Care Coordination/Care Management in Idaho
Care Coordination/Care Management in Idaho
| Subtopic | Statute/Regulation | Description |
|---|
| Information sharing across providers (including communication with other providers, across state lines, patient transfer) | Idaho Admin. Code r. 16.03.02.100, Administration | Establishes standards for the skilled nursing facility governing bodies and administrators. Requires skilled nursing facility administrators to... |
| Idaho Admin. Code r. 16.03.02.154, Medical Direction | Requires skilled nursing facilities and intermediate care facility administrators to contract with a physician to serve as the facility’s... | |
| Idaho Admin. Code r. 16.03.02.302, Specialized Rehabilitative Services | Requires skilled nursing facilities and intermediate care facilities to contract with qualified personnel for the provision of specialized... | |
| 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... | |
| Idaho Admin. Code r. 16.03.09.723, Home Health Services: Procedural Requirements | Requires a physician to order home health services and specifies the information that physicians must include in these orders (e.g., the physician... | |
| Idaho Admin. Code r. 16.03.09.733, Therapy Services: Procedural Requirements | Permits Medicaid reimbursement for therapy services when ordered by a physician, nurse practitioner or physician assistant. Requires the ordering... | |
| Idaho Admin. Code r. 16.03.10.209, Private Duty Nursing: Provider Qualifications and Duties | Requires a child’s primary RN to submit a plan of care to the Department of Health and Welfare annually for reauthorization. Requires... | |
| Idaho Admin. Code r. 24.26.01.356, Scope and Practice Standards | Adopts the National Association of Certified Professional Midwives’ Essential Documents as the scope and practice standards for licensed Idaho... | |
| Idaho Admin. Code r. 24.26.01.360, Newborn Transfer of Care or Consultation | Identifies the circumstances in which a licensed midwife must transfer a newborn to a hospital (e.g., infant displays respiratory distress, seizure... | |
| Idaho Admin. Code r. 27.01.01.350, Pharmacist Prescribing: General Requirements | Authorizes pharmacists to prescribe drugs and devices if they have a patient-prescriber relationship with the patient, have met proper educational... | |
| Idaho Admin. Code r. 27.01.01.351, Collaborative Pharmacy Practice | Permits pharmacist to enter into collaborative agreements with other providers. Specifies the elements that such agreements must address (e.g., the... | |
| Idaho Code Ann. § 54-1769, Communication Regarding Biological Products | Requires pharmacists that dispense a biological product to notify the prescribing practitioner of the name and manufacturer of the dispensed... |
| Treatment planning when using interdisciplinary team (including assessments, plan of care, discharge/transfer planning | Idaho Admin. Code r. 16.03.02.200, Nursing Services | Requires skilled nursing facilities and intermediate care facilities to designate a licensed registered nurse as their Director of Nursing Services.... |
| Idaho Admin. Code r. 16.03.07.022, Director | Establishes qualifications and responsibilities for home health agency directors— the licensed physician or registered nurse who supervises,... | |
| Idaho Admin. Code r. 16.03.07.030, Plan of Care | Requires home health agencies to establish a written care of plan for each patient and specifies the content of this plan (e.g., diagnoses, needed... | |
| Idaho Admin. Code r. 16.03.09.403, Inpatient Hospital Services: Procedural Requirements | Establishes procedural requirements for inpatient hospital services provided to Medicaid recipients (e.g., prior authorization, certificates of need... | |
| Idaho Admin. Code r. 16.03.09.703, Inpatient Behavioral Health Services: Procedural Requirements | Specifies the information that providers must include when submitting prior authorization requests for inpatient behavioral health services (e.g.,... | |
| Idaho Admin. Code r. 16.03.09.733, Therapy Services: Procedural Requirements | Permits Medicaid reimbursement for therapy services when ordered by a physician, nurse practitioner or physician assistant. Requires the ordering... | |
| Idaho Admin. Code r. 16.03.10.204, Private Duty Nursing: Coverage and Limitations | Authorizes Medicaid coverage of private duty nursing (PDN) services when ordered by a physician. Requires a multi-disciplinary team to develop a plan... | |
| Idaho Admin. Code r. 16.03.10.266, Nursing Facility: Behavioral Care Unit (BCU) and Rate Structure | Establishes Behavioral Care Unit rates, criteria for participation in a BCU, staffing and training requirements, and care planning standards.... | |
| Idaho Admin. Code r. 16.03.10.304, Personal Care Services: Procedural Requirements | Requires personal care services (PCS) to be provided in accordance with a plan of care or a negotiated service agreement (NSA). Requires a plan of... | |
| Idaho Admin. Code r. 16.03.10.316, Home and Community Based Person-Centered Planning Requirements | Requires providers of home and community based services to allow participants—or the participant’s decision-maker— to direct the... | |
| Idaho Admin. Code r. 16.03.10.317, Home and Community Based Person-Centered Service Plan Requirements | Identifies the elements that home and community based person-center service plans must include (e.g., necessary services, service delivery... | |
| Idaho Admin. Code r. 16.03.10.350, Transition Management | Establishes standards for transition management services provided to participants who are transferring from a facility to a community setting. Tasks... | |
| Idaho Admin. Code r. 16.03.10.524, Children’s DD HCBS State Plan Option: Plan of Service Process | Requires the Department of Health and Welfare to ensure that every participant who receives home and community based services (HCBS) has a plan of... | |
| Idaho Admin. Code r. 16.03.10.583, ICF/ID: Information Required for Determination | Requires participants receiving care in an ICF/ID to undergo medical, social, and psychological evaluations and have a plan of care created for them... | |
| Idaho Admin. Code r. 16.03.13.170, Person-Centered Planning | Establishes criteria for the ‘person-centered planning’ process that must occur in ICFs/ID. Grants the participant the ability to direct... | |
| Idaho Admin. Code r. 16.03.14.440, Rehabilitation Services | Requires hospitals that provide rehabilitation services to offer, at minimum, physical therapy, occupational therapy, speech pathology, and audiology... | |
| Idaho Admin. Code r. 16.07.15.341, Individualized Service Plans | Requires behavioral health programs to create an individualized service plan for each participant based on a health assessment. Specifies the... | |
| Idaho Admin. Code r. 16.07.33.200, Individualized Treatment Plan | Requires the Department of Health and Welfare to create an individualized treatment plan for clients receiving adult mental health services. Requires... | |
| Idaho Admin. Code r. 16.07.37.115, Treatment Plan | Requires the Department of Health and Welfare to develop a treatment plan for recipients of child’s mental health services. Require’s a... | |
| Idaho Code Ann. § 39-306, Acceptance for Treatment — Rules | Requires the Board of Health and Welfare to establish rules for acceptance into a treatment program for alcoholism or substance use disorder.... |
| Discharge instructions/Required follow-up. | Idaho Admin. Code r. 16.03.09.561, Healthy Connections: Participant Eligibility | Requires Idaho Medicaid participants to enroll in the Healthy Connections program unless the Department of Health and Welfare provides an exemption.... |
| Idaho Admin. Code r. 16.03.14.540, Infection Control | Requires hospitals to establish an infection control committee, infection control program, and infection control prevention procedures. Requires the... |
| New coordinated systems of care (ACOs, Patient Centered Medical Homes/Health homes) (Cross reference with Quality Measurement) | Idaho Admin. Code r. 16.03.09.561, Healthy Connections: Participant Eligibility | Requires Idaho Medicaid participants to enroll in the Healthy Connections program unless the Department of Health and Welfare provides an exemption.... |
| Idaho Admin. Code r. 16.03.09.562, Healthy Connections: Primary Care Services | Defines the services that Healthy Connections participants who are enrolled with a primary care provider may receive (e.g., care management and... | |
| Idaho Admin. Code r. 16.03.09.563, Healthy Connections: Procedural Requirements | Requires the Department of Health and Welfare to provide 60 days notice to providers of any changes to the Healthy Connections program. Requires the... | |
| 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... | |
| Idaho Code Ann. § 31-3503F, Medical Home | Requires the Department of Health and Welfare to create a community-based system for referring medically indigent patients to medical homes upon... | |
| Idaho Code Ann. § 56-263, Medicaid Managed Care Plan | Requires the Department of Health and Welfare to present a Medicaid Managed Care Plan to Idaho’s legislate that focuses on high-cost... |
| Informed consent requirements (If the information is going beyond the patient and provider | Idaho Admin. Code r. 16.03.09.682, Family Planning Services: Coverage and Limitations | Identifies the family planning treatments, supplies, and services covered by Medicaid and places limits on such coverage. Prohibits reimbursement for... |
| Payment reform initiatives | Idaho Admin. Code r. 16.03.10.296, Nursing Facility: Quality Incentives | Authorizes the Department of Health and Welfare to issue incentive payments to nursing facility providers that provide quality care. Permits the... |
| Disease management | Idaho Admin. Code r. 27.01.01.351, Collaborative Pharmacy Practice | Permits pharmacist to enter into collaborative agreements with other providers. Specifies the elements that such agreements must address (e.g., the... |
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