Developmental Disabilities Program Information

Home- and community-based settings (HCBS) include all locations where members who receive HCBS live or receive their services. These settings are required to have the following qualities:

• Integration and access - The setting is integrated in and supports full access to the greater community for members receiving HCBS. Typical, age-appropriate activities include opportunities to seek employment and work in competitive integrated settings, engage in community life, control personal resources, and receive services in the community in the same manner as people who don't require supports or services to remain in their home or community.
• Selection of setting - Home-and community-based settings are selected by the member's decision-making authority from among disability-specific and non-disability-specific settings and are based on the member's needs and preferences, including consideration of the member's safety and the safety of those around the member.
• Member rights - The setting ensures a member's rights of privacy, dignity, and respect, and freedom from coercion and unauthorized restraint are honored.
• Autonomy and independence - The setting optimizes but does not regiment an individual's initiative, autonomy, and independence in making life choices, including daily activities, physical environment, and who they interact with.
• Choice - The setting promotes opportunities for members to have choices regarding the services and supports provided in the setting.

For HCBS information, guidance, and documents, visit HCBS Information.

Providers of the services below must submit to the semi-annual and annual status reviews reflecting the status of behavioral objectives or services identified in the plan of service. For more information, visit Provider Status Review Forms

• Residential habilitation-supported living or certified family home
• Supported employment
• Developmental disabilities agency providing individual or group developmental therapy
• Adult day health
• Behavior consultation or crisis management
• Developmental disabilities waiver nursing

All/Multiple Provider Types
Maintenance of Contact Information 02.2025
Cloning Notes -Unacceptable Documentation Practices 07.2024
Guardian/Conservator Signatures - Adult DD Signature Requirements 11.2024
Interpretation Services - New Resource for Language Access Plans11.2024
Documentation Requirements 04.2024
Signatures on Documentation 05.2023
Telehealth Services 05.2023
Billing 15-minute Time Based Codes 03.2023
Provider Responsibility to Check Eligibility 12.2022
Provider Self Report of Overpayments 05.2022
Cloning Notes - Unacceptable Documentation Practices 01.2022
Correct Billing Using Date Spanning 09.2021
Duplicate and Overlapping Claims 08.2020
Adult Developmental Disability Medical Form 04.2020
Documentation Requirements 07.2019
Adult Participants Accessing DD Services Enrolled in MMCP - Traditional and Self-Directed Options 01.2019
BDDS Process for Citation Disputes 11.2018
Adult Developmental Disability (DD) Services - Safety Plans 10.2018
Documentation of Services Provided - Signature Required 10.2018
Medicaid Program Integrity Unit - Provider Self Report of Overpayments 06.2018
Process Update: Requests for Corrective Action Plans 06.2017
Medicaid Program Integrity Unit - Developmental Disability Services Documentation 05.2017
Adult Developmental Disability: Procedural Requirements - Provider Records 02.2015
Updates to the Adult Developmental Disability Quality Improvement Strategy 03.2014

Background Check
Recent Updates to Criminal History and Background Check Updates 07.2020
Medicaid Program Integrity Unit - Use of Previously Issued Criminal History Checks 10.2018

Certified Family Homes
When Must My Home be Certified as a Certified Family Home? (09/2023)

DDAs
Staffing Requirement - Developmental Disability Agencies -Requirements (07/2024)

Durable Medicaid Equipment
Therapies and Durable Medical Equipment on Adult Developmental Disability Service Plans 03.2018

NEMT
Non-Emergency Medical Transportation Mileage Reimbursement Process Overview 03.2023

Residential Habilitation
Supported Living: Resident Limits (04/2024)
RH not authorized at DDA - Attention Residential Habilitation Providers and Service Coordinators (05/2022)
Attention Residential Habilitation Providers -Information for Provider-Owned or Controlled Settings (01/2020)
Hourly Supported Living and Participant Support When Sleeping (11/2018)
Residential Habilitation -Supported Living: Participant Choice and Plan Flexibility (10/2018)
Residential Habilitation -Intense Level of Support (06/2014)

Respite
Coverage and Limitations for Respite Care Services (09/2022)
Documentation Requirements for Respite Care Service Providers (09/2020) 

Service Coordination
Service Coordination - Documentation (01/2025)
Service Coordination - Conflict of Interest (09/2024)
Paraprofessionals and Service Coordination (04/2024)
Service Coordination by Paraprofessionals for Adult Developmental Disability Services (09/2023)
Service Coordination -Provider Qualifications (03/2018)

Supported Employment
Supported Employment Services (07/2019)
Changes Coming to Community Supported Employment for DD Services (09/2017) 

Any member or legal guardian who would like to request additional budget dollars based on a change in condition may submit a change in condition request if they believe they have met both of the following requirements:

• Documented changes in the member's condition resulting in a need for services that meet medical necessity criteria
• The change in condition results in a change in a response on the current inventory of individual needs

For more information and forms on submitting a change in condition request, see Change in Condition

Members with developmental disabilities may qualify for intense supported living services if they meet certain criteria such as:

• Sustained history of serious aggressive behavior causing harm to themselves or others
• Chronic or acute medical conditions that are complex and unstable and require one-to-one staffing
• Felony charges or convictions for offenses related to serious injury or harm of another person
• History of predatory sexual offenses and are at high risk to offend again

Members requesting these services should complete the Intense Supported Living Questionnaire with their PCP team and submit the questionnaire and supporting documents to the independent assessment provider. Intense services are typically 24-hour 1:1 supports. Individuals who may need a blend of 1:1 and group staffing will be reviewed on a case-by-case basis.

To access intense supported living information and forms, go the Intense Supported Requests library.

Health & safety exception review
The department will complete an exception review of plans or addendums requesting services that exceed the assigned budget authorized by the assessor if services are needed to assure the health or safety of members and the services requested are medically necessary.

For more information on how to request a health or safety exception review and additional documents, visit Exception Review Information.

Supported employment exception review
The department will complete an exception review of plans or addendums requesting services that exceed the assigned budget authorized by the assessor if services are needed for the member to obtain or maintain employment.

For more information on how to request a health or safety exception review and additional documents, visit Exception Review Information for Supported Employment.

If the member disagrees with the eligibility determination or budget established by the independent assessment provider, theyhave the right to appeal that decision.

View Requesting an Appeal Instructions

To view the no-cost suitable representative training, visit the Our Health and Welfare website developed by ACLU of Idaho. The link is listed as “TSC Training” but anyone can be an advocate for an individual.

For more information on the appeal process for department eligibility determinations, visit Your Rights to Appeal or Request a Fair Hearing