Medicaid/CHIP Data Requirements in Idaho
Medicaid/CHIP Data Requirements in Idaho
| Subtopic | Statute/Regulation | Description |
|---|
| Access to Medicaid data (by patients, providers, and government agencies) | Idaho Admin. Code r. 16.03.09.230, General Payment Procedures | Permits Idaho Medicaid recipients to obtain care from the participating provider of their choice. Requires providers to submit Medicaid claims to the... |
| Idaho Admin. Code r. 16.03.09.330, Provider’s Responsibility to Maintain Records | Requires providers to maintain records regarding expenditures, cost allocations processes, and revenues. Requires providers to allow an auditor to... | |
| Idaho Admin. Code r. 16.03.09.736, Therapy Services: Quality Assurance Activities | Prohibits coverage for therapy services that are not medically necessary and imposes penalties on providers that receive medicaid reimbursement for... | |
| Idaho Admin. Code r. 16.03.10.040, Provider’s Responsibility to Maintain Records | Requires providers to maintain records regarding expenditures, cost allocations processes, and revenues. Requires providers to allow an auditor to... | |
| Idaho Admin. Code r. 16.03.10.612, ICF/ID: Audit Standards and Requirements | Requires a fiscal intermediary to review a prospective ICF/ID provider’s accounting system before the provider receives Medicaid payments to... | |
| Idaho Admin. Code r. 16.05.07.101, Documentation of Services and Access to Records | Requires Medicaid providers to document services in a manner sufficient to justify the service or claim. Requires providers to retain this... | |
| Idaho Admin. Code r. 16.05.07.200, Denial of Payment | Specifies the grounds on which the Department of Health and Welfare may deny payment to a Medicaid provider (e.g., barring access the records,... | |
| Idaho Admin. Code r. 16.05.07.250, Permissive Exclusions from the Medicaid Program | Identifies the circumstances in which the Department of Health and Welfare may exclude a person or entity from the Medicaid program (e.g., placing a... | |
| Idaho Admin. Code r. 16.07.15.152, On-Site Review | Requires behavioral health programs to allow the Department of Health and Welfare to conduct on-site reviews as a means of determining the program... | |
| Idaho Code Ann. § 31-3503E, Medicaid Eligibility Determination | Requires hospitals to complete and submit a medical assistance application and a request for a Medicaid eligibility determination within 31 days of... | |
| Idaho Code Ann. § 56-226, Medicaid Fraud Control Unit | Establishes a Medicaid Fraud Control Unit (“MFCU”) within Idaho’s Office of the Attorney General. Grants the MFCU authority to... |
| Mandatory reporting by Medicaid providers (cost/utilization information) | Idaho Admin. Code r. 16.03.09.300, Cost Reporting | Requires Medicaid providers to use the Department of Health and Welfare’s Medicaid cost report forms when filing their cost reports. Permits... |
| Idaho Admin. Code r. 16.03.09.405, Inpatient Hospital Services: Provider Reimbursement | Establishes standards and procedures for Medicaid reimbursement of inpatient hospital services. Requires a Medicaid participant’s admission and... | |
| Idaho Admin. Code r. 16.03.10.226, Nursing Facility: Procedural Responsibility | Requires nursing facility administrators to report readmissions, discharges, changes in participant income, and when a participant’s account... |
| Quality reporting by Medicaid providers (cross post to care coordination/care management (chronic disease management; sharing information across providers; enrollee participation) | 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... |
| Medicaid medical records maintenance by providers (including retention period, storage, and other recordkeeping requirements) | Idaho Admin. Code r. 16.03.09.574, Children’s Habilitation Intervention Services: Procedural Requirements | Requires providers of children’s habilitation intervention services to obtain prior authorization from the Department of Health and Welfare.... |
| Idaho Admin. Code r. 16.03.10.328, Aged and Disabled Waiver Services: Procedural Requirements | Requires the Department of Health and Welfare—or their contractor— to develop an individual service plan for participants who are... | |
| Idaho Admin. Code r. 16.03.10.525, Children’s DD HCBS State Plan Option: Procedural Requirements | Requires children’s DD HCBS services to receive prior authorization. Requires providers of HCBS services to assure quality services by... | |
| Idaho Admin. Code r. 16.03.10.612, ICF/ID: Audit Standards and Requirements | Requires a fiscal intermediary to review a prospective ICF/ID provider’s accounting system before the provider receives Medicaid payments to... | |
| Idaho Admin. Code r. 16.03.10.704, Adult DD Waiver Services: Procedural Requirements | Requires the development of a plan of service for participants who receive adult DD waiver services. Requires providers of such waiver services to... | |
| Idaho Admin. Code r. 16.05.07.101, Documentation of Services and Access to Records | Requires Medicaid providers to document services in a manner sufficient to justify the service or claim. Requires providers to retain this... | |
| Idaho Code Ann. § 56-209o, Failure to Retain Records | Required persons that receive payment for providing Medicaid services to maintain records for at least five years from the date of payment.... |
| Confidentiality of Medicaid data (including penalties for violating confidentiality) | Idaho Code Ann. § 56-209j, Substance Abuse Screening and Testing Programs | Requires the Department of Health and Welfare to implement a substance abuse screening program for temporary assistance applicants. Requires the... |
| Idaho Code Ann. § 56-222, Misuse of Public Assistance Lists and Records | Prohibits the use or disclosure of information and records regarding public assistance applicants or recipients unless such use or disclosure is... |
.png)