Idaho Admin. Code r. 16.03.09.009

Current through September 2, 2024

Section 16.03.09.009 - BACKGROUND CHECK REQUIREMENTS

01.Compliance With Background Checks. Background checks are required for certain types of providers under these rules. Providers who are required to have a background check must comply with IDAPA 16.05.06, "Criminal History and Background Checks."

02.Department-Issued Variances to Requirements for a Clearance.

a. Notwithstanding those provider types required to obtain a clearance or enhanced clearance under these rules or under IDAPA 16.05.06, "Criminal History and Background Checks," the Department may allow variances to clearance requirements under certain circumstances. Providers who are subject to a background check must still complete and notarize an application for a background check.

b. In cases where the application process results in a denial rather than a clearance, and the denial is due to the applicant's prior convictions for disqualifying drug and alcohol-related offenses, the applicant may, with prior written approval of the Department, deliver covered Medicaid Peer Support and Recovery Coaching services.

c. A variance may be granted on a case-by-case basis upon review by the Department of any underlying facts and circumstances in each individual case. The Department will establish the process for the administrative review which will be conducted separate from the background check unit. During the Department's review, the following factors may be considered:

i. The severity or nature of the crimes or other findings;

ii. The period of time since the incidents occurred;

iii. The number and pattern of incidents being reviewed;

iv. Circumstances surrounding the incidents that would help determine the risk of repetition;

v. The relationship between the incidents and the position sought;

vi. Activities since the incidents, such as continuous employment, education, participation in treatment, completion of a problem-solving court or other formal offender rehabilitation, payment of restitution, or any other factors that may be evidence of rehabilitation;

vii. A pardon granted by a state governor or the President of the United States;

viii. The falsification or omission of information on the self-declaration form and other supplemental forms submitted; and

ix. Any other factor deemed relevant to the review.

d. A variance granted under these rules is not a criminal history and background check clearance and does not set a precedent for subsequent application for variance. The Department may revoke a variance when it identifies a risk to participants' health and safety. Providers who have been granted a variance must still meet all other Department requirements for Medicaid coverage and reimbursement of Peer Support and Recovery Coaching services, and are prohibited from delivering any other covered Medicaid service without the required clearance or Department enhanced clearance.

03.Availability to Work or Provide Service.

a. The employer may allow an individual to provide care or services on a provisional basis once the application for a background check is completed and notarized, and the employer has reviewed the application for any disqualifying crimes or relevant records. The employer determines whether the individual could pose a health and safety risk to the vulnerable participants it serves. The individual is not allowed to provide care or services when the employer determines the individual has disclosed a disqualifying crime or relevant records.

b. Those individuals licensed or certified by the Department are not available to provide services or receive licensure or certification until the background check is completed and a clearance issued by the Department.

04.Additional Criminal Convictions. Once an individual has received a clearance, any additional criminal convictions must be reported by the agency to the Department when the agency learns of the conviction.

05.Providers Subject to Background Check Requirements. The following providers must receive a clearance:

a. Contracted Non-Emergency Medical Transportation Providers. All staff of transportation providers having contact with participants except for individuals contracted as transportation providers defined in Subsection 870.02 of these rules.

b. Provider types deemed by the Department to be at high risk for fraud, waste, and abuse under Subsection 200.02 of these rules and 42 CFR 455.434.

Idaho Admin. Code r. 16.03.09.009

Effective July 1, 2024