Current through August 30, 2021

For the purposes of this chapter, the following definitions and abbreviations apply. (7-1-21)T

01. Administrative Review. An informal review by a Division Administrator or designee, to determine whether a Department decision is correct. (7-1-21)T
02. Appellant. A person or entity who files an appeal of Department action or inaction. (7-1-21)T
03. Board. The Idaho Board of Health and Welfare. (7-1-21)T
04. Complainant. A person or individual who has a grievance regarding Youth Empowerment Services (YES). (7-1-21)T
05. Cost Report. A fiscal year report of provider costs required by the Medicare program and any supplemental schedules required by the Department. (7-1-21)T
06. Cost Settlement. Final determinations of payment, based on cost reports, to a Medicaid-enrolled provider. (7-1-21)T
07. Department. The Idaho Department of Health and Welfare. (7-1-21)T
08. Director. The Director of the Department of Health and Welfare. (7-1-21)T
09. Hearing Officer. The person designated to preside over a particular hearing and any related proceedings. (7-1-21)T
10. IPV. Intentional program violation. (7-1-21)T
11. Intervenor. Any person, other than an appellant or the Department, who requests to be admitted as a party in an appeal. (7-1-21)T
12. Managed Care Entity (MCE). An entity contracted by Medicaid to administer Medicaid services, which may be a Prepaid Ambulatory Health Plan (PAHP), Prepaid Inpatient Health Plan (PIHP), or other Managed Care Organization (MCO) as defined in 42 CFR 438.2. As used in these rules, the term does not include service brokers or entities providing non-emergency medical transportation (NEMT) services. (7-1-21)T
13. Party. An appellant, the Department and an intervenor, if intervention is permitted. (7-1-21)T
14. Youth Empowerment Services (YES) Program Participant. A YES program participant, is an Idaho resident with a Serious Emotional Disturbance who: (7-1-21)T
a. Is under the age of eighteen (18); (7-1-21)T
b. Has a mental health condition described in the current Diagnostic and Statistical Manual of Mental Disorders (DSM) and diagnosable by a qualified professional operating within the scope of their practice as defined by Idaho state law; and (7-1-21)T
c. Has a substantial functional impairment that is measured by and documented through the use of a standardized instrument conducted or supervised by a qualified clinician. (7-1-21)T
d. A substance use disorder or development disorder alone does not constitute an eligible diagnosis, although one (1) or more of these conditions may coexist with an eligible mental health diagnosis. (7-1-21)T


Idaho Admin. Code r.

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