Independent Providers for Children

For you to be approved to provide Respite and/or CBS services to a child, you need to contact the child’s case manager and get added to the child’s plan of service. Before you deliver services, you need to sign and return a provider signature page to the child’s case manager, indicating that you will be providing the service.

The Child’s case manager will give you a copy of the child’s plan of service. It will explain the services and number of hours you can use during the year, month, or week.

When you enter the Idaho Medicaid Provider website you can access instructions for billing on the provider handbook tab under General billing instructions at www.idmedicaid.com. The procedure code that you will bill can be found on the Children’s DD Independent Providers Fee Schedule document on Idaho Medicaid Fee Schedule. You will also be asked for an ICD-10 code which is Z74.2. If you have questions about billing, please contact your local Provider Relations Consultant (PRC) using the contact information found at www.idmediciad.com.

Always document the services you provide at the time the services are completed. All Medicaid providers must keep documentation of the visit date, time in and time out, type of service, location of service, session summary, and your dated signature for each service provided to a child.  Be sure to include a full handwritten signature or verified electronic signature. Typed initials or names are not sufficient to meet the signature requirement.

You must keep documentation for at least 5 years and it can be handwritten or typed. 

Yes, you will receive an email with a reminder letter notifying you when your CPR/FA certification is within 90 days of expiration and each month until you submit documentation of updated certification. Instructions on how to submit your updated certification can be found here.

Any individual meets the rule requirements for an intervention specialist or intervention professional can provide supervision to an intervention specialist. Evidence-based Model intervention specialists must ensure they meet the requirements of their model prior to providing supervision.  * Providers must document that their supervisor meets the minimum rule requirements to provide supervision. 

Yes, rule identifies that the individual who is completing supervision for these staff must ensure that they meet the minimum requirements to also complete assessment and clinical treatment plans and implementation plans. 

An intervention specialist must be supervised if they are providing any Medicaid reimbursable services. In this situation, since the individual is completing assessment and clinical treatment plans (which is a Medicaid reimbursable service), they must be supervised.  

Because this individual is not providing a Medicaid reimbursable service, according to the Children’s Habilitation Intervention Services rules, they would not need to be supervised. 

No. Staff need to receive supervision as well as continuing training. These are two separate requirements. 

The method of how supervision can be provided is not identified in rule. Guidelines for supervision are outlined in the Medicaid Handbook. The supervisor and supervisee must ensure that HIPAA compliance is maintained regardless of the supervision delivery method. 

Independent providers must follow their Medicaid Provider Agreement which includes ensuring HIPAA requirements. 

Yes, if the format is HIPAA compliant. 

For Evidence-Based Model intervention specialists, the supervisor must ensure they meet their credential/certification requirements with regards to the provision of direct services provided and supervision.  For Evidence Informed providers, the independent intervention specialist must ensure that their supervisor meets the minimum rule requirements to provide supervision, that supervision is occurring monthly as required, and that all supporting documentation of supervision is maintained. 
 

No. An independent provider cannot provide services in their own home or an office/center location. If an independent provider would like to open an office or center location, they must become a DDA in accordance with IDAPA 16.03.21.   

The comprehensive interview form must be used with the parent/caregiver for the screening. 

The written definition of behavioral intervention and habilitative skill building does not allow for the family training component of this service to be delivered without the child present.  

Interdisciplinary training is professional instruction to the direct service provider that helps meet the needs of the child. It is collaboration between direct service providers and must only be provided during the provision of a direct service.  
This service allows two providers to provide different services to the child, on the same date of service at the same time. The Developmental Disability Agency (DDA) or independent provider will bill interdisciplinary training and the provider (i.e., SLP, OT, etc) will bill for the appropriate procedural code for the direct service. 

No. Interdisciplinary training is collaboration between an intervention specialist or intervention professional and a Speech Language and Hearing Professional (SLP), Physical Therapist (PT), Occupational Therapist (OT), medical professional, behavioral or mental health professional. 

Yes. 

No. The 40-hour ABA training must be standardized in content for the individual to meet competency to provide the direct intervention service. This information is further defined in the Medicaid Provider Handbook.  

Yes. 

Yes. To ensure that there is not a duplication of services, implementation plans must be created that are unique to each service being provided. 

For you to be approved to provide this service to a child, you will need to contact their case manager/contractor and get added to the child’s plan of service. You will need to sign a provider signature page, indicating that you will be providing the service.  
Because family education is a support service, these authorizations do not go through Telligen, they are identified and approved on the child’s support plan of service.  
For billing this support service, you will do that in Gainwell Technologies, but you will be billing out of the child’s budget, rather than a prior authorization which is an approval for intervention services. Once you have signed the signature page, you can provide that service and bill in Gainwell Technologies.  

Yes. If a child has had an approved assessment completed and those scores/reports are embedded into other documents, you may use them for your screening and/or your assessment and clinical treatment plan once, but you would not be able to use scores embedded into other documents the following year. For example, you can use these scores/reports for your initial assessment and clinical treatment plan, but at your annual assessment and clinical treatment plan you would need to complete or obtain a skills assessment/developmental assessment in its entirety.  
Also, if you are using Vineland scores that are embedded into other documents to meet the Screening requirement (i.e. demonstrate the child's need for services), you will need to make sure that you submit that document with your initial prior authorization (PA) request. For example, if you are using the Vineland scores that are embedded into an IEP, then you will need to submit that IEP with your initial PA request.