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July 1, 2006
 
MEDICAID INFORMATION RELEASE MA06-29
 
TO:  Developmental Disabilities Agencies
 
FROM:  Leslie M. Clement, Administrator
 
SUBJECT:  TRANSITION OF PARTICIPANTS FROM BASIC TO ENHANCED DEVELOPMENTAL DISABILITIES AGENCIES (DDA) SERVICES
 
The purpose of this Information Release is to describe how participants covered under the Idaho Medicaid Basic Plan become eligible for DDA services and how providers fulfill their role in helping to ensure that the DDA services are reimbursable.
 
All participants enrolled in the Medicaid Basic Plan who require enhanced DDA services must first obtain the required assessments to establish eligibility for DDA services under the Medicaid Enhanced Plan presently described at IDAPA 16.03.09.120. New rules publishing August 2, 2006 will describe the same requirements at IDAPA 16.03.10.653.02.
 
Criteria for Receiving DDA Services Still Remains
The criteria for establishing the need for DDA services for both adults and children remains the same as it has been prior to Medicaid Modernization. The assessments to establish DDA service eligibility are covered under the Medicaid Basic Plan (see Information Release # MA 2006-15). New rules publishing August 2, 2006 will describe the criteria at IDAPA 16.03.10.500-503.
 
New Process and Form Effective July 1, 2006
Adults
The Independent Assessment Provider (IAP) will perform a new step for processing enrollment  of adults who qualify for DDA services into the Medicaid Enhanced Plan. When the IAP has determined that an adult participant is eligible for DDA services, the IAP must complete IDHW form H0002 and submit it via fax or electronically to the Family Medicaid Unit. The IAP should maintain the original copy of the H0002 and the assessment in the participant’s medical record. Upon receipt of form H0002, the Family Medicaid unit will enroll the participant in the Medicaid Enhanced Plan so that the DDA provider’s claims for enhanced services may be reimbursed. The IAP must keep the original signed copy of form H0002 in the participant’s medical record.
 
Children
The DDA that determines a child participant’s eligibility for DDA services must complete the same process described above. The DDA provider must keep the original signed copy of form H0002 in the participant’s medical record. Otherwise the process to determine eligibility for DDA services for children remains the same as described in IDAPA 16.04.11, “Developmental Disabilities Agencies (DDA)”.
 
If you have any questions concerning the information contained in this release, please contact Pat Guidry at (208) 364-1813
Thank you for your continued participation in the Idaho Medicaid Program.
 
LMC/pg/sw

Directions: Please fill in all blanks, print and sign the form, submit to Family Medicaid by fax at 208-528-5980.  Maintain original in participant’s records. You may choose to submit the form electronically to:  familymedicaid@idhw.state.id.us
 
IDENTIFYING INFORMATION
 
Name of Participant:_________________________   Medicaid ID#:___________________
 
Name of Provider Certifying Medicaid Enhanced Plan:
 

 
Name of Agency and Agency provider#:__________________________________________
 
 
RATIONALE FOR ENHANCED PLAN SERVICES
 
(Provider: please check the appropriate box as indication of the justification for this participant needing Medicaid Enhanced Plan)
 
Participant needs the following services:
 
o Additional Psychotherapy               o Service Coordination
o Partial Care                                     o Developmental Disabilities
o Psychosocial Rehabilitation            o Inpatient Psychiatric Hospitalization
 
CERTIFICATION
 
 
I have assessed ______________________on _____________and certify that this
                                        (Name of participant)                             (date)
participant meets the requirements in IDAPA 16.03.10 for receiving the above indicated services in the Medicaid Enhanced Plan.
 
 
Signature of Provider Certifying Participant’s Eligibility                       Date