Promoting and protecting the health and safety of all Idahoans

Idaho Receives Final Approval of the Statewide Transition Plan

Effective October 3, 2018, Idaho became the tenth state to receive Final Approval for the Home and Community Based Services (HCBS) Statewide Transition Plan. The HCBS project team appreciates the hard work and dedication from all participants, providers, advocates, and staff throughout this process. The team is appreciative of the amount of work from all involved to complete this momentous task. Final approval would not have been possible without each person involved. CMS’ letter to Idaho can be found under the resources tab to the right in the Statewide Transition Plan link.

Moving forward, all HCBS providers will need to follow IDAPA rules, including creating and maintaining policies and procedures, while offering HCB services. Maintaining and following current policies and procedures, which address HCBS rules, will help ensure continued compliance. All providers will be required to ensure their policies and procedures are implemented as written and have documented evidence as support.

Idaho has updated the ongoing monitoring processes to ensure each provider offering HCBS will be reviewed for compliance at least every three years. Idaho will use a variety of program staff and the Division of Licensing and Certification to make sure each HCBS setting quality is reviewed. Additionally, all new providers enrolling with Medicaid through the New Provider Enrollment process will be expected to produce policies and procedures that comply with the IDAPA rules identified in the Medicaid Enhanced Benefits Plan

Providers can continue to use the Provider Toolkit located on the right side of this webpage. All information and guidance in the Provider Toolkit section is current and can be used by providers to understand HCBS rules, develop policies and procedures, and implement practices to ensure a compliant setting.

Process Updates: Requests for Corrective Action Plans

This communication impacts all Medicaid Home and Community-Based Services (HCBS) providers, including Certified Family Homes (CFH), Residential Assisted Living Facilities (RALF), Adult Day Health (ADH), Developmental Disability Agencies (DDA), Supported-Living providers, Personal Care Services (PCS), Supported Employment, and any other entity providing HCBS.

Any time a Medicaid provider is found to be in violation of IDAPA rules and requirements, they may be asked to complete a Corrective Action Plan (CAP) explaining how the violation will be corrected and prevented in the future.  Previously, each program providing oversight to the various provider types had their own process related to CAPs.

In order to simplify the procedure and provide consistency across all provider types, Medicaid's Bureau of Developmental Disability Services (BDDS) and Bureau of Long-Term Care (BLTC) have collaborated with the Division of Family and Community Services (FACS) to develop a single CAP process. 
The new process includes standardization of time frames and documentation.  This will allow providers sufficient time to make needed correction.  Additionally, this will give the Department time to provide any needed technical assistance to help providers reach compliance.  

Changes to the process 

If a provider receives a request for a CAP, the provider is expected to develop and implement an acceptable CAP within 45 days. Department Quality Assurance/Quality Improvement staff can help the provider by offering:
• Technical assistance
• An onsite meeting
• Reasonable support to help the provider comply

Once the CAP has been accepted, the provider will need to submit evidence demonstrating the CAP was successfully implemented.  

If a provider is unable to supply an acceptable CAP, or provide proof of successful implementation, action(s) against their Medicaid Provider Agreement may be recommended.  Provider Agreement Enforcement Actions can be found in IDAPA 16.03.09, “Medicaid Basic Plan Benefits,” subsection 205.03. 

These changes will be effective May 15, 2017. 

Initial Approval of the Statewide Transition Plan

Idaho Medicaid’s Home and Community Based Services (HCBS) project team is pleased to announce that Idaho has received initial approval of the Statewide Transition Plan (STP) from the federal waiver authorities. Initial approval of the STP means that Idaho has completed a systemic assessment of residential and non-residential HCBS service settings. Using the systemic assessment, Idaho identified gaps between Medicaid program areas and federal HCBS regulations in order to plan the remediation actions Idaho will take. Finally, Idaho identified the timeframes that the state will use to fully comply with the federal HCBS regulations. The Centers for Medicare and Medicaid Services (CMS) has reviewed Idaho’s STP and determined that the systemic assessment, remediation actions, and the timeframes are appropriate to comply with the federal timeframes and issued Idaho an initial approval.  

Idaho has much work to do in order to receive final approval of the STP.  Idaho must complete the following actions in order to obtain final approval:

  • Complete site-specific assessment of all HCBS settings
  • Develop a remediation plan for providers that do not comply with the HCBS regulations
  • Validate documentation from providers who have undergone remediation
  • Identify and assess settings that are presumed to have institutional characteristics
  • Identify a plan for participants who live in non-compliant setting to transition to compliant HCBS settings

Establish a plan for ongoing monitoring of HCBS settings in IdahoThe HCBS project team is working diligently to ensure that Idaho is working toward final approval of the STP. Idaho will continue to work closely with CMS to ensure that their concerns and expectations are addressed. Idaho’s initial approval letter is located on this site, under the Resources tab.

HCBS Provider Toolkit

The Division of Medicaid with the Department of Health and Welfare has developed a provider toolkit to assist all Idaho providers of Home and Community Based Services (HCBS) to comply with the new HCBS federal regulations and HCBS-related IDAPA rules. The provider toolkit gives Medicaid providers guidance about how to come into and remain compliant with the regulations and rules.  This toolkit contains information about the HCBS IDAPA rules, the intent of the HCBS IDAPA rules, best practices for compliance with HCBS IDAPA rules, and the Assessment documents that providers will be required to complete.  The toolkit also includes a glossary of terms that relate to HCBS settings, a participants right document,  sample policies and procedures for certified family homes, as well as additional resources for providers. 

The HCBS provider toolkit can be located on this page under the “Provider Toolkit” section in the right hand column. A hard copy of this document can be accessed at the regional Medicaid offices throughout the state.  The locations of the regional Idaho Medicaid offices are: Coeur D’ Alene, Lewiston, Caldwell, Boise, Twin Falls, Pocatello, and Idaho Falls.  

An updated training schedule has been included on this page as well.  This training schedule is entitled “Home and Community Based Setting training”.  This document is located under the “What’s New” section on the right hand side of this web page.

HCBS Rules

Medicaid Home and Community Based Services (HCBS) went into effect Friday, July 01, 2016. The Medicaid HCBS rules are contained in the Medicaid Enhanced rules in IDAPA 16.03.10 and the Consumer-Directed Services rules in IDAPA 16.03.13 which are published on the Idaho Department of Administration Website.  A direct link to these two sections of rules is posted on this page, under the “What’s New” section.

The Medicaid HCBS rules implement requirements to ensure that individuals receiving Medicaid Home and Community Based Services are integrated in and supported to gain full access to their community. Idaho Medicaid is currently working with stakeholders to establish a resource toolkit that will  assist Idaho providers of Medicaid HCBS services to come into compliance with the new HCBS IDAPA rules.  

Home and Community Based Settings 

The Department of Health and Human Services’ Centers for Medicare and Medicaid Services (CMS) published regulations in the Federal Register on January 16, 2014, which became effective on March 17, 2014, implementing new requirements for Medicaid’s 1915(c), 1915(i), and 1915(k) Home and Community-Based Services (HCBS) waivers. The purpose of the regulation is to ensure that individuals receive Medicaid HCBS in settings that are integrated in and support full access to the greater community and that the individual’s role in service planning is optimized. This includes opportunities to seek employment and work in competitive and integrated settings, engage in community life, control personal resources, and receive services in the community to the same degree as individuals who do not receive HCBS.

CMS expects all states to develop a HCBS transition plan that provides an assessment of potential gaps in compliance with the new regulation, as well as strategies and timelines for becoming compliant with the rule’s requirements. CMS further requires that states seek input from the public in the development of this transition plan.

Idaho has completed its’ fourth version of the state plan. This plan sets forth the actions Idaho will take to operate all applicable HCBS programs in compliance with the final rules. It is Idaho’s effort to comply/demonstrate compliance with the regulations around Home and Community Based (HCB) setting requirements. To access the updated Idaho Transition Plan, please go to Resources in the right hand column, Idaho Transition Plan – Version 4.


Ask The Program

We are interested in receiving your comments, recommendations, and questions as we work to move to full compliance with the new HCBS setting requirements. The State’s Transition Plan - Version 4 is posted here under Resources.  If you have any questions or comments about the plan or the new requirements (see Final Regulation under Resources) please send us an email and we will get back to you as soon as possible.

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