Idaho Admin. Code r. 16.03.09.564, Healthy Connections: Provider Qualifications and Duties

Permits physicians, physician assistants, advanced practice register nurses, and their care teams to provide primary care services to Healthy Connections participants. Mandates that Healthy Connections providers offer the services listed in Idaho Admin. Code r. 16.03.09.562. Permits these providers to obtain a higher reimbursement for offering additional patient-centered medical home services. Defines these services as including participation in the Idaho Health Data Exchange, using an evidence-based primary care services model as a means of improving outcomes, reporting clinical data to the Department of Health and Welfare, coordinating care, and integrating behavioral health services. Establishes conditions for provider participation in the Healthy Connections program (e.g., execution of a provider agreement, enrolling all of their clinic locations in the program). Permits providers to set limits on the number of Medicaid patients they see, but requires providers to accept all Medicaid participants that choose the provider or are assigned to the provider until they reach their limit. Permits providers to withdraw from their role as a Medicaid participant’s primary care provider by notifying the Department and the participant in writing 30 days prior to the effective date of the withdrawal. Requires providers to maintain financial and patient records for at least six years following the last date of service. Requires providers to transfer copies of records to a participant’s new primary care provider when requested by the participant. Authorizes the Department to access provider records.