced Plan Benefits described in IDAPA 16.03.10, "Medicaid Enhanced Plan Benefits."

20.Traditional Children's HCBS State Plan Option Services. A program option for children eligible for the Children's Home and Community-Based Services (HCBS) State Plan Option consisting of the specific Medicaid Enhanced Plan Benefits described in IDAPA 16.03.10, "Medicaid Enhanced Plan Benefits."

21.Waiver Services. A collective term that refers to services provided under a Medicaid Waiver program.

Idaho Admin. Code r. 16.03.13.010

Effective March 17, 2022