Idaho HCBS Medicaid Provider Orientation Guide General Information: Part I Division of Medicaid An Introduction to Medicaid Guidelines, Rules, and Programs for Home and Community Services Waiver Providers.

Idaho HCBS Medicaid Provider Orientation Guide, Part I Regional Medicaid Services Provider Application and Orientation Policy:  Medicaid Provider Defined  Applications from In-State and Out-of-State Provider Applicants  Agreements and conditions for accepting, denying, and terminating agreements.  Application and Orientation Procedure Review

Idaho HCBS Medicaid Provider Orientation Guide, Part I CHAPTER 1 General Medicaid Information  What is Medicaid  Medicaid Defined  Basis of Eligibility  Medicaid Services  Payment for Medicaid Services

Idaho HCBS Medicaid Provider Orientation Guide, Part I CHAPTER 2 Definitions and Abbreviations  Definitions Reviewed  Abbreviations Reviewed

Idaho HCBS Medicaid Provider Orientation Guide, Part I CHAPTER 3 Medicaid Eligibility  Medicaid Eligibility  Differences Between Medicaid and Medicare  Home and Community Based Services Eligibility

Idaho HCBS Medicaid Provider Orientation Guide, Part I CHAPTER 4 Health and Welfare Organizational Overview  Idaho Department of Health and Welfare History  Idaho Department of Health and Welfare Divisions  Division of Medicaid Organization  Regional Offices  Regional Map

Idaho HCBS Medicaid Provider Orientation Guide, Part I CHAPTER 5 Idaho Medicaid Provider Agreement  Provider Agreement Overview  Compliance  Contact  Professionalism  Fairness  Record Keeping

Idaho HCBS Medicaid Provider Orientation Guide, Part I CHAPTER 5, (continued) Idaho Medicaid Provider Agreement  Accurate Billing  Secondary Payer  Full Payment  Service Providers  Ownership  Advance Directives

Idaho HCBS Medicaid Provider Orientation Guide, Part I CHAPTER 5, (continued) Idaho Medicaid Provider Agreement  Confidentiality  Officers and Employees Not Liable  Duration and Termination of Agreement

Idaho HCBS Medicaid Provider Orientation Guide, Part I CHAPTER 6 General Billing Guidelines  General Billing Guidelines  Timely Filing Limit  Claims Submission  Provider Signature  Provider Number  Prior Authorization and Adjustments

Idaho HCBS Medicaid Provider Orientation Guide CHAPTER 7 Criminal History Requirements  Mandatory Criminal History Checks  Individuals Subject to Mandatory CHC  Initial and Update Timeframes for CHC  Unconditional/Conditional Denials, Exemption Reviews

Idaho HCBS Medicaid Provider Orientation Guide, Part I CHAPTER 8 Advance Directives and Participant Rights  Advance Directives and Participant Rights Defined  Advance Directives  Participant Rights

Idaho HCBS Medicaid Provider Orientation Guide, Part I CHAPTER 9 Complaints and Reporting Requirements  Complaints  Medicaid Provider Complaint and Reporting Requirements  Duty to Report Cases of Abuse, Neglect, Exploitation for Adults

Idaho HCBS Medicaid Provider Orientation Guide, Part I CHAPTER 9, (continued) Complaints and Reporting Requirements  Definitions, Adult Abuse, Neglect, and Exploitation Act  Duty to Report Child Abuse, Abandonment, or Neglect  Definitions, Child Protection Act

Idaho HCBS Medicaid Provider Orientation Guide, Part I CHAPTER 10 Safe and Effective  What is Safe and Effective  The Role of Idaho Medicaid  The Role of the Medicaid Provider  The Role of the Medicaid Provider Staff

Idaho HCBS Medicaid Provider Orientation Guide, Part I CHAPTER 11 Quality Assurance Process  Quality Assurance  Provider Quality Assurance  Department Quality Assurance  Ethics

Idaho HCBS Medicaid Provider Orientation Guide, Part I CHAPTER 12 Record Keeping  Record Keeping Requirements