§ 56-101. Definitions.

Unless the context clearly requires otherwise, the definitions in this section apply throughout this chapter and shall have the following meanings:

1. “Appraisal” means the method of determining the value of the property as determined by an appraisal conducted by a member of the appraisal institute (MAI), or successor organization. The appraisal must specifically identify the values of land, building, equipment, and goodwill.
2. “Assets” means economic resources of the contractor, recognized and measured in conformity with generally accepted accounting principles.
3. “Bed-weighted median” is determined by arraying the average per diem cost per bed of all facilities from high to low and identifying the bed at the point in the array at which half of the beds have equal or higher per diem costs and half have equal or lower per diem costs. The identified bed is the median bed. The per diem cost of the median bed is the bed-weighted median.
4. “Case mix index” is a numeric score assigned to each facility resident, based on the resident’s physical and mental condition, which projects the amount of relative resources needed to provide care to the resident.
5. “Depreciation” means the systematic distribution of the cost or other basis of tangible assets, less salvage, over the estimated useful life of the assets.
6. “Direct care costs” consists of the following costs directly assigned to the nursing facility or allocated to the nursing facility through medicare cost finding principles:
   1. Direct nursing salaries which include the salaries of registered nurses, licensed professional nurses, certificated nurse’s aides, and unit clerks; and
   2. Routine nursing supplies; and
   3. Nursing administration; and
   4. Direct portion of medicaid related ancillary services; and
   5. Social services; and
   6. Raw food; and
   7. Employee benefits associated with the direct salaries.
7. “Director” means the director of the department of health and welfare or the director’s designee.
8. “Equity” means the net book value of all tangible and intangible assets less the recorded value of all liabilities, as recognized and measured in conformity with generally accepted accounting principles.
9. “Facility” means an entity which contracts with the director to provide services to recipients in a structure owned, controlled, or otherwise operated by such entity, and which entity is responsible for operational decisions. In conjunction with the use of the term “facility”:
   1. “Freestanding intermediate care” means an intermediate care facility, as defined in and licensed under chapter 13, title 39, Idaho Code, which is not owned, managed, or operated by, nor is otherwise a part of a hospital, as defined in section 39-1301(a), Idaho Code; and
   2. “Freestanding skilled care” means a nursing facility, as defined in and licensed under chapter 13, title 39, Idaho Code, which is not owned, managed, or operated by, nor is otherwise a part of a hospital, as defined in section 39-1301(a), Idaho Code; and (c) “Freestanding special care” means a facility that provides either intermediate care, or skilled care, or intermediate care for people with intellectual disabilities, or any combination of either, which is not owned, managed, or operated by, nor is otherwise a part of a hospital, as defined in section 39-1301(a), Idaho Code; and
   3. “Freestanding special care” means a facility that provides either intermediate care, or skilled care, or intermediate care for people with intellectual disabilities, or any combination of either, which is not owned, managed, or operated by, nor is otherwise a part of a hospital, as defined in section 39-1301(a), Idaho Code; and
   4. “Hospital-based” means a nursing or intermediate care facility, as defined in and licensed under chapter 13, title 39, Idaho Code, which is owned, managed, or operated by, or is otherwise a part of a hospital, as defined in section 39-1301(a), Idaho Code.
10. “Forced sale” is a sale required by a bankruptcy, foreclosure, the provisions of a will or estate settlement pursuant to the death of an owner, physical or mental incapacity of an owner which requires ownership transfer to existing partner or partners, or a sale required by the ruling of a federal agency or by a court order.
11. “Goodwill” means the amount paid by the purchaser that exceeds the net tangible assets received. The value of goodwill is derived from the economic benefits that a going concern may enjoy, as compared with a new one, from established relations in the related markets, with government departments and other noncommercial bodies and with personal relationships. These intangible assets cannot be separated from the business and sold as can plant and equipment. Under the theory that the excess payment would be made only if expected future earnings justified it, goodwill is often described as the price paid for excess future earnings. The amortization of goodwill is nonallowable, nonreimbursable expense.
12. “Historical cost” means the actual cost incurred in acquiring and preparing an asset for use, including feasibility studies, architect’s fees, and engineering studies.
13. “Indirect care costs” consists of the following costs either directly coded to the nursing facility or allocated to the nursing facility through the medicare step-down process:
    1. Administrative and general care cost; and
    2. Activities; and
    3. Central services and supplies; and
    4. Laundry and linen; and
    5. Dietary (“non-raw food” costs); and
    6. Plant operation and maintenance (excluding utilities); and
    7. Medical records; and
    8. Employee benefits associated with the indirect salaries; and
    9. Housekeeping; and
    10. Other costs not included in direct care costs or costs exempt from cost limits.
14. “Interest rate limitation” means that the interest rate allowed for working capital loans and for loans for major movable equipment for intermediate care facilities for people with intellectual disabilities shall be the prime rate as published in the western edition of the Wall Street Journal or successor publication, plus one percent (1%) at the date the loan is made. All interest expense greater than the amount derived by using the limitation above shall be nonreimbursable; provided, however, that this interest rate limitation shall not be imposed against loans or leases which were made prior to July 1, 1984. Said loans or leases shall be subject to the tests of reasonableness, relationship to patient care and necessity.
15. “Intermediate care facility for people with intellectual disabilities” means an habilitative facility designed and operated to meet the educational, training, habilitative and intermittent medical needs of the developmentally disabled.
16. “Major movable equipment” means such items as accounting machines, beds, wheelchairs, desks, furniture, vehicles, etc. The general characteristics of this equipment are: (a) A relatively fixed location in the building;
17. “Medicaid” means the 1965 amendments to the social security act (P.L. 89-97), as amended.
18. “Minor movable equipment” includes such items as wastebaskets, bedpans, syringes, catheters, silverware, mops, buckets, etc. The general characteristics of this equipment are:
    1. In general, no fixed location and subject to use by various departments of the provider’s facility;
    2. Comparatively small in size and unit cost;
    3. Subject to inventory control;
    4. Fairly large quantity in use; and
    5. Generally, a useful life of approximately three (3) years or less.
19. “Net book value” means the historical cost of an asset, less accumulated depreciation.
20. “Normalized per diem costs” refers to direct care costs that have been adjusted based on the facility’s case mix index for purposes of making the per diem costs comparable among facilities. Normalized per diem costs are calculated by dividing the facility’s direct care per diem costs by its facility-wide case mix index, and multiplying the result by the statewide average case mix index.
21. “Nursing facility inflation rate” means the most specific skilled nursing facility inflation rate applicable to Idaho established by data resources, inc., or its successor. If a state or regional index has not been implemented, the national index shall be used.
22. “Patient-day” means a calendar day of care which will include the day of admission and exclude the day of discharge unless discharge occurs after 3:00 p.m. or it is the date of death, except that, when admission and discharge occur on the same day, one (1) day of care shall be deemed to exist.
23. “Property costs” means the total of allowable interest expense, plus depreciation, property insurance, real estate taxes, amortization, and allowable lease/rental expense. The department may require and utilize an appraisal to establish those components of property costs which are identified as an integral part of an appraisal.
24. “Raw food” means food used to meet the nutritional needs of the residents of a facility, including liquid dietary supplements, liquid thickeners, and tube feeding solutions.
25. “Reasonable property insurance” means that the consideration given is an amount that would ordinarily be paid by a cost-conscious buyer for comparable insurance in an arm’s length transaction. Property insurance per licensed bed in excess of two (2) standard deviations above the mean of the most recently reported property insurance costs per licensed bed of all facilities in the reimbursement class as of the end of a facility’s fiscal year shall not be considered reasonable.
26. “Recipient” means an individual determined eligible by the director for the services provided in the state plan for medicaid.
27. “Rural hospital-based nursing facilities” are those hospital-based nursing facilities not located within a metropolitan statistical area (MSA) as defined by the United States bureau of the census. (28) “Urban hospital-based nursing facilities” are those hospital-based nursing facilities located within a metropolitan statistical area (MSA) as defined by the United States bureau of the census.
28. “Urban hospital-based nursing facilities” are those hospital-based nursing facilities located within a metropolitan statistical area (MSA) as defined by the United States bureau of the census.
29. “Utilities” means all expenses for heat, electricity, water and sewer.

(b) Capable of being moved, as distinguished from building equipment;

(c) A unit cost sufficient to justify ledger control;

(d) Sufficient size and identity to make control feasible by means of identification tags; and

(e) A minimum life of approximately three (3) years.

§ 56-116. Nursing facility payment methodology.

The department shall work with Idaho nursing facility providers to establish a new prospective payment method for nursing facilities to replace existing reimbursement methods. Payments to nursing facilities under this method shall take into account patient needs, facility quality of care, reasonable cost principles, and state budget limitations. Budgets for nursing facility payments shall be subject to prospective legislative approval. The new payment methodology shall be implemented effective July 1, 2021.

§ 56-102. Principles of prospective rates and payment. [Repealed.]

Repealed by S.L. 2011, ch. 164, § 2, effective July 1, 2011.

§ 56-103. Prospective base rates by class of facilities. [Repealed.]

§ 56-104. Recapture of depreciation.

1. Where depreciable assets that were reimbursed based on cost and were used in the medicaid program subsequent to January 1, 1982, and for which depreciation has been reimbursed by the director, are sold for an amount in excess of their net book value, depreciation so reimbursed shall be recaptured from the buyer of the facility in an amount equal to reimbursed depreciation or gain on the sale, whichever is less. Depreciation shall be recaptured in full if a sale of a depreciated facility takes place within the first five (5) years of seller’s ownership after January 1, 1982.
2. Depreciation shall be recaptured by the director from the buyer of the facility over a period of time not to exceed five (5) years from the date of sale, with not less than one-fifth (1/5) of the total amount being recaptured for each year after such date.
3. Leases of facilities entered into on or after the effective date of this subsection shall be reimbursed in the same manner as an owned asset, with recapture of depreciation being effected against the buyer of the facility in the case where the facility’s assets are sold by the lessor of the facility. Leases in existence prior to the effective date of this subsection shall be reimbursed at the rate established prior to such date for each such lease. Renegotiated leases shall be reimbursed at established rates, plus a reasonable annual increase.

§ 56-105 — 56-107. Prospective payments — Adjustment— Audit and settlement. [Repealed.]

§ 56-108. Property reimbursement — Facilities will be paid a property rental rate, property taxes and reasonable property insurance.

The provisions of this section shall not apply to hospital-based facilities which are subject to the provisions of section 56-120, Idaho Code, or to intermediate care facilities for people with intellectual disabilities which are subject to the provisions of section 56-265, Idaho Code. The provisions of this section are applicable to all other facilities. The property rental rate includes compensation for major movable equipment but not for minor movable equipment. The property rental rate is paid in lieu of payment for amortization, depreciation, and interest for financing the cost of land and depreciable assets. Prior to final audit, the director shall determine an interim rate that approximates the property rental rate. The property rental rate shall be determined as follows:

1. Except as determined pursuant to this section:
   1. “Property base” = $9.24 for all facilities.
   2. “Change in building costs” = 1.0 from April 1, 1985, through December 31, 1985. Thereafter “Change in building costs” will be adjusted for each calendar year to reflect the reported annual change in the building cost index for a class D building in the western region, as of September of the prior year, published by the Marshall Swift Valuation Service. However, for freestanding skilled care facilities “change in building costs” = 1.145 from July 1, 1991, through December 31, 1991. Thereafter, change in building costs for freestanding skilled care facilities will be adjusted each calendar year to reflect the reported annual change in the building cost index for a class D building in the western region, as of September of the prior year as published by the Marshall Swift Valuation Service or the consumer price index for renter’s costs available in September of the prior year, whichever is greater.
   3. “Age of facility” = the director shall determine the effective age, in years, of the facility by subtracting the year in which the facility, or portion thereof, was constructed from the year in which the rate is to be applied. No facility or portion thereof shall be assigned an age of more than thirty (30) years. However, beginning July 1, 1991, for freestanding skilled care facilities, “age of facility” will be a revised age which is the lesser of the age established under other provisions of this section or the age which most closely yields the rate allowable to existing facilities as of June 30, 1991, under subsection (1) of this section. This revised age shall not increase over time.
      1. If adequate information is not submitted by the facility to document that the facility, or portion thereof, is newer than thirty (30) years, the director shall set the effective age at thirty (30) years. Adequate documentation shall include, but not be limited to, such documents as copies of building permits, tax assessors’ records, receipts, invoices, building contracts, and original notes of indebtedness. The director shall compute an appropriate age for facilities when documentation is provided to reflect expenditures for building expansion or remodeling prior to the effective date of this section. The computation shall decrease the age of a facility by an amount consistent with the expenditure and the square footage impacted and shall be calculated as follows: 1. Determine, according to indexes published by the Marshall Swift Valuation Service, the construction cost per square foot of an average class D convalescent hospital in the western region for the year in which the expansion or renovation was completed.
      2. The director shall adjust the effective age of a facility when major repairs, replacement, remodeling or renovation initiated after April 1, 1985, would result in a change in age of at least one (1) year. Such changes shall not increase the allowable property rental rate by more than three-fourths (3/4) of the difference between the adjusted property base determined in subsections (1)(a) and (1)(b) of this section and the rental rate paid to the facility at the time of completion of such changes but before the change component has been added to said rate. The adjusted effective age of the facility will be used in future age determinations, unless modified by provisions of this chapter.
      3. The director shall allow for future adjustments to the effective age of a facility or its rate to reimburse an appropriate amount for property expenditures resulting from new requirements imposed by state or federal agencies. The director shall, within twelve (12) months of verification of expenditure, reimburse the medicaid share of the entire cost of such new requirements as a one-time payment if the incurred cost for a facility is less than one hundred dollars ($100) per bed.
   4. At no time shall the property rental rate, established under subsection (1) of this section, be less than that allowed in subsection (1)(c)(ii), with the rate in effect December 31, 1988, being the base. However, subsequent to the application of this paragraph, before any rate increase may be paid, it must first be offset by any rate decrease that would have been realized if the provisions of this paragraph had not been in effect.
2. A “grandfathered rate” for existing facilities will be determined by dividing the audited allowable annual property costs, exclusive of taxes and insurance, for assets on hand as of January 1, 1985, by the total patient days in the period July 1, 1984, through June 30, 1985. The property rental rate will be the greater of the amount determined pursuant to subsection (1) of this section, or the grandfathered rate. The director shall adjust the grandfathered rate of a facility to compensate the owner for the cost of major repairs, replacement, expansion, remodeling and renovation initiated prior to April 1, 1985, and completed after January 1, 1985, but completed no later than December 31, 1985. For facilities receiving a grandfathered rate making major repairs, replacement, expansion, remodeling or renovation, initiated after January 1, 1986, the director shall compare the grandfathered rate of the facility to the actual depreciation, amortization, and interest for the current audit period plus the per diem of the recognized cost of major repairs, replacement, expansion, remodeling or renovation, amortized over the American hospital association guideline component useful life. The greater of the two (2) numbers will be allowed as the grandfathered rate. Such changes shall not increase the allowable grandfathered rate by more than three-fourths (3/4) of the difference between the current grandfathered rate and the adjusted property base determined in subsections (1)(a) and (1)(b) of this section. (3) The property rental rate per day of care paid to facilities with leases signed prior to March 30, 1981, will be the sum of the annualized allowed lease costs and the other annualized property costs for assets on hand as of January 1, 1985, exclusive of taxes and insurance when paid separately, divided by total patient days in the period June 30, 1983, through July 1, 1984. Effective July 1, 1989, the director shall adjust the property rental rate of a leased skilled facility under this paragraph to compensate for the cost of major repairs, replacement, expansion, remodeling and renovation initiated after January 1, 1985, by adding the per diem of the recognized cost of such expenditures amortized over the American hospital association guideline component useful life. Such addition shall not increase the allowable property rental rate by more than three-fourths (3/4) of the difference between the current property rental rate and the adjusted property base as determined in paragraphs (a) and (b) of subsection (1) of this section. Where such leases contain provisions that bind the lessee to accept an increased rate, reimbursement shall be at a rate per day of care which reflects the increase in the lease rate. Where such leases bind the lessee to the lease and allow the rate to be renegotiated, reimbursement shall be at a rate per day of care which reflects an annual increase in the lease rate not to exceed the increase in the consumer price index for renters costs. After the effective date of this subsection, if such a lease is terminated or if the lease allows the lessee the option to terminate other than by purchase of the facility, the property rental rate shall become the amount determined by the formula in subsection (1) of this section as of the date on which the lease is or could be terminated.

Property rental rate = (“Property base”) x (“Change in building costs”) x (40 /ms “Age of facility”)

40

where:

2. Multiply the total square footage of the building following the expansion or renovation by the cost per square foot to establish the estimated replacement cost of the building at that time.

3. The age of the building at the time of construction shall be multiplied by the quotient of total actual renovation or remodeling costs divided by replacement cost. If this number is equal to or greater than 2.0, the age of the building in years will be reduced by this number, rounded to the nearest whole number. In no case will the age be less than zero (0).

(4)(a) In the event of a sale, the buyer shall receive the property rental rate as provided in subsection (1) of this section, except under the conditions of paragraph (b) of this subsection or except in the event of the first sale for a freestanding skilled care facility receiving a grandfathered rate after June 30, 1991, whereupon the new owner shall receive the same rate that the seller would have received at any given point in time.

(b) In the event of a forced sale of a facility where the seller has been receiving a grandfathered rate, the buyer will receive a rate based upon his incurred property costs, exclusive of taxes and insurance, for the twelve (12) months following the sale, divided by the facility’s total patient days for that period, or the property rental rate, whichever is higher, but not exceeding the rate that would be due the seller.

§ 56-109. Property rental rate implementation schedule. [Repealed.]

§ 56-110 — 56-112. New and existing free-standing skilled care facilities — Free-standing intermediate care facilities. [Repealed.]

§ 56-113. Intermediate care facilities for people with intellectual disabilities. [Repealed.]

Repealed by S.L. 2011, ch. 164, § 4, effective July 1, 2011.

§ 56-114. Freestanding special care facilities.

For a freestanding special care facility which seeks to contract for the first time to provide medicaid services to recipients, the director shall determine payment for such facility as specified in rule.

§ 56-115. Capitalization of assets. [Repealed.]

§ 56-117. Payment of special rates.

The director shall have authority to pay facilities at special rates for care given to patients who have long-term care needs not adequately reflected in the rates calculated pursuant to the principles set forth in section56-265, Idaho Code. The payment for such specialized care will be in addition to any payments made in accordance with other provisions of this chapter. The incremental cost to a facility that exceeds the rate for services provided pursuant to the provisions of section56-265, Idaho Code, will be excluded from the computation of payments or rates under other provisions of this chapter. Until the facility applies for a special rate, patients with such needs will be included in the computation of the facility’s rates following the principles described in section 265 [56-265], Idaho Code.

§ 56-118. Reimbursement rates.

1. The department shall implement a methodology for reviewing and determining reimbursement rates to private businesses providing developmental disability agency services, mental health services, service coordination and case management services and residential habilitation agency services by rule.
2. In addition to any policy or federal statutory requirements, such methodology shall incorporate, at a minimum, the actual cost of providing quality services, including personnel and total operating expenses, directly related to providing such services which shall be provided by the private business entities.
3. The results of this review and analysis do not guarantee a change in reimbursement rates, but shall be a fair and equitable process for establishing and reviewing such rates.

§ 56-119. [Reserved.]

§ 56-120. Property reimbursement for hospital-based skilled nursing facilities.

In addition to the basic payment per patient-day of care, each hospital-based nursing facility shall be paid on a prospective basis its actual property and utility costs per patient-day, to be determined by dividing its total projected property and utility costs, as calculated from the cost report selected for rate setting, by the total number of patient-days from the same cost reporting period.

§ 56-121. New hospital-based facilities. [Repealed.]

§ 56-122 — 56-129. [Reserved.]

§ 56-130. Development of payment, adjustment, audit and settlement mechanisms. [Repealed.]

§ 56-131. Multiple-use plans.

The director shall promulgate such rules, as the director deems advisable to enable and encourage facilities to adopt plans for offering additional services or programs within their institutions which will promote appropriate levels of care for recipients residing in their service areas and, as a result, achieve cost savings for the medicaid program. In developing such rules, the director shall consult with representatives of freestanding skilled care, freestanding intermediate care, freestanding special care, and hospital-based facilities.

§ 56-132. Disputes.

1. If any facility wishes to contest the way in which a rule or contract provision relating to the prospective, cost-related reimbursement system was applied to such facility by the director, it shall first pursue the administrative review process set forth in section 56-133, Idaho Code.
2. The administrative review process in section 56-133, Idaho Code, need not be exhausted if a facility wishes to challenge the legal validity of a statute, rule, or contract provision.

§ 56-133. Administrative review process.

1. Within thirty (30) days after a facility is notified of an action or determination it wishes to challenge, such facility shall request in writing that the director review such determination. The request shall be signed by the licensed administrator of the facility, shall identify the challenged determination and the date thereof, and shall state as specifically as practicable the grounds for its contention that the determination was erroneous. Copies of any documentation on which such facility intends to rely to support its position shall be included with the request.
2. After receiving a request meeting the above criteria, the director will contact the facility to schedule a conference for the earliest mutually convenient time. The conference shall be scheduled for no later than thirty (30) days after a properly-completed request is received, unless both parties agree in writing to a specified later date.
3. The facility and the director shall attend the conference. In addition, representatives selected by the facility may attend and participate. The facility shall bring to the conference, or provide to the director in advance of the conference, any documentation on which the facility intends to rely to support its contentions. The parties shall clarify and attempt to resolve the issues at the conference. If additional documentation is needed to resolve the issues, a second session of the conference shall be scheduled for not later than thirty (30) days after the initial session, unless both parties agree in writing to a specific later date.
4. A written decision by the director will be furnished to the facility within thirty (30) days after the conclusion of the conference.
5. If the facility desires review of an adverse decision of the director, it shall, within twenty-eight (28) days following receipt of such decision, request a hearing in writing on the contested matter, in accordance with the provisions of chapter 52, title 67, Idaho Code.

§ 56-134. Denial, suspension, revocation of license or provisional license — Penalty.

The director is authorized to deny, suspend, or revoke a license or provisional license or, in lieu thereof or in addition thereto, assess monetary penalties of a civil nature not to exceed one thousand dollars ($1,000) per violation in any case in which it finds that the facility, or any partner, officer, director, owner of five per cent (5%) or more of the assets of the facility, or managing employee:

1. Failed or refused to comply with the requirements of this chapter, or the rules and regulations established hereunder; or
2. Has knowingly or with reason to know made a false statement of a material fact in any record required by this chapter; or
3. Refused to allow representatives or agents of the director to inspect all books, records, and files required to be maintained by the provisions of this chapter, or to inspect any portion of the facility’s premises; or
4. Wilfully prevented, interferred [interfered] with, or attempted to impede in any way the work of any duly authorized representative of the director and the lawful enforcement of any provision of this chapter; or
5. Wilfully prevented or interferred [interfered] with any representative of the director in the preservation of evidence of any violation of any of the provisions of this chapter, or the rules and regulations promulgated hereunder.

§ 56-134A. Remedies for deficient care.

If the director finds that a facility is deficient in, or no longer meets, any of the requirements of participation set forth in 42 U.S.C. 1396r(b), (c) and (d), which are hereby incorporated by reference, the director has the authority, as provided in title XIX of the social security act, to:

1. terminate the facility’s participation in the medicaid program;
2. deny payment;
3. assess and collect a civil money penalty with interest;
4. appoint temporary management of the facility;
5. close the facility and/or transfer residents to another certified facility;
6. direct a plan of correction;
7. ban admission of persons with certain diagnoses or requiring specialized care;
8. ban all admissions to the facility;
9. assign monitors to the facility; or
10. reduce the licensed bed capacity.

§ 56-135. Adoption of rules.

The director shall adopt, promulgate, amend, and rescind such administrative rules as are necessary to carry out the policies and purposes of this chapter, as provided in chapter 52, title 67, Idaho Code.

Part D Miscellaneous

§ 56-136. Physician and dentist reimbursement. [Repealed.]

Repealed by S.L. 2011, ch. 164, § 7, effective July 1, 2011.

§ 56-201. Definitions.

As used in this act:

1. “State department” means the state department of health and welfare;
2. “Director” means the director of the department of health and welfare;
3. “Public welfare” means public assistance and social services;
4. “Social services” means activities of the department in efforts to bring about economic, social and vocational adjustment of families and persons;
5. “Public assistance” includes general assistance, old-age assistance, aid to the blind, assistance to families with children, aid to the disabled, and medical assistance;
6. “General assistance” means direct assistance in cash, direct assistance in kind, and supplementary assistance;
7. “Direct assistance in cash” means money payments to eligible people not classified as old-age assistance, or aid to the blind, or assistance to families with children, or aid to the disabled, or medical assistance;
8. “Direct assistance in kind” means payments to others on behalf of a person or family for food, rent, clothing, and other normal subsistence needs;
9. “Supplementary assistance” means payments to others on behalf of a person or family for transportation and costs incidental to vocational adjustment or employment;
10. “Old-age assistance” means money payments to or on behalf of needy aged people;
11. “Aid to the blind” means money payments to or on behalf of blind people who are needy;
12. “Assistance to families with children” means money payments, direct assistance in kind, supplementary assistance, and social services targeted toward self-sufficiency with respect to or on behalf of eligible families with children;
13. “Aged” means any person sixty-five (65) years or older;
14. “Aid to the disabled” means money payments to or on behalf of needy individuals who are disabled, and whose disability prevents self-support through employment for a period of at least one (1) year from the date of onset of the disability;
15. “Medical assistance” means payments for part or all of the cost of such care and services allowable within the scope of title XIX of the federal social security act as amended as may be designated by department rule;
16. “Provider” means any individual, partnership, association, corporation or organization, public or private, who provides residential or assisted living services, certified family home services, nursing facility services, services offered pursuant to the medicaid program, or services offered pursuant to titles IV or XX of the social security act;
17. “Needy” means the condition where a person or family does not have income and available resources in accordance with the provisions of section 56-210, Idaho Code.

§ 56-202. Duties of director of state department of health and welfare.

The director of the state department of health and welfare shall:

1. Administer public assistance and social services to eligible people;
2. Promulgate, adopt and enforce such rules and such methods of administration as may be necessary or proper to carry out the provisions of title 56, Idaho Code, except as provided in section 56-203A, Idaho Code;
3. Conduct research and compile statistics relating to public welfare;
4. Prepare for the governor and legislature an annual report of activities and expenditures; make such reports in such form and containing such information as the federal government may from time to time require; and comply with such provisions as the federal government may from time to time find necessary to assure the correctness and verification of such reports;
5. Cooperate with the federal government through its appropriate agency or instrumentality in establishing, extending, and strengthening services for the protection and care of homeless, dependent, and neglected children, and children in danger of becoming delinquent; and to undertake other services for children authorized by law;
6. Cooperate with the federal government through its appropriate agency or instrumentality in establishing and maintaining a comprehensive system of in-home services as defined in section 67-5006, Idaho Code, designed to assist older persons, as defined in section 67-5006, Idaho Code, of Idaho to continue living in an independent and dignified home environment and to undertake other services for older persons as authorized by law;
7. Exercise the opt out provision in section 115 of the personal responsibility and work opportunity reconciliation act of 1996, P.L. 104-193. Consistent with this, the department may provide food stamps and services funded under title 4A (including cash assistance, TANF supportive services and at risk payments) to a person who has been convicted of a felony involving a controlled substance as defined in chapter 27, title 37, Idaho Code, if they comply with the terms of a withheld judgment, probation or parole.

§ 56-203A. Authority of department to enforce child support — Support enforcement services.

Whenever the department receives an application for public assistance on behalf of a child and it shall appear to the satisfaction of the department that said child has been abandoned by its parents, or that the child and one (1) parent have been abandoned by the other parent, or that the parent or other person who has a responsibility for the care, support or maintenance of such child has failed or neglected to give proper care or support to such child, the department shall take appropriate action under the provisions of this chapter, the abandonment or nonsupport statutes, or other appropriate statutes of this state to ensure that such parent or other person responsible shall pay for the care, support or maintenance of said dependent child.

The department may accept applications for support enforcement services on behalf of persons who are not recipients of public assistance and may take action as it deems appropriate to establish, modify or enforce support obligations against persons owing a duty to pay support. Action to establish support obligations may be taken under the abandonment or nonsupport statutes or other appropriate statutes of this state.

The department may charge fees to compensate it for services rendered in establishment of or enforcement of support obligations. The director shall, by rule, establish reasonable fees for support enforcement services, and said schedules of fees shall be made available to all applicants for support enforcement services. The department may, on showing of necessity, waive or defer any such fee.

Effective October 1, 1998, the department shall maintain a state case registry that contains records of each case in which enforcement services are being provided under this section and each child support order established or modified in the state from and after that date. Effective the same date, the department shall collect and disburse payments for all support orders related to cases for which services are provided under this section and each child support order established or modified after January 1, 1994, that is subject to income withholding orders. For child support orders established prior to January 1, 1994, at the option of each county and upon payment of the cost of the service, the department shall collect and disburse payments.

§ 56-203B. Payment of public assistance for child constitutes debt to department by parents — Limitations — Department subrogated to rights.

Any payment of public assistance money made to or for the benefit of any dependent child or children creates a debt due or owing to the department by the parent or others who are responsible for support of such children in an amount equal to the support obligation as is subsequently determined by court order pursuant to the Idaho child support guidelines which debt arises at the end of the first month for which the payment of public assistance commences. If a judgment entered by the court under the Idaho child support guidelines is more than the public assistance expended, the amount in excess of the public assistance expended shall be payable to the custodial parent or caretaker. Provided, that where there has been a district court order, the debt shall be limited to the amount provided for by said order. The department shall have the right to petition the appropriate district court for modification of a district court order on the same grounds as a party to said cause. Where a child has been placed in foster care, and a written agreement for payment of support has been entered into by the responsible parent or parents and the department, the debt shall be limited to the amount provided for in said agreement. Provided, that if a court order for support is or has been entered, the provisions of said order shall prevail over the agreement.

The department shall be subrogated to the right of said child or children or person having the care, custody and control of said child or children to prosecute or maintain any support action existing under the laws of the state of Idaho to obtain reimbursement of moneys thus expended. If a district court order enters judgment for an amount of support to be paid by an obligor parent, the department shall be subrogated to the debt created by such order, and said money judgment shall be deemed to be in favor of the department. This subrogation shall specifically be applicable to temporary spouse support orders, family maintenance orders and alimony orders up to the amount paid by the department in public assistance moneys to or for the benefit of a dependent child or children but allocated to the benefit of said children on the basis of providing necessities for the caretaker of said children.

Debt under this section shall not be incurred by, nor at any time be collected from a parent or other person who would be or is eligible for or who is the recipient of public assistance moneys for the benefit of minor dependent children for the period such person or persons are in such status and the collection of the debt from such person would not be in the fiscal interest of the state or would not be in the best interest of the child(ren) for whom such person owes support.

§ 56-203C. Powers of department.

1. In order to carry out its responsibilities imposed under this chapter and title IV-D of the social security act, the state department of health and welfare, through the attorney general or the respective county prosecuting attorney, or through private counsel is hereby authorized to take the following action:
   1. Petition to establish an order for support including medical support and support for a period during which a child received public assistance;
   2. Petition to establish paternity and order genetic testing of any individual involved in the paternity action;
   3. Petition to modify an order for support in accordance with the Idaho child support guidelines at the request of an obligor, obligee or state agency providing services under title IV-D of the social security act;
   4. Petition to enforce an order for support of a child or a spouse or former spouse who is living with a child for whom the individual also owes support; and
   5. Intervene in a divorce or separate maintenance action or proceedings supplemental thereto, for the purpose of advising the court regarding support of a child or advising the court as to the financial interest of the state of Idaho therein without necessity of further leave of the court.
   6. Other services as required by title IV-D of the social security act.
2. The department of health and welfare is not authorized to provide services regarding visitation or custody of a child unless so authorized by title IV-D of the social security act.
3. In any action taken under this section, the prevailing party may, at the discretion of the court, be allowed reasonable attorney’s fees and costs to be set by the court.

§ 56-203D. Set-off procedure for child support debt.

1. The state tax commission shall withhold and set-off any income tax or tax credit refund of any taxpayer upon notification from the department of health and welfare to collect any unpaid child support, including a judgment for reimbursement of public assistance, or unpaid spousal support. The state tax commission shall also withhold and set-off any income tax or tax credit refund of any taxpayer upon notification from the department of health and welfare to collect any payment received from a third party for the costs of health services to a child by a person who is required by court or administrative order to provide the costs of health services to a child and such payment has not been used to reimburse either the other parent or guardian of such child, the provider of such services, or the state agency, to the extent necessary to reimburse the other parent, guardian, provider or state agency for such costs. Any claims for current or past-due child support shall take priority over any such claims for the costs of such health services. The set-off or withholding of a refund due a taxpayer shall be completed only after the following conditions have been met:
   1. A delinquency exists, which shall be defined as any unpaid child or spousal support including public assistance, pursuant to a court order from this state or a court or administrative order of another state.
   2. All outstanding tax liabilities collectible by the state tax commission are satisfied.
   3. The department of health and welfare, bureau of child support enforcement, shall forward to the state tax commission the full name and social security number of the taxpayer. The tax commission shall notify the department of health and welfare of the amount of refund due the taxpayer and the taxpayer’s address on the income tax return.
   4. Notice of the proposed set-off shall be sent by registered or certified mail to the taxpayer at the address listed on the income tax return. Within fourteen (14) days after such notice has been mailed (not counting Saturday, Sunday or state holidays as the 14th day) the taxpayer may file a protest in writing requesting a hearing before the department of health and welfare. The hearing shall be held within thirty-five (35) days from the date of the mailing of the original notice. No issues at that hearing may be considered that have been litigated previously. The department of health and welfare shall issue its findings and decision either at the hearing or by mail to the taxpayer within ten (10) days of the hearing.
   5. When set-off is attempted on a joint return under the provisions of this section the taxpayer not specified to be the obligor in the claim may protest under the provisions of subsection (1)(d) of this section, and the set-off will be limited to one-half (1/2) of the joint refund.
   6. After the decision of the department of health and welfare is issued, or if the taxpayer has failed to file a timely protest of the claim, the set-off procedure shall become final.
2. The proceeds from the set-off shall be credited to an account designated by the department of health and welfare, and notice shall be given to the appropriate clerk of the district court.
3. This procedure for set-off shall not be subject to section 67-1021 [67-1026], Idaho Code.
4. Any information furnished by the state tax commission, its employees or agents, under this section shall not be subject to the restrictions and penalties enumerated in section 63-3076, Idaho Code.
5. Upon request, the department of health and welfare, bureau of child support enforcement, shall make the procedures established in this section for collecting child support arrears available to county prosecuting attorneys. The provisions of this subsection apply only if appropriate arrangements have been made for reimbursement by the requesting prosecuting attorney for the administrative costs incurred by the bureau which are attributable to the request.

§ 56-203E. Lottery prize set-off procedure for support debt.

1. The Idaho state lottery shall immediately withhold, set-off and transfer prize moneys of a lottery prize winner to the department of health and welfare upon notification and verification from the department of health and welfare to collect a support delinquency. The set-off or withholding of a prize shall be final only after the following conditions have been met:
   1. A delinquency exists, which shall be defined as any unpaid child or spousal support including public assistance, pursuant to a court order from this state or a court or administrative order of another state.
   2. The department of health and welfare, bureau of child support enforcement, shall forward to the Idaho state lottery the full name and social security number of the obligor and the amount of the delinquent child support. The Idaho state lottery shall notify the department of health and welfare of the amount of the prize withheld to satisfy the child support delinquency and the prize winner’s address.
   3. The department of health and welfare shall provide notice of the proposed set-off by registered or certified mail to the prize winner at the address provided to the Idaho state lottery. Within fourteen (14) days after such notice has been mailed (not counting Saturday, Sunday or state holidays as the 14th day) the prize winner may file a protest in writing requesting a hearing before the department of health and welfare. The hearing shall be held within thirty-five (35) days from the date of the mailing of the original notice. No issues at that hearing may be considered that have been litigated previously. The department of health and welfare shall issue its findings and decision either at the hearing or by mail to the prize winner within ten (10) days of the hearing.
   4. After the decision of the department of health and welfare is issued, or if the prize winner has failed to file a timely protest of the claim, the set-off procedure shall become final.
2. The proceeds from the set-off shall be credited to an account designated by the department of health and welfare, and notice shall be given to the appropriate clerk of the district court.

§ 56-203F. Registration of foreign support orders.

Notwithstanding any other provision of law, the state department of health and welfare shall register a family support order or family support agreement originating in a foreign country prior to taking enforcement action on the resulting family support obligation. A foreign support order or foreign support agreement shall be registered pursuant to the provisions of chapter 10, title 7, Idaho Code.

§ 56-204. Personnel. [Repealed.]

§ 56-204A. Services for children.

The state department is hereby authorized and directed to maintain, by the adoption of appropriate rules and regulations, activities which, through social casework and the use of other appropriate and available resources, shall embrace:

1. Protective services on behalf of children whose opportunities for normal physical, social and emotional growth and development are endangered for any reason;
2. Services for unmarried parents, which may be necessary to assure or provide adequate care, and to safeguard the rights and promote the well-being of such parents and their infants;
3. Services on behalf of children in their own homes to help overcome problems that may result in dependency, neglect or delinquency, and to strengthen parental care and supervision; and
4. Undertaking care of, and planning for children including those committed to the state department by the courts.
   1. Receiving from any source and investigating all reasonable reports or complaints of neglect, abuse, exploitation or cruel treatment of children;
   2. Initiation of appropriate services and action where indicated with parents or other persons for the protection of children exposed to neglect, abuse, exploitation or cruel treatment;
   3. Filing pleadings with appropriate courts in cases requiring court action;
   4. Arrangements for prenatal care of unmarried expectant mothers and payment for such care when necessary for the well-being of the parents and infant;
   5. Counseling with unmarried parents in relation to their plans for their children, including assisting parents to reach a decision concerning relinquishment through an understanding of what would be best for the child and themselves;
   6. Services and assistance for minor unmarried parents;
   7. Services on behalf of children in their own homes to strengthen parental care and supervision;
   8. Specifying the conditions under which payment shall be made for the purchase of services and care for children, such as medical, psychiatric or psychological services and foster family or institutional care, group care, homemaker service, or day care;
   9. Procedures to be observed in planning and caring for or placing for adoption a child committed to the state department following the termination of his parent-child relationship;
   10. The establishment of appropriate administrative procedures for the conduct of administrative reviews and hearings as required by federal statute for all children committed to the department and placed in out of home care.

Such rules and regulations shall provide for:

§ 56-204B. Temporary shelter care.

The state department shall provide places of shelter as authorized by law for the placement of children for temporary care who have been brought into the custody of the magistrate courts or who have been taken into custody for their protection by peace officers. Such places of shelter may be maintained by the state department or may be licensed foster family homes or licensed foster institutional facilities employed or retained for shelter care by the state department.

§ 56-205. Issuance of SNAP benefits.

1. In each month that the state department or its authorized agent issues benefits under the supplemental nutrition assistance program (SNAP) to eligible persons, such benefits shall be issued over the course of not less than ten (10) consecutive days within the month.
2. To reduce the burden on state general funds, any implementation costs incurred by the department under subsection (1) of this section shall be paid using SNAP performance bonus money if such money is received from the United States department of agriculture. If the department does not receive sufficient SNAP performance bonus money, state general funds shall be requested to implement the provisions of this act. This act is dependent upon ongoing operating and personnel appropriations.

§ 56-206. General assistance.

Public assistance awarded under the terms of this act which is not classified as old-age assistance, or aid to the blind, or assistance to families with children, or aid to the disabled, or medical assistance, shall be designated as general assistance.

§ 56-207. Old-age assistance.

Old-age assistance shall be awarded to needy people who have attained the age of sixty-five (65) years, are residents of the state, and who are not inmates of public institutions at the time of receiving assistance except as patients in public medical institutions and who are not patients in any institution for tuberculosis or for mental diseases or who are not patients in any medical institution as a result of having been diagnosed as having tuberculosis or psychosis.

§ 56-208. Aid to the blind.

Aid to the blind shall be awarded to needy people who have no vision, or whose vision is so defective as to prevent the performance of ordinary activities for which eyesight is essential, who are not receiving old-age assistance, and who are not inmates of public institutions at the time of receiving assistance.

§ 56-209a. Aid to the disabled.

Aid to the disabled shall be awarded to needy persons who are disabled and whose disability prevents self-support through employment for a period of at least one (1) year from the date of onset of the disability, but who are not inmates of public institutions (except as patients in medical institutions) and who are not patients in an institution for tuberculosis or mental diseases or who are not patients in any medical institution as a result of having been diagnosed as having tuberculosis or psychosis.

§ 56-209b. Medical assistance — Medical assistance account.

1. Medical assistance shall be awarded to persons as mandated by federal law; and medical assistance may be awarded to such other persons not required to be awarded medical assistance as mandated by federal law when such award is to the fiscal advantage of the state of Idaho.
2. There is hereby created in the dedicated fund the medical assistance account. The medical assistance account shall be an entity primarily designed to receive moneys from the families and relatives of patients receiving medical assistance under the state plan for medicaid, and to provide a source of moneys to pay for the state’s share of medical assistance expenses. Moneys in the medical assistance account may not be commingled with moneys in the cooperative welfare account [fund]. Moneys in the medical assistance account must be appropriated in order to be expended to pay for the state’s share of medical assistance expenses.
3. In all cases where the department of health and welfare through the medical assistance program has or will be required to pay medical expenses for a recipient and that recipient is entitled to recover any or all such medical expenses from any third party or entity, the department of health and welfare will be subrogated to the rights of the recipient to the extent of the amount of medical assistance benefits paid by the department as the result of the occurrence giving rise to the claim against the third party or entity.
4. If a recipient of medical assistance pursues a claim against a third party or entity through litigation or a settlement, the recipient will so notify the department. If a recipient fails to notify the department of such claim, the department may recover the amount of any public assistance obtained by the recipient while the recipient pursued such claim. In addition, if the recipient recovers funds, either by settlement or judgment, from such a third party or entity, the recipient shall reimburse the department to the extent of the funds received in settlement minus attorney’s fees and costs, the amount of the medical assistance benefits paid by the department on his behalf as a result of the occurrence giving rise to the need for medical assistance. The department shall be entitled to all the legal rights and powers of a creditor against a debtor in enforcing the recipient’s reimbursement obligation.
5. The department shall have priority to any amount received from a third party or entity which can reasonably be construed to compensate the recipient for the occurrence giving rise to the need for medical assistance, whether the settlement or judgment is obtained through the subrogation right of the department or through recovery by the recipient, and whether or not the recipient is made whole by the amount recovered. The department will be entitled to reimbursement of medical assistance benefits paid on behalf of the recipient arising from the incident or occurrence prior to any amount being distributed to the recipient. The department may notify such third party or entity of the department’s entitlement to receive the reimbursement prior to any amount being distributed to the recipient. Furthermore, the department may instruct the third party or entity to make such payment directly to the department prior to any amount being distributed to the recipient. Any third party or entity who distributed funds in violation of such a notice shall be liable to the department for the amount of the reimbursement.

§ 56-209c. Denial of payment for abortions under certain conditions.

No funds available to the department of health and welfare, by appropriation or otherwise, shall be used to pay for abortions, unless it is the recommendation of one (1) consulting physician that an abortion is necessary to save the life of the mother, or unless the pregnancy is a result of rape, as defined in section 18-6101, Idaho Code, or incest as determined by the courts.

§ 56-209e. Eligibility of married couples for medical assistance under the medicaid program.

1. It is the intent of the legislature in enacting this section to reduce the number of situations in which medicaid regulations as they apply to long term care costs, cause either the destitution of the entire family, or a dissolution of marriage carried out to prevent destitution. It is further the intent of this section to protect the community and separate property rights, insofar as such rights are not specifically preempted by federal law, of a married person whose spouse applies for medical assistance regardless of whether they are living together.
2. 1. In determining the eligibility of an aged, blind or disabled married individual or of a couple for medical assistance under title XIX of the social security act, the amount of income and resources to be counted as available to such individual or couple shall be calculated in accordance with the community property provisions of chapter 9, title 32, Idaho Code, or should it be to the advantage of such individual or couple, in accordance with the methods utilized by the federal supplemental security income program under title XVI of the social security act. (2)(a) In determining the eligibility of an aged, blind or disabled married individual or of a couple for medical assistance under title XIX of the social security act, the amount of income and resources to be counted as available to such individual or couple shall be calculated in accordance with the community property provisions of chapter 9, title 32, Idaho Code, or should it be to the advantage of such individual or couple, in accordance with the methods utilized by the federal supplemental security income program under title XVI of the social security act.
   2. Where both spouses are applying or are covered by medical assistance, the same method of counting income and resources shall be applied to both spouses and utilized to determine the liability of each for the cost of medical care; however, for any month for which either spouse receives a supplemental security income payment or a state supplement under section 56-207, 56-208 or 56-209a, Idaho Code, or for which an application is filed and subsequently approved, the methodology of the supplemental security income program shall be applied.
   3. The presumption of the availability of income under either the community property or supplemental security income method may be rebutted by either spouse.
   4. The department of health and welfare shall furnish to each married medical assistance applicant who is aged, blind or disabled, a clear and simple statement in writing advising them of the provisions of this section.
   5. 1. The provisions of paragraphs (a) through (d) of this subsection shall continue to apply on and after September 30, 1989, to married couples who are living together. (e)(i) The provisions of paragraphs (a) through (d) of this subsection shall continue to apply on and after September 30, 1989, to married couples who are living together.
      2. Beginning September 30, 1989, eligibility for any married person living in a medical institution whose spouse does not live in a medical institution, shall be determined by evaluating income first by attributing such income to the individual or individuals in whose name or names such income is paid, and if such attribution exceeds the maximum eligibility limit, secondly by attributing income in accordance with the community property provisions of chapter 9, title 32, Idaho Code.
      3. Beginning September 30, 1989, the post eligibility treatment of income of any married person living in a medical institution whose spouse does not live in a medical institution, shall be in accordance with section 1924(b) and (d) of the social security act regardless of whether eligibility was determined in accordance with the name or names by which income was paid or in accordance with the community property provisions of chapter 9, title 32, Idaho Code.
      4. The provisions of paragraphs (a), (b) and (d) of this subsection as they relate to resources shall continue to apply on and after September 30, 1989, to couples separated because one (1) spouse entered a medical institution for a continuous stay on or before September 29, 1989; and the provisions of section 1924(c) of the social security act shall apply to couples separated because one (1) spouse enters a medical institution for a continuous stay on or after September 30, 1989. (3) If any provision of this section or the application thereof to any person or circumstance is held invalid, such invalidity shall not affect other provisions or applications of the section that can be given effect without the invalid provisions or applications, and to this end the provisions of this section are severable.

§ 56-209f. State financial assistance program for medically indigent residents.

Beginning October 1, 1991, subject to the requirements and limitations of chapter 35, title 31, Idaho Code, the state shall fund the catastrophic health care cost program from the catastrophic health care cost account which shall provide financial assistance to medically indigent residents who are not eligible under the state plan for medicaid under title XIX of the social security act or medicare under title XVIII of that act, as amended.

§ 56-209g. Pharmacy reimbursement.

1. Medicaid pharmacy reimbursement levels are a combination of the cost of the drug and a dispensing fee which includes such pharmaceutical care services as counseling, obtaining a patient history, documentation and dispensing. Pharmacy reimbursement levels may be adjusted in accordance with rules promulgated by the director through negotiated rulemaking with interested parties including representatives of the pharmacy profession.
2. The department will pay the lesser of the provider’s lowest charge to the general public for a drug or the estimated acquisition cost (EAC) plus a dispensing fee.
   1. The EAC is defined by the department as the average acquisition cost (AAC) of the drug, or when no AAC is available, reimbursement will be wholesale acquisition cost (WAC). WAC shall mean the price, paid by a wholesaler for the drugs purchased from the wholesaler’s supplier, typically the manufacturer of the drug as published by a recognized compendia of drug pricing on the last day of the calendar quarter that corresponds to the calendar quarter.
   2. The department shall establish pharmacy dispensing fee payments based on the results of surveys of pharmacies and dispensing rates paid to other payers. The dispensing fee structure will be tiered, with the tiers based on the annual medicaid claims volume of the enrolled Idaho retail pharmacy. All other pharmacy dispensing fees will be the lowest dispensing fee for the tiered structure.
3. The AAC will be established by the department by state or national surveys to the pharmacy for the product. When surveys are requested by the department to pharmacies participating in the Idaho medicaid program, they are required to participate in these periodic state cost surveys by disclosing the costs of all drugs net of any special discounts or allowances. Participating pharmacies that refuse to respond to the periodic state surveys will be disenrolled as a medicaid provider.

§ 56-209h. Administrative remedies.

1. Definitions. For purposes of this section:
   1. “Abuse” or “abusive” means provider practices that are inconsistent with sound fiscal, business, child care or medical practices, and result in an unnecessary cost to a public assistance program, in reimbursement for services that are not medically necessary or that fail to meet professionally recognized standards for health care, or in physical harm, pain or mental anguish to a public assistance recipient.
   2. “Claim” means any request or demand for payment, or document submitted to initiate payment, for items or services provided under a public assistance program, whether under a contract or otherwise.
   3. “Fraud” or “fraudulent” means an intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to himself or some other person.
   4. “Intentional program violation” means intentionally false or misleading action, omission or statement made in order to qualify as a provider or recipient in a public assistance program.
   5. “Knowingly,” “known” or “with knowledge” means that a person, with respect to information or an action:
      1. Has actual knowledge of the information or action; or
      2. Acts in deliberate ignorance of the truth or falsity of the information or the correctness or incorrectness of the action; or
      3. Acts in reckless disregard of the truth or falsity of the information or the correctness or incorrectness of the action.
      4. Is an officer or director of an entity that is organized as a corporation; or
      5. Is a partner in an entity that is organized as a partnership; or
      6. Is a managing member in an entity that is organized as a limited liability company.
   6. “Managing employee” means a general manager, business manager, administrator, director or other individual who exercises operational or managerial control over, or who directly or indirectly conducts the day-to-day operation of, an institution, organization or agency.
   7. “Medicaid fraud control unit” means that medicaid fraud control unit as provided for in section 56-226, Idaho Code.
   8. “Ownership or control interest” means a person or entity that:
   9. Has an ownership interest totaling twenty-five percent (25%) or more in an entity; or
      1. “Provider” means an individual, organization, agency or other entity providing items or services under a public assistance program.
   10. “Public assistance program” means assistance for which provision is made in any federal or state law existing or hereafter enacted by the state of Idaho or the congress of the United States by which payments are made from the federal government to the state in aid, or in respect to payment by the state for welfare purposes to any category of needy person, and any other program of assistance for which provision for federal or state funds for aid may from time to time be made.
2. The department shall establish and operate an administrative fraud control program to enforce violations of the provisions of this chapter and of the state plan pursuant to subchapters XIX and XXI, chapter 7, title 42, U.S.C., that are outside the scope of the duties of the medicaid fraud control unit and to render and receive referrals from and to said unit. (3) Review of documentation of services. All claims submitted by providers for payment are subject to prepayment and postpayment review as designated by rule. Except as otherwise provided by rule, providers shall generate documentation at the time of service sufficient to support each claim, and shall retain the documentation for a minimum of five (5) years from the date the item or service was provided. The department or authorized agent shall be given immediate access to such documentation upon written request.
   1. Submits a claim with knowledge that the claim is incorrect, including reporting costs as allowable which were known to be disallowed in a previous audit, unless the provider clearly indicates that the item is being claimed to establish the basis for an appeal and each disputed item and amount is specifically identified; or
   2. Submits a fraudulent claim; or
   3. Knowingly makes a false statement or representation of material fact in any document required to be maintained or submitted to the department; or
   4. Submits a claim for an item or service known to be medically unnecessary; or
   5. Fails to provide, upon written request by the department, immediate access to documentation required to be maintained; or
   6. Fails repeatedly or substantially to comply with the rules and regulations governing medical assistance payments or other public assistance program payments; or
   7. Knowingly violates any material term or condition of its provider agreement; or
   8. Has failed to repay, or was a “managing employee” or had an “ownership or control interest” in any entity that has failed to repay, any overpayments or claims previously found to have been obtained contrary to statute, rule, regulation or provider agreement; or
   9. Has been found, or was a “managing employee” in any entity that has been found, to have engaged in fraudulent conduct or abusive conduct in connection with the delivery of health care or public assistance items or services; or (j) Fails to meet the qualifications specifically required by rule or by any applicable licensing board.

(4) Immediate action. In the event that the department identifies a suspected case of fraud or abuse and the department has reason to believe that payments made during the investigation may be difficult or impractical to recover, the department may suspend or withhold payments to the provider pending investigation. In the event that the department identifies a suspected case of fraud or abuse and it determines that it is necessary to prevent or avoid immediate danger to the public health or safety, the department may summarily suspend a provider agreement pending investigation. When payments have been suspended or withheld or a provider agreement suspended pending investigation, the department shall provide for a hearing within thirty (30) days of receipt of any duly filed notice of appeal.

(5) Recovery of payments. Upon referral of a matter from the medicaid fraud control unit, or if it is determined by the department that any condition of payment contained in rule, regulation, statute, or provider agreement was not met, the department may initiate administrative proceedings to recover any payments made for items or services under any public assistance contract or provider agreement the individual or entity has with the department. Interest shall accrue on overpayments at the statutory rate set forth in section 28-22-104, Idaho Code, from the date of final determination of the amount owed for items or services until the date of recovery.

(6) Provider status. The department may terminate the provider agreement or otherwise deny provider status to any individual or entity who:

Any individual or entity denied provider status under this section may be precluded from participating as a provider in any public assistance program for up to five (5) years from the date the department’s action becomes final.

(7) The department must refer all cases of suspected medicaid provider fraud to the medicaid fraud control unit and shall promptly comply with any request from the medicaid fraud control unit for access to and free copies of any records or information kept by the department or its contractors, computerized data stored by the department or its contractors, and any information kept by providers to which the department is authorized access by law.

(8) Civil monetary penalties. The department may also assess civil monetary penalties against a provider and any officer, director, owner, and/or managing employee of a provider in the circumstances listed in paragraphs (a) and (b) of this subsection. The penalties provided for in this subsection are intended to be remedial, recovering, at a minimum, costs of investigation and administrative review, and placing the costs associated with noncompliance on the offending provider. The department shall promulgate rules clarifying the methodology used when computing and assessing a civil monetary penalty.

(a) For conduct identified in subsection (6)(a) through (i) of this section, the amount of the penalties shall be up to one thousand dollars ($1,000) for each item or service improperly claimed, except that in the case of multiple penalties the department may reduce the penalties to not less than ten percent (10%) of the amount of each item or service improperly claimed if an amount can be readily determined. Each line item of a claim, or cost on a cost report is considered a separate claim.

(b) For failing to perform required background checks or failing to meet required timelines for completion of background checks, the amount of the penalty shall be five hundred dollars ($500) for each month worked for each staff person for whom the background check was not performed or not timely performed up to a maximum of five thousand dollars ($5,000) per month. A partial month is considered a full month for purposes of determining the amount of the penalty.

(9) Exclusion. Any individual or entity convicted of a criminal offense related to the delivery of an item or service under any state or federal program shall be excluded from program participation as a medicaid provider for a period of not less than ten (10) years. Unless otherwise provided in this section or required by federal law, the department may exclude any individual or entity for a period of not less than one (1) year for any conduct for which the secretary of the department of health and human services or designee could exclude an individual or entity.

(10) Sanction of individuals or entities. The department may sanction individuals or entities by barring them from public assistance programs for intentional program violations where the federal law allows sanctioning individuals from receiving assistance. Individuals or entities who are determined to have committed an intentional program violation will be sanctioned from receiving public assistance for a period of twelve (12) months for the first violation, twenty-four (24) months for the second violation and permanently for the third violation.

(11) Individuals or entities subject to administrative remedies as described in subsections (4) through (10) of this section shall be provided the opportunity to appeal pursuant to chapter 52, title 67, Idaho Code, and the department’s rules for contested cases.

§ 56-209i. Legislative findings.

It is the intent of the legislature that the provisions of this act enhance the employability of participants in the temporary assistance for families in Idaho (TAFI) programs through substance abuse screening and, where appropriate, testing and treatment. The legislature finds that a significant number of employers use preemployment drug testing. Substance abuse adds to the difficulties such individuals have in securing employment. The legislature also finds that substance abuse in and of itself impairs personal responsibility and self-sufficiency and stands in the way of the very intent of the TAFI program to care for the health and welfare of certain qualified recipients and in so doing results in welfare costs that burden the state’s taxpayers. The legislature further finds that substance abuse adversely affects a significant portion of the workforce, which results in billions of dollars of lost productivity each year and poses a threat to the safety of the workplace and to the public safety and security. In balancing the interests of taxpayers, participants in the TAFI program and potential employers against the interests of those who will be screened and tested under this act, the legislature finds that screening, testing and treatment as provided for in this act are in the greater interests of all concerned.

§ 56-209j. Substance abuse screening and testing programs.

1. The department of health and welfare shall develop for implementation in fiscal year 2001, a program to screen each applicant who is otherwise eligible for temporary cash assistance provided under this chapter, and to subject to testing any applicant or participant who the department has reasonable suspicion to believe, based on the screening or other factors, is at risk of substance abuse.
2. Prior to the first regular session of the fifty-sixth Idaho legislature, the department shall promulgate the necessary rules, pursuant to chapter 52, title 67, Idaho Code, to govern substance abuse screening and testing for TAFI programs. Rules shall, at a minimum:
   1. Specifically address the confidentiality of the screening and test results, and provide that individual results are protected under section 74-106(6), Idaho Code, and are not subject to disclosure except to an evaluating or treating substance abuse program, and cannot be released for use in any criminal investigation or proceeding;
   2. Provide notice of screening and testing requirements to each applicant at the time of application. The notice must, at a minimum, advise the applicant that substance abuse screening and possible testing will be conducted as a condition for receiving temporary assistance or services under this chapter. The applicant shall be advised that the required screening and possible testing may be avoided if the applicant does not apply for or receive assistance or services. The screening and testing program is not applicable in child only cases;
   3. Develop procedures for substance abuse screening and testing of applicants for and recipients of temporary assistance or services under the TAFI program;
   4. Provide a procedure to advise each person to be tested, before the test is conducted, that he or she may, but is not required to, advise the agent administering the test of any prescription or over-the-counter medication he or she is taking;
   5. Require each person to be tested to sign a written acknowledgment that he or she has received and understood the notice and advice provided under paragraphs (a) and (d) of this subsection;
   6. Provide a procedure to assure each person being tested a reasonable degree of dignity while producing and submitting a sample for drug testing, consistent with the state’s need to ensure the reliability of the sample;
   7. Specify circumstances under which a person who tests positive has the right to take one (1) or more additional tests;
   8. Provide a procedure for appealing the results of a test by a person who tests positive, and denial of TAFI services or benefits;
   9. Provide a definition for reasonable suspicion and high risk;
   10. Delineate the substances which will be screened;
   11. Establish outcome measures which can substantiate program effectiveness.

§ 56-209k. Children.

If a parent is deemed ineligible for cash assistance due to the operation of this act, his or her dependent child’s eligibility for cash assistance is not affected.

If a parent is deemed ineligible for cash assistance due to the operation of this act, an appropriate protective payee may be established for the benefit of the child.

If the parent refuses to cooperate in establishing an appropriate protective payee for the child, the department may appoint one.

§ 56-209l. Treatment provisions.

The department shall refer for appropriate evaluation and provide for the treatment of any applicant or participant who, in the reasonable suspicion of the department, is engaged in substance abuse. Treatment shall be community-based and gender-specific. The department shall provide for the transportation and child care needs of the applicant if necessary. TAFI benefits or services may be denied to any applicant or participant who refuses to cooperate with reasonable screening, testing or treatment requests, or who, based on a preponderance of the evidence, engages in substance abuse following treatment. Any individual referred to treatment shall be notified of the local treatment programs appropriate to that person’s needs.

§ 56-209m. Weight control pilot project.

Based upon available funding, the director of the department of health and welfare is directed to apply for the appropriate waiver or waivers from the centers for medicare and medicaid services for the state medicaid program to conduct a pilot project to determine the effectiveness of, and projected cost savings which may result from, providing reimbursement for weight control therapies, including anorexic drugs, and nutritional, diet and exercise counseling, in the state medicaid drug program, with the following limitations:

1. Participation in the pilot program shall be limited to one hundred (100) clients;
2. The length of the pilot program shall be limited to three (3) years;
3. Participation shall be limited to clients with a body mass index (BMI) over twenty-five (25); and
4. The department shall report annually to the senate and house health and welfare committees concerning the progress on all programs initiated under the waiver.

§ 56-209n. Medicaid for workers with disabilities.

1. The legislature finds that many individuals with disabilities would like to work but cannot afford to enter the workforce due to the fear of losing necessary medical services received through medicaid. Idaho hereby seeks to avail itself of the opportunity available through the federal ticket to work and work incentives improvement act of 1999, which allows states to establish new medicaid eligibility categories for working people with disabilities whose income or resources would otherwise make them ineligible for medicaid. Eliminating barriers to health care and other needed services and supports and creating financial incentives to work will greatly improve the short and long-term financial independence and well-being of people with disabilities. Medicaid for workers with disabilities will serve to increase the productivity of Idaho residents with disabilities and thereby enhance the economic and fiscal status of this state.
2. An individual is eligible to participate in the medicaid for workers with disabilities program if the individual:
   1. Is at least sixteen (16) years of age and not more than sixty-four (64) years of age;
   2. Has a disability as defined in title XVI of the federal social security act, as amended. An individual shall be determined to be eligible under this section without regard to his or her ability to engage in, or actual engagement in, substantial gainful activity, as defined in section 223(d)(4) of the social security act (42 U.S.C. section 423(d)(4));
   3. Is employed, including self-employment, and has provided the department of health and welfare with satisfactory written proof of employment. Hourly wage or hours worked shall not be used to determine employment;
   4. Has countable resources of ten thousand dollars ($10,000) or less. In calculating resources the following items shall be excluded: a second car, life insurance policies, retirement accounts, beneficial trusts, and any other resources excluded under current rules promulgated by the department of health and welfare for aid to aged, blind and disabled (AABD); and
   5. Has countable income, after exclusions and disregards as set forth in rules promulgated by the department of health and welfare for participants receiving AABD benefits, which do [does] not exceed five hundred percent (500%) of the federal poverty level.
3. An eligible individual who has an income as determined pursuant to subsection (2)(e) of this section less than one hundred thirty-three percent (133%) of the federal poverty level shall not be required to pay a premium for medicaid.
4. The department of health and welfare may require an eligible individual who has an income as determined pursuant to subsection (2)(e) of this section of one hundred thirty-three percent (133%) to two hundred fifty percent (250%) of the federal poverty level to pay a monthly premium as set forth in rules promulgated by the department of health and welfare.

§ 56-209o. Failure to retain records.

1. Whoever receives payment for treatment, services or goods under the provisions of this chapter or under the state plan pursuant to subchapter XIX or XXI, chapter 7, title 42, U.S.C., shall retain for a period of at least five (5) years all records required to be maintained by rule of the department for administration of the medicaid program.
2. It shall be unlawful with an intent to evade or avoid the provisions of this act: to fail to retain the records specified in subsection (1) of this section for a period of at least five (5) years from the date payment was claimed or received, whichever is later; or to knowingly destroy or cause the records specified in subsection (1) of this section to be destroyed within five (5) years from the date payment was claimed or received, whichever is later. Any person who, with an intent to evade or avoid the provisions of this act, fails to retain records or destroys records or causes records to be destroyed as provided in this subsection (2), with an intent to evade or avoid the provisions of this act, shall be subject to the following criminal sanctions:
   1. If the treatment, services or goods for which records were not retained or for which records were destroyed amount to not more than one thousand dollars ($1,000), the person shall be guilty of a misdemeanor and shall be sentenced pursuant to section 18-113, Idaho Code.
   2. If the value of the treatment, services or goods for which records were not retained or for which records were destroyed is more than one thousand dollars ($1,000), the person shall be guilty of a felony and shall be sentenced pursuant to section 18-112, Idaho Code.
   3. If the records not retained or destroyed were used in whole or in part to determine a rate of payment under the program, the person shall be guilty of a misdemeanor and shall be sentenced pursuant to section 18-113, Idaho Code.

§ 56-209p. Payment for midwife services.

A midwife licensed pursuant to chapter 55, title 54, Idaho Code, shall be entitled to payment under the rules of the medical assistance program for midwife services provided to an eligible recipient of medical assistance.

§ 56-210. Amount of assistance.

1. The amount of public assistance which any eligible person or family may receive shall be determined in accordance with the rules of the state department subject to the availability of funds for such assistance.
2. Old age assistance, aid to the blind and aid to the permanently and totally disabled shall be granted to a person who is needy as defined by the department and who meets the nonfinancial requirements of title XVI of the social security act.
3. The department may also increase or decrease the payment for groups of cases where the circumstances are specifically identified. The department shall be the single state agency for administration of public assistance programs or plans that receive federal funding.

§ 56-211. Application for public assistance — Verification for federal food stamp program.

1. Application for public assistance under this act shall be made in the manner and form prescribed by the state department and the application shall contain such information bearing on the applicant’s eligibility as the state department may require and as required in subsection (2) of this section.
2. Applicants seeking benefits under the federal food stamp program shall verify to the state department the identity of each household member the applicant lists on the application for such benefits. Identification may be verified either through readily available documentary evidence, such as a birth certificate, or through a collateral contact as set forth in federal law, 7 CFR 273.2. Upon a showing of good cause by the applicant as to why such documentary evidence or collateral contact has not been provided, the state department shall grant an extension and the applicant may receive the public assistance for which he or she has applied for one (1) month. A showing of good cause shall be required each month the applicant fails to provide the state department with the required documentary evidence or collateral contact. Good cause is not shown where a delay in providing documentary evidence or providing a collateral contact is due to illness, lack of transportation or temporary absences. The provisions of this subsection shall not apply to applicants who provide, or who have previously provided, a document as set forth in section 67-7903(4)(b)(viii) or (ix), Idaho Code.
3. The state department may promulgate rules to implement the provisions of this section.

§ 56-212. Investigation of application.

Whenever the state department shall receive an application for public assistance under this act, it shall promptly make an investigation and record of the circumstances of the applicant in order to ascertain the facts supporting the application and to obtain such other information as it may require.

§ 56-213. Examination to determine blindness.

No application for aid to the blind shall be approved until an ophthalmologist or physician skilled in diseases of the eye, or an optometrist, approved or designated by the state department, shall have examined the applicant and shall have certified his findings in the manner and form required by the state department.

§ 56-214. Award of public assistance — Ineligibility upon transfer of property.

Upon the completion of the investigation, the state department shall determine whether the applicant is eligible for public assistance under the provisions of this act, the type and amount of public assistance he shall receive, and the date upon which such public assistance shall begin. Public assistance shall be paid in the manner prescribed by the state department.

1. Assistance to families with children shall not be granted under this act to any person who within six (6) months prior to applying for or at any time during which such assistance is received, has either made an assignment or transfer of property for the purpose of rendering himself eligible for assistance under this act, or who has divested himself of any interest in property without adequate consideration which interest or proceeds therefrom could reasonably be expected to contribute to the support and maintenance of such person and his family, except that any person who is ineligible for public assistance due solely to such assignment or transfer shall become eligible provided:
   1. There is a showing that such person has caused such property to be assigned or transferred back to him; or
   2. There is a showing that the person to whom such property is assigned or transferred has, subsequent to such assignment or transfer, met subsistence and medical care costs exclusive of any obligation for support, of such person or family, according to the department’s assistance standard, equal to, or in excess of, the market value of the property so assigned or transferred; or
   3. There is a showing that the subsistence and medical care costs of such person, according to the department’s assistance standard, subsequent to such assignment or transfer, equal or exceed the market value of the property so assigned or transferred.
2. Eligibility for old age assistance under section 56-207, Idaho Code, or aid to the blind under section 56-208, Idaho Code, or aid to the disabled under section 56-209a, Idaho Code, shall be determined by continuing to consider as available any resource that was transferred prior to July 1, 1988, until such resource is fully accounted for under the provisions of section 1613(c) of the social security act as such section read on June 30, 1988.
3. Eligibility for medical assistance under section 56-209b, Idaho Code, shall continue to apply the rules of the director of the department of health and welfare concerning transfer of property as such rules read on October 29, 1988, to transfers that occur prior to July 1, 1989, to persons other than to the spouse of the person receiving or applying for medical assistance, and to interspousal transfers that occur prior to October 1, 1989.
4. The provisions of section 1917(c) of the social security act as amended by public law 100-360 and further amended by public law 100-485 and as hereafter amended shall apply as of July 1, 1989, to transfers of assets other than to the spouse, and as of October 1, 1989, to transfers between spouses, except that such provisions shall not apply either to transfers that occurred before July 1, 1988, or to transfers that have been fully accounted for under subsection (3) of this section. Notwithstanding the foregoing, any transfer of assets not otherwise specifically permitted by federal law or rule of the department not for fair market value is presumed to be for the purpose of sheltering assets to qualify for medical assistance. Such assets transferred shall be counted as available in determining eligibility, and will subject the applicant to penalties prescribed by the director, unless the applicant for assistance can demonstrate by clear and convincing evidence that the transfer was intended for another purpose.
5. Any funds, securities, accounts, contracts and all other property held in or transferred to a special needs trust as provided in chapter 14, title 68, Idaho Code, section 15-5-409, Idaho Code, and section 15-5-409a, Idaho Code, shall not be considered by the state department in determining whether the applicant is eligible for public assistance under the provisions of this act, so long as the action is permitted under the provisions of section 1917(c) and (d) of the social security act, as amended.
6. If any provision of this section or the application thereof to any person or circumstance is held invalid, such invalidity shall not affect other provisions or applications of the section that can be given effect without the invalid provisions or applications, and to this end the provisions of this section are severable.

§ 56-214A. Award of public assistance — Recipient’s right of free choice.

If an award of public assistance which includes an eye examination is made to or in behalf of an individual, that individual or his legal custodian shall have the right to select any practitioner to perform such examination who is licensed by the state of Idaho to perform eye examinations. Whenever such an award is applied for or approved, the state department or its personnel shall not recommend any practitioner or system of practice from among those licensed to perform eye examinations.

§ 56-215. Redetermination of awards.

Awards of public assistance may be changed or withdrawn whenever the circumstances have altered sufficiently to warrant such action. If at any time during the continuance of public assistance the recipient thereof becomes possessed of income or resources in excess of the amount previously reported by him, it shall be his duty to notify the state department of this fact immediately on the receipt or possession of such additional income or resources.

§ 56-217. Cooperative agreements.

The state department and the several counties of the state or other branches of state, county or municipal government are authorized to enter into cooperative agreements, through their appropriate officials, with respect to the administration of public assistance and social services. Among other things such an agreement may provide for:

1. The assumption by the state department of responsibilities involving public assistance or social services ordinarily incumbent upon the county or other branch of government;
2. The direct administration through the state department of any form of public assistance or care of the poor now or hereafter authorized to be granted by a county, but subject to the financial control of the county;
3. Mutual financial participation in programs of public assistance and social services in conformity with regulations of the department.
4. The intake and investigation of applications for public assistance by the appropriate office of the state department;
5. The granting of public assistance financed in whole or in part by county funds on the basis of policies, rules and regulations governing eligibility and amount of assistance adopted by the state department under this act.

§ 56-218. Recovery of certain medical assistance.

1. Except where exempted or waived in accordance with federal law medical assistance pursuant to this chapter paid on behalf of an individual who was fifty-five (55) years of age or older when the individual received such assistance may be recovered from the individual’s estate, and the estate of the spouse, if any, for such aid paid to either or both:
   1. There shall be no adjustment or recovery until after the death of both the individual and the spouse, if any, and only at a time when the individual has no surviving child who is under twenty-one (21) years of age or is blind or permanently and totally disabled as defined in 42 U.S.C. 1382c.
   2. While one (1) spouse survives, except where joint probate will be authorized pursuant to section 15-3-111, Idaho Code, a claim for recovery under this section may be established in the estate of the deceased spouse.
   3. The claim against the estate of the first deceased spouse must be made within the time provided by section 15-3-801(b), Idaho Code, if the estate is administered and actual notice is given to the director as required by subsection (5) of this section. However, if there is no administration of the estate of the first deceased spouse, or if no actual notice is given to the director as required by subsection (5) of this section, no claim shall be required until the time provided for creditor claims in the estate of the survivor.
   4. Nothing in this section authorizes the recovery of the amount of any aid from the estate or surviving spouse of a recipient to the extent that the need for aid resulted from a crime committed against the recipient.
2. Transfers of real or personal property, on or after the look-back dates defined in 42 U.S.C. 1396p, by recipients of such aid, or their spouses, without adequate consideration are voidable and may be set aside by an action in the district court.
3. Except where there is a surviving spouse, or a surviving child who is under twenty-one (21) years of age or is blind or permanently and totally disabled as defined in 42 U.S.C. 1382c, the amount of any medical assistance paid under this chapter on behalf of an individual who was fifty-five (55) years of age or older when the individual received such assistance is a claim against the estate in any guardianship or conservatorship proceedings and may be paid from the estate.
4. For purposes of this section, the term “estate” shall include:
   1. All real and personal property and other assets included within the individual’s estate, as defined for purposes of state probate law; and
   2. Any other real and personal property and other assets in which the individual had any legal title or interest at the time of death, to the extent of such interest, including such assets conveyed to a survivor, heir, or assign of the deceased individual through joint tenancy, tenancy in common, survivorship, life estate, living trust or other arrangement.
5. Claims made pursuant to this section shall be classified and paid as a debt with preference as defined in section 15-3-805(5), Idaho Code. Any distribution or transfer of the estate prior to satisfying such claim is voidable and may be set aside by an action in the district court. The personal representative of every estate subject to a claim under this section must, within thirty (30) days of the appointment, give notice in writing to the director of his or her appointment to administer the estate. (6) The department may file a notice of lien against the property of any estate subject to a claim under this section.
   1. In order to perfect a lien against real or personal property, the department shall, within ninety (90) days after the personal representative or successor makes a written request for prompt action to the director, or three (3) years from the death of the decedent, whichever is sooner, file a notice of lien in the same general form and manner as provided in section 56-218A(3)(a), Idaho Code, in the office of the secretary of state, pursuant to section 45-1904, Idaho Code. Failure to file a notice of lien does not affect the validity of claims made pursuant to this section.
   2. The department may release the lien in whole or in part to permit the estate property to be administered by a court-appointed personal representative.
   3. The department may foreclose its lien, without probate, in any of the following circumstances:
      1. Where no personal representative has been appointed after one (1) year from the date of death of the survivor of both the individual and spouse, if any;
      2. Where the property has been abandoned by the decedent’s heirs or successors, if any;
      3. Where the real property taxes that are due and payable have remained unpaid for two (2) years and, after demand by the department, the heirs or successors, if any, have failed to seek appointment or pay the property taxes; or
      4. Where all parties interested in the estate consent to foreclosure of the lien.
      5. A son or daughter of the individual, who was residing in the individual’s home for a period of at least two (2) years immediately before the date of the individual’s admission to the medical institution and who establishes to the satisfaction of the state that he or she provided care to such individual which permitted such individual to reside at home rather than in an institution.

(7) The director shall promulgate rules reasonably necessary to implement this section including, but not limited to, rules establishing undue hardship waivers for the following circumstances:

(a) The estate subject to recovery is income-producing property that provides the primary source of support for other family members; or

(b) The estate has a value below an amount specified in the rules; or

(c) Recovery by the department will cause the heirs of the deceased individual to be eligible for public assistance.

(8) The cause of action to void a transfer without adequate consideration established in this section shall not be deemed to have accrued until the department discovers, or reasonably could have discovered, the facts constituting the transfer without adequate consideration.

§ 56-218A. Medical assistance liens during life of recipient.

1. The department may recover and may impose a lien against the real property of any individual prior to his death for medical assistance paid or about to be paid under this chapter on behalf of an individual:
   1. Who is an inpatient in a nursing facility, intermediate care facility for people with intellectual disabilities, or other medical institution, if such individual is required, as a condition of receiving services in such institution under the state plan, to spend for costs of medical care all but a minimal amount of his income required for personal needs; and
   2. With respect to whom the department has determined, after notice and opportunity for hearing, that he cannot reasonably be expected to be discharged from the medical institution and to return home.
2. No lien may be imposed on the home of an individual under subsection (1) of this section if any of the following is lawfully residing in such home:
   1. The spouse of such individual;
   2. Such individual’s child under age twenty-one (21) years;
   3. Such individual’s child who is blind or permanently and totally disabled as defined in 42 U.S.C. 1382c; or
   4. A sibling of such individual who holds an equity interest in such home and who was residing in such home for a period of at least one (1) year prior to the individual’s admission to the medical institution.
3. 1. The lien shall be perfected by filing in the office of the secretary of state a notice of lien pursuant to section 45-1904, Idaho Code. The notice of lien shall include, in addition to the information required by section 45-1904, Idaho Code, the amount paid or about to be paid by the department on behalf of the individual, and, if applicable, the fact that the amount of the lien may increase over time. (3)(a) The lien shall be perfected by filing in the office of the secretary of state a notice of lien pursuant to section 45-1904, Idaho Code. The notice of lien shall include, in addition to the information required by section 45-1904, Idaho Code, the amount paid or about to be paid by the department on behalf of the individual, and, if applicable, the fact that the amount of the lien may increase over time.
   2. The department shall file any notice of lien under this section within ninety (90) days of the final determination of the department, after hearing if any, required in subsection (1)(b) of this section, with the exception of property against which the department is prevented from filing a lien pursuant to subsection (2) of this section. With respect to the property described in subsection (2) of this section, the department shall file a notice of lien within ninety (90) days after the department is notified in writing that subsection (2) of this section ceases to apply to the property.
4. Any lien imposed in accordance with subsection (1) of this section shall dissolve upon the individual’s discharge from the medical institution and return home.
5. No recovery shall be made under this section for medical assistance correctly paid except from such individual’s estate as defined in subsection (4) of section 56-218, Idaho Code, and subject to subsections (1)(d), (5) and (6) of section 56-218, Idaho Code, or upon sale of the property subject to a lien and may be made only after the death of such individual’s surviving spouse, if any, and only at a time:
   1. When he has no surviving child who is under age twenty-one (21) years, or who is blind or permanently and totally disabled as defined in 42 U.S.C. 1382c; or
   2. In the case of a lien on an individual’s home under subsection (1) of this section, when none of the following is lawfully residing in such home who has lawfully resided in such home on a continuous basis since the date of the individual’s admission to the medical institution: (i) A sibling of the individual, who was residing in the individual’s home for a period of at least one (1) year immediately before the date of the individual’s admission to the medical institution; or
6. The director shall promulgate rules reasonably necessary to implement this section including, but not limited to, rules establishing undue hardship waivers, as provided in section 56-218(7), Idaho Code, and a procedure for notice and opportunity for hearing on the department’s determination that an individual cannot reasonably be expected to be discharged from a medical institution and to return home.

§ 56-219. Payment for incompetent recipient — Appointment of guardian for public assistance.

If the recipient is under legal disability, or is incompetent or unable to handle the assistance granted him under this act, and has no other legal guardian, the district court, after due notice and hearing, shall appoint, without fee, on petition of the state department, and with the consent of the recipient’s nearest kin, next friend, natural guardian or custodian, a capable and trustworthy person as his guardian for public assistance, without bond, whose duty it shall be, without compensation, to receive and disburse the recipient’s assistance on his behalf, and to make true and accurate account thereof as often as required by regulation to the state department, and as otherwise provided by law, to the district court. Funds in the hands of such guardian shall be disbursed only for the purposes contemplated by this act, or as directed in the grant thereof.

§ 56-220. Payment on death of recipient — Appointment of administrator of public assistance.

In the event of the death of a recipient, leaving little or no estate requiring formal administration, but to whom a check for public assistance has been delivered prior to his death, or for whose interment burial relief has been granted, the district court, without fee, on petition of the state department, and with the consent of the deceased recipient’s nearest kin, next friend, guardian, natural guardian or custodian, after due notice and hearing, shall appoint a capable and trustwarthy [trustworthy] person as his administrator for public assistance, without bond, whose duty it shall be, without compensation, to receive and disburse the recipient’s assistance on behalf of the deceased recipient’s estate, making true and accurate account thereof to the state department and the district court. Funds in the hands of such administrator shall be disbursed only for the purposes contemplated by this act, or as directed in the grant thereof.

§ 56-221. Confidential character of public assistance records.

The rule-making power of the state department shall include the power to establish and enforce reasonable rules and regulations governing the custody, use and preservation of the records, papers, files and communications of the state department. Wherever, under provisions of law, names and addresses of recipients of public assistance are furnished to or held by any state or county official, the names and addresses shall be subject to disclosure according to chapter 1, title 74, Idaho Code; but any exemption from disclosure shall not prevent the furnishing to a state or local law enforcement officer, upon his written request, with the current address of any AFDC recipient if the officer furnishes the state department with such recipient’s name and social security account number and proof that such recipient is a convicted fugitive felon or an indicted fugitive felon, or a person for whom a fugitive warrant has been issued, and that the location or apprehension of such felon or person is within the officer’s official duties, and that the request is made in the proper exercise of those duties.

§ 56-223. Public assistance not assignable.

Public assistance awarded under this act shall not be transferable or assignable, and none of the money paid or payable under this act shall be subject to execution, attachment, or other legal process; except that the department may transfer funds to another public agency in lieu of payments to recipients, said funds to be transferred by such agency to project sponsors for payment as wages to said recipients participating in special work projects.

§ 56-224. Recovery.

The department may recover the amount of any public assistance obtained by any person who was not entitled thereto. If at any time during the continuance of assistance, the recipient thereof becomes possessed of any property or income in excess of the amount stated in the application, it shall be the duty of the recipient to notify the state department immediately of the receipt or possession of such property or income. Any assistance granted after the recipient has come into possession of such property or income in excess of eligibility standards, may be recovered by the state department.

On the death of a recipient who has received public assistance to which he was not entitled, or who has received public assistance in an amount greater than that to which he was entitled, by reason of possession or having come into possession of resources which he did not disclose to the department, or which had, or which acquired, a greater value than was disclosed, the total amount of such assistance paid to such recipient to which he was not entitled shall be allowed as a preferred claim against the estate of such recipient.

§ 56-224a, 56-224b. Recovery from recipients who own real property — Authorizing director to compromise or release claims and liens. [Repealed.]

§ 56-224c. Old age assistance recipients

Liens and indebtedness excused. [Repealed.]

§ 56-225. Request for notice of transfer or encumbrance of real property — Rulemaking.

1. When an individual receives medical assistance subject to recovery under this chapter and the individual is the holder of record title to real property or the purchaser under a land sale contract, the department of health and welfare may present to the county recorder for recording in the grants and conveyances records of a county a request for notice of transfer or encumbrance of the real property. The department shall adopt a rule providing prior notice and hearing rights to the record titleholder or purchaser under a land sale contract.
2. The department shall present to the county recorder for recording a termination of request for notice of transfer or encumbrance when, in the judgment of the department, it is no longer necessary or appropriate for the department to monitor transfers or encumbrances related to the real property.
3. The department shall adopt by rule a form for the request for notice of transfer or encumbrance and the termination of request for notice of transfer or encumbrance that, at a minimum:
   1. Contains the name of the public assistance recipient, and the spouse of such public assistance recipient, if any, and a departmental case identifier or other appropriate information that links the individual who is the holder of record title to real property or the purchaser under a land sale contract to the individual’s public assistance records;
   2. Contains the legal description of the real property;
   3. Contains a mailing address for the department to receive the notice of transfer or encumbrance; and
   4. Complies with the requirements for recording in section 55-805, Idaho Code, for those forms intended to be recorded.
4. The request for notice of transfer or encumbrance described in this section does not affect title to real property and is not a lien on, encumbrance of, or other interest in, the real property.

§ 56-226. Medicaid fraud control unit.

1. There is hereby established in the office of the attorney general the medicaid fraud control unit which shall have the authority and responsibilities as set forth in this section.
2. Notwithstanding the authority and responsibility granted to the director of the department to provide for fraud control in other aspects of public assistance and public health programs, the medicaid fraud control unit shall have the authority and responsibility to conduct a statewide program for the investigation and prosecution of violations of all applicable Idaho laws pertaining to fraud in the administration of the medicaid program, the provision of medical assistance and in the activities of providers of medical assistance and services under the state plan. Further, upon approval of the inspector general of the relevant federal agency, the office of the attorney general shall have the authority and responsibility to investigate and to prosecute violations of any aspect of the provision of health care services and activities of providers of such services under any federal health care program as defined in 42 U.S.C. section 1320(a)-7b(f)1, if the suspected fraud or violation of law in such investigation or prosecution is substantially related to the state plan. The medicaid fraud control unit shall be under the exclusive control of the attorney general and be separate and distinct from the department. No official from the department shall have authority to review or override the prosecutorial decisions made by the medicaid fraud control unit.
3. The medicaid fraud control unit shall also:
   1. Review complaints of abuse or neglect of medicaid recipients in health care facilities which receive payment pursuant to the state plan and may review complaints of the misappropriation of patients’ private funds in such facilities; and
   2. Review complaints of abuse or neglect of medicaid recipients residing in a board and care facility.
4. The medicaid fraud control unit shall attempt to collect or refer to the department for collection overpayments that are made to providers of facilities under the state plan or under any federal health care program to health care facilities that are the result of fraudulent acts and that are discovered by the medicaid fraud control unit in carrying out its responsibilities under this section. Notwithstanding any other provision of Idaho Code, all funds collected by the medicaid fraud control unit in accordance with this subsection (4) shall be deposited into the state general fund.
5. The office of the attorney general shall employ such auditors, attorneys, investigators and other personnel as are necessary to carry out the responsibilities of the medicaid fraud control unit as set forth under this section.
6. The office of the attorney general shall submit to the secretary of the federal department of health and human services applications and reports containing such information as is determined by the secretary by regulation to be necessary to meet the requirements of subchapter XIX, chapter 7, title 42, U.S.C.
7. In carrying out its duties and responsibilities under this section, the medicaid fraud control unit may:
   1. Request and receive the assistance of any prosecutor or law enforcement agency in the investigation and prosecution of any violation of any applicable Idaho laws pertaining to fraud in the administration of the medicaid program, the provision of medical assistance and in the activities of providers of medical assistance and services under the state plan; (b) Enter upon the premises of any provider participating in the medicaid program to:
      1. Examine all accounts and records that are relevant in determining the existence of fraud in the medicaid program;
      2. Investigate alleged abuse or neglect of medicaid recipients; or
      3. Investigate alleged misappropriation of patients’ private funds. The accounts or records of a nonmedicaid recipient may not be reviewed by, or turned over to the medicaid fraud control unit without the patient’s written consent or a court order; and
         1. Existence of civil violations or criminal offenses under this chapter or related offenses;
         2. Existence of medicaid recipient abuse, mistreatment or neglect; or
         3. Theft of medicaid recipient funds.
8. The medicaid fraud control unit shall safeguard the privacy rights of medicaid recipients to avoid unnecessary disclosure of personal information concerning named medicaid recipients. The medicaid fraud control unit may transmit such information that it deems appropriate to the department and to other agencies concerned with the regulation of health care facilities or health professionals.
9. The attorney general shall have the authority to adopt rules necessary to implement the duties and responsibilities assigned to the medicaid fraud control unit under this section.
10. As used in this section:
    1. “Board and care facility” means a provider of medicaid services in a residential setting which receives payment from or on behalf of two (2) or more unrelated adults who reside in such facility, and for whom one (1) or more of the following is provided:
       1. Nursing care services provided by, or under the supervision of, a registered nurse, licensed practical nurse or certified nurses aide; or
       2. A substantial amount of personal care services that assist residents with the activities of daily living, including personal hygiene, dressing, bathing, eating, toileting, ambulation, transfer of positions, self-medication, body care, travel to medical services, essential shopping, meal preparation, laundry and housework.
    2. “Department” means the Idaho department of health and welfare.
    3. “Director” means the director of the Idaho department of health and welfare.
    4. “Medicaid” means Idaho’s medical assistance program.
    5. “Provider” means any individual, partnership, association, corporation or organization, public or private, which provides residential or assisted living services, certified family home services, nursing facility services or services offered pursuant to medical assistance.
    6. “Recipient” means an individual determined eligible by the director for the services provided in the state plan for medicaid.
    7. “State plan” means the Idaho state plan pursuant to subchapter XIX, chapter 7, title 42 U.S.C.

(c) Notwithstanding any other provision of law, upon written request have full access to all records held by a medicaid provider, or by any other person on his or her behalf, that are relevant to the determination of the:

No person holding such records shall refuse to provide the medicaid fraud control unit access to such records for the purposes described in this section on the basis that release would violate the medicaid recipient’s right of privacy or privilege against disclosure or use or any professional or other privilege or right.

§ 56-227. Fraudulent acts — Penalty.

1. Whoever knowingly obtains, or attempts to obtain, or aids or abets any person in obtaining, by means of a willfully false statement or representation, material omission, or fraudulent devices, public assistance to which he is not entitled, or in an amount greater than that to which he is justly entitled, shall be punished in the same manner and to the same extent as for larceny or theft of the money or value of the public assistance so obtained or attempted to be so obtained.
2. Whoever sells, conveys, mortgages or otherwise disposes of his property, real or personal, or conceals his income or resources, for the purpose of rendering him eligible for public assistance, theretofore or thereafter applied for, to which he would not otherwise be entitled, shall be punished in the same manner and to the same extent as for larceny or theft of the money or value of the public assistance so obtained or so attempted to be obtained. Provided however, this provision shall not be construed to be more restrictive than federal or state provisions regarding the transfer of property for public assistance.
3. Every person who knowingly aids or abets any person in selling, conveying, mortgaging or otherwise disposing of his property, real or personal, or in concealing his income or resources for the purpose of rendering him eligible for public assistance, theretofore or thereafter applied for and received, to which he would not otherwise be entitled, shall be punished in the same manner and to the same extent as for larceny or theft of the money or value of the public assistance so obtained or attempted to be obtained. Provided however, this provision shall not apply to any person who communicates information or renders advice to another regarding federal or state provisions regarding the transfer of property for public assistance.
4. For the purpose of this section public assistance shall include the specific categories of assistance for which provision is made in any federal or state law existing or hereafter enacted by the congress of the United States or the state of Idaho by which payments are made from the federal government to the state in aid or in respect to payment by the state for welfare purposes to any category of needy person and any other program of assistance for which provision for federal or state funds for aid may from time to time be made.
5. The state department of health and welfare shall establish and operate a fraud control program to investigate suspected fraud relating to applications for public assistance benefits, and public assistance benefits received by individuals or entities. Such activities shall be those which do not fall under the authority of the medicaid fraud control unit as provided in section 56-226, Idaho Code. The department shall establish a procedure to coordinate information with prosecuting attorneys to prosecute offenders who commit fraudulent acts pursuant to this chapter.

§ 56-227A. Provider fraud — Criminal penalty.

It shall be unlawful for any provider or person, knowingly, with intent to defraud, by means of a wilfully false statement or representation or by deliberate concealment of any material fact, or any other fraudulent scheme or device, to:

1. present for allowance or payment any false or fraudulent claim for furnishing services or supplies; or
2. attempt to obtain or to obtain authorization for furnishing services or supplies; or
3. attempt to obtain or to obtain compensation from public funds greater than that to which he is legally entitled for services or supplies furnished or purportedly furnished.

Any provider or person who violates the provisions of this section shall be guilty of a felony. Nothing in this section shall prohibit or preclude a provider or person from being prosecuted under any other provision of the criminal code.

§ 56-227B. Provider fraud — Damages.

Any provider who knowingly with intent to defraud by means of false statement or representation, obtains compensation from public funds greater than that to which he is legally entitled for services or supplies furnished or purportedly furnished shall be liable for civil damages equal to three (3) times the amount by which any figure is falsely overstated. The director of the department of health and welfare or the attorney general shall have the right to cause legal action to be taken for the recovery of such damages when persuaded that a reimbursement claim for payment is falsely overstated. The burden of proof for such recovery action shall be that which is used in other civil actions for the recovery of damages. The remedy provided by this section shall be in addition to any other remedy provided by law.

If any provider of services or supplies is required to refund or repay all or part of any payment received by said provider under the provisions of this section, said refund or repayment shall bear interest from the date payment was made to such provider to the date of said refund or repayment. Interest shall accrue at the rate of ten percent (10%) per annum. The prevailing party in an action, under this section shall be awarded costs and reasonable attorney’s fees incurred in bringing or defending the action. Notwithstanding any other provision of the Idaho Code, all costs and attorney’s fees awarded to the department of health and welfare or the attorney general pursuant to this section shall be deposited into the state general fund.

§ 56-227C. Subpoena power.

1. The director, or his authorized representative, and the director of the Idaho state police or his authorized representative, for the purposes contemplated by this act, have power to issue subpoenas, compel the attendance of witnesses, administer oaths, certify to official acts, take depositions within and without the state of Idaho, as now provided by law, compel the production of pertinent books, payrolls, accounts, papers, records, documents and testimony. If a person in attendance before such director or his authorized representative refuses, without reasonable cause, to be examined or to answer a legal and pertinent question, or to produce a book or paper or other evidence when ordered so to do by the director or his authorized representative, said director or his authorized representative may apply to the judge of the district court of the county where such person is in attendance, upon affidavit for an order returnable in not less than two (2) or more than five (5) days, directing such person to show cause before such judge, or any other judge of such district, why he should not be punished for contempt; upon the hearing of such order, if the judge shall determine that such person has refused, without reasonable cause or legal excuse, to be examined or to answer a legal or pertinent question, or to produce a book or paper which he was ordered to bring or produce, he may forthwith punish the offender as for contempt of court.
   1. If any person asks to be excused from attending or testifying or from producing any books, payrolls, accounts, papers, records, documents or other evidence in connection with any investigation or inquiry or upon any hearing before any officer so authorized pursuant to this subsection (1), or in any proceeding or action before any court upon a charge or violation of this subsection (1), on the ground that the testimony or evidence required of him may tend to incriminate him or subject him to penalty or forfeiture, and if such person, notwithstanding such request, is directed to give such testimony or produce such evidence, the person must, if so directed by the director or his authorized representative, comply with such direction.
   2. After complying, and if, but for this subsection (1), the person would have been privileged to withhold the answer given or the evidence produced by him, then the answer, the evidence and any information directly or indirectly derived from the answer or evidence, may not be used against the compelled person in any manner in a criminal case, except that the person may nevertheless be prosecuted or subjected to penalty or forfeiture for any perjury, false swearing or contempt committed in answering or failing to answer or in producing or failing to produce evidence in accordance with the order. Such evidence may be used in the refusal, suspension or revocation of any license, permission or authority conferred, or to be conferred, pursuant to Idaho Code.
2. The attorney general or any prosecuting attorney or the designated agent of either shall have the authority to issue subpoenas to an enrolled or formerly enrolled provider of services pursuant to the medicaid program to compel production of any books, payrolls, accounts, papers, records or documents that are required to be maintained under the medicaid provider agreement executed by such provider or formerly enrolled provider as may be relevant to an investigation of fraud or other crime directly related to the use of medicaid program funds or services provided through the medicaid program that are not already in the possession of the director of the department of health and welfare or his designated agent. The attorney general or any prosecuting attorney or the designated agent of either may also compel testimony by the custodian of the items subpoenaed concerning the production and authenticity of those items. Subpoenas for records or information which are not required to be maintained under a provider agreement shall only be issued through subpoena powers in judicial proceedings. A subpoena under this subsection (2) shall describe the items required to be produced with particularity and prescribe a return date of a reasonable period of time within which the items can be assembled and made available to the attorney general or any prosecuting attorney or the designated agent of either.
3. Subpoenas issued pursuant to this section shall be served and witness fees and mileage paid as allowed in civil cases in the district courts of this state.
4. Investigators employed by the attorney general for the investigation and prosecution of providers of services pursuant to the medicaid program shall have all the authority given by statute to peace officers of the state of Idaho, including, but not limited to, authority to obtain, serve and execute warrants of arrest and warrants of search and seizure.

§ 56-227D. Federal food stamps, also known as supplemental nutrition assistance program — Unauthorized use — Exception — Definition.

1. It is a misdemeanor for any person to buy, receive, sell, give away, dispose of, exchange or barter any federal food stamp benefits of a value less than one hundred dollars ($100).
2. It is a felony for any person to buy, receive, sell, give away, dispose of, exchange or barter any federal food stamp benefits of a value of one hundred dollars ($100) or more.
3. This section does not apply to any person buying, receiving, selling, giving away, disposing of, exchanging or bartering any federal food stamp benefits subsequent to the redemption of such stamps in the manner provided by state or federal law.
4. As used in this section, federal food stamp benefits refers to food stamp benefits issued in any form by the United States department of agriculture or its duly authorized agent for the sole purpose of purchasing food.
5. This section shall be enforced by the director of the department of health and welfare in cooperation with local law enforcement and prosecuting agencies. Such enforcement shall not be the responsibility of the medicaid fraud control unit as provided in section 56-226, Idaho Code.

§ 56-227E. Obstruction of investigation.

1. An obstruction of investigation consists of knowingly:
   1. Providing false information to, or knowingly withholding information from, any person requesting such information if that person is authorized to investigate a violation of this chapter or to enforce the criminal or civil remedies of this chapter where that information is properly requested and is material to the investigation or enforcement; or
   2. Altering any document or record required to be retained pursuant to this chapter or any rule issued by the department of health and welfare, when the alteration is intended to mislead an investigation and concerns information material to that investigation.
2. Whoever commits an obstruction of investigation shall be guilty of a felony and shall be sentenced pursuant to the provisions of section 18-112, Idaho Code.

§ 56-227F. Public assistance benefit cards — Prohibited uses.

1. Any recipient of public assistance is prohibited from using public assistance benefit cards or cash obtained with public assistance benefit cards:
   1. For the purpose of participating in any of the activities described under chapters 38 and 49, title 18, Idaho Code, or authorized pursuant to any state-tribal gaming compact under section 67-429A, Idaho Code;
   2. For the purpose of pari-mutuel betting authorized under chapter 25, title 54, Idaho Code;
   3. To purchase lottery tickets or shares authorized under chapter 74, title 67, Idaho Code;
   4. For the purpose of participating in or purchasing tattoo, branding or body piercing services as defined in section 18-1523, Idaho Code;
   5. To purchase cigarettes as defined in section 39-7802(d), Idaho Code, or tobacco products or electronic smoking devices as defined in section 39-5702(13), Idaho Code;
   6. To purchase any items regulated under title 23, Idaho Code;
   7. For the purpose of adult entertainment at venues with performances that contain sexually oriented material where minors under the age of eighteen (18) years are prohibited; or
   8. For the purpose of purchasing or participating in any activities in any location listed in subsection (2) of this section.
2. The following businesses are required to comply with the provisions of this section:
   1. Any establishment or business licensed under chapter 9, title 23, Idaho Code;
   2. State liquor stores defined under section 23-902, Idaho Code, with the exception of special distributors as referenced in chapter 3, title 23, Idaho Code;
   3. Any business or agency that issues or underwrites bail bonds as defined in section 41-1038(3), Idaho Code;
   4. Gambling establishments licensed under Idaho law;
   5. Any business or establishment that offers tattoo, body piercing or branding services as defined in section 18-1523, Idaho Code;
   6. Adult entertainment venues with performances that contain sexually oriented material where minors under the age of eighteen (18) years are prohibited; and
   7. Any establishment where persons under the age of eighteen (18) years are not permitted.
3. The department shall notify any business determined to be in violation of the provisions of subsection (2) of this section and the licensing authority of any such business, if applicable, that such business has continued to allow the use of a public assistance benefit card in violation of subsection (2) of this section. The department may require the Idaho quest electronic benefits transfer (EBT) card business identification number (BIN) be disabled at any business found to be in violation of subsection (2) of this section. Any business in violation of subsection (2) of this section may also be required to deny all public assistance cash transactions made with an Idaho quest EBT card at any automated teller machine (ATM) located in their establishment. All costs associated with disabling the BIN and ATM will be the responsibility of such business owner.
4. Only the recipient, an eligible member of the recipient’s household or the recipient’s authorized representative may use a public assistance benefit card or the benefit, and such use shall only be for the respective benefit program purposes. The recipient shall not sell, attempt to sell, exchange or donate a public assistance benefit card or any benefits to any other person or entity. (5) A violation of subsection (1) or (4) of this section by a recipient constitutes a misdemeanor.
   1. The department shall notify all recipients of public assistance benefit cards that any violation of subsection (1) or (4) of this section could result in legal proceedings and forfeiture of all cash public assistance.
   2. Whenever the department has confirmed that a person has violated subsection (1) or (4) of this section, the department shall notify the person in writing that the violation could result in legal proceedings and forfeiture of all cash public assistance.

(6) As used in this section, “public assistance” or “public assistance benefit” means benefits provided to a recipient pursuant to the temporary assistance for families in Idaho (TAFI) program on an Idaho quest EBT card account.

(7) This section shall be enforced by the director of the department of health and welfare in cooperation with local law enforcement and prosecuting agencies.

§ 56-228. Limitations of act.

All assistance awarded under this act shall be deemed to be awarded and to be held subject to the provisions of any amending or repealing act that may hereafter be passed, and no recipient shall have any claim for compensation, or otherwise, by reason of his assistance being affected in any way by any amending or repealing act.

§ 56-229. Separability.

If any portion of this act is for any reason held to be unconstitutional, such decision shall not affect the validity of the main portions thereof.

§ 56-230. Short title.

This act may be cited as the “Public Assistance Law.”

§ 56-231. Public assistance in locating and determining the financial resources of parents and other persons liable for support of dependents.

To assist in locating and determining the financial resources of parents who have deserted their children and other persons liable for support of dependents, the department of health and welfare and county prosecuting attorneys may request and shall receive information from the records of all departments, boards, bureaus or other agencies of this state, and may request and may receive information from businesses and financial entities; and the same are authorized to provide such information as is necessary for this purpose, notwithstanding any provisions of chapter 1, title 74, Idaho Code, making the information exempt from disclosure. There shall be no legal sanctions imposed against a business or financial entity which refuses to provide requested information, unless the business or financial entity has been served with a subpoena requesting the information. Only information directly bearing on the identity, financial resources, and whereabouts of a person owing or asserted to be owing an obligation of support shall be requested and used or transmitted by the department of health and welfare and county prosecuting attorneys pursuant to the authority conferred by this act. The department of health and welfare and county prosecuting attorneys may make such information available only to public officials and agencies of this state, other states and the political subdivisions of this state and other states seeking to locate parents who have deserted their children and other persons liable for support of dependents for the purpose of enforcing their liability for support.

§ 56-232. Medical assistance programs — Contracts with independent agencies for administration of programs.

The agency, board, or governmental unit of the state of Idaho designated as the responsible agency for the administration of medical assistance programs which involve the participation of the federal government under the provisions of title XIX of the Social Security Act of 1965, as amended, is authorized to enter into contracts or agreements with life insurance companies qualified in this state, hospital or medical service corporations qualified in this state, or other appropriate independent organizations or corporations for the administration of such medical assistance programs, subject however, to the rules and regulations of the designated responsible governmental agency. Any such contract shall, among other provisions, set forth the term, consideration to be paid for such service, the general duties and procedures of the contract, accounting procedures, and such other matters as may be required to insure the proper administration of the benefits provided by the statutes of Idaho and the rules and regulations authorized therein with reference to the programs established by title XIX of the Social Security Act of 1965, as amended. Such contract shall be signed by the governor of the state of Idaho on behalf of the state.

§ 56-233. Procedure for disbursement of funds to recipients.

Notwithstanding the provisions of section 56-405 and section 56-406, Idaho Code, any such contract entered into between the designated and responsible governmental agency and an independent contractor for the administration of such medical assistance programs may set forth therein a procedure for the disbursement of funds to the recipients of such program and, upon the approval of the procedures so established by the state controller, disbursements of funds shall be made by the state of Idaho to the independent contractor and by the independent contractor to the recipients in accordance with the procedures so established. Procedures established by contract for the disbursement of funds shall have reference only to such funds as involve the participation of the federal government under the provisions of title XIX of the Social Security Act of 1965, as amended.

§ 56-233a. Costs of nonfederal share of skilled and intermediate nursing care for medically eligible persons

Source of payment. [Repealed.]

§ 56-234. Legislative intent.

It is hereby declared by the legislature that, in keeping with current state and national goals and best practice, increasing numbers of persons with developmental disabilities are being discharged to community facilities or private residences as an alternative to large public institutions licensed as intermediate care facilities for persons with intellectual disabilities. Such deinstitutionalization is highly desirable since it can lead to a fuller, richer and more independent life for persons with developmental disabilities. Recognizing that every individual has unique needs and differing abilities, the purpose of the following provisions is to clarify the department of health and welfare’s duties and responsibilities with respect to persons with developmental disabilities, who are or may become residents of the southwest Idaho treatment center, a public institution licensed for nine (9) or more beds as an intermediate care facility for persons with intellectual disabilities. The following provisions shall be liberally construed to accomplish these purposes.

§ 56-234A. Definitions.

As used in sections 56-234 through 56-235E, Idaho Code:

1. “Admission-discharge committee” means an interdisciplinary team of at least three (3) individuals designated by the director to evaluate persons as required by the provisions of sections 56-234 through 56-235E, Idaho Code. Each committee member must be specially qualified by training and experience in the diagnosis and treatment of persons with a developmental disability.
2. “Certified family home” means a family home as defined in section 39-3502, Idaho Code.
3. “Community facility” means a privately owned or operated nursing facility, intermediate care facility for persons with intellectual disabilities, licensed residential or assisted living facility, other organization licensed, recognized, or certified by the department to provide care or treatment to persons with developmental disabilities, or a publicly owned or operated facility licensed for eight (8) beds or less as an intermediate care facility for persons with intellectual disabilities.
4. “Department” means the Idaho department of health and welfare.
5. “Developmental disabilities” means a chronic disability of a person as defined in section 66-402, Idaho Code.
6. “Director” means the director of the Idaho department of health and welfare or his designee.
7. “Discharge” means an admission-discharge committee has determined that there is an available community facility or private residence that is least restrictive, appropriate and consistent with the needs of the individual.
8. “Medically fragile” means an individual with a developmental disability and a chronic medical condition that is characterized by periods of acute exacerbation or potentially life-threatening episodes and that may require frequent hospitalizations or prolonged recuperation periods and ongoing monitoring and assistance by a licensed registered nurse.
9. “Private residence” means a certified family home or a single family dwelling or apartment in a multiple dwelling or apartment complex that is used by an individual as a place of abode and that is not used for commercial purposes.
10. “Resident” means an individual who is admitted to or resides at the southwest Idaho treatment center.
11. “Transfer” means relocating and moving a person who is a resident of the southwest Idaho treatment center from that institution to a community facility or private residence or from one (1) community facility or private residence to another. Transfer does not include relocating or moving a resident of the southwest Idaho treatment center between rooms or beds within the southwest Idaho treatment center.

§ 56-235. Southwest Idaho treatment center.

The establishment by law of the southwest Idaho treatment center at Nampa, Idaho, is hereby ratified and affirmed, and its operation continued; provided, however, that on and after the effective date of this act, the treatment center shall be in the general supervision, control and government of the state department of health and welfare. All rights and title to property, real and personal, belonging to or vested in the state board of health [and welfare] are hereby transferred and vested in the state department of health and welfare. The state department is empowered to acquire, by purchase or exchange, any property which in the judgment of the department is needful for the operation of the treatment center, and to dispose of, by sale or exchange, any property which in the judgment of the department is not needful for the operation of the same. The department of health and welfare shall have authority to administer the treatment center, to employ and release such personnel as are required for the operation of the treatment center, fix salaries, and to perform any other necessary and proper functions in the efficient and beneficial operation of the treatment center.

§ 56-235A. Prohibitions, restrictions and limitations on admission.

1. The southwest Idaho treatment center shall not admit, accept or receive any person unless an admission-discharge committee determines that:
   1. The individual has a developmental disability;
   2. The individual meets the level of care requirements and active treatment requirements for admission to an intermediate care facility for persons with intellectual disabilities;
   3. All community facilities, options and supports have been exhausted, and there is no available community facility or private residence that is least restrictive, appropriate and consistent with the needs of the individual; and
   4. The southwest Idaho treatment center is the least restrictive available residential placement consistent with the needs of the individual after considering all available and appropriate community facilities and private residences.
2. The director may limit admissions and establish admission priorities to the southwest Idaho treatment center through rulemaking in order to ensure that expenditures for services do not exceed amounts appropriated by the legislature and allocated by the department to the facility. The southwest Idaho treatment center may refuse any applicant for voluntary admission.
3. Subsections (1) and (2) of this section do not apply to:
   1. Temporary emergency admissions or placements for crisis stabilization only, for up to ninety (90) days, that are preauthorized by the director; or
   2. Admissions or placements made by the director pursuant to section 66-406, Idaho Code.

§ 56-235B. Discharge planning — Authorization to discharge.

The director may discharge a resident of the southwest Idaho treatment center on such terms and conditions as the director may determine whenever an admission-discharge committee determines there is an available community facility or private residence that is least restrictive, appropriate and consistent with the individual’s needs. The director shall use reasonable efforts to discharge a resident to a community facility or private residence where the individual can be readily visited by those persons interested in his well-being.

§ 56-235C. Notice of discharge — Request for hearing.

1. Before a discharge plan is implemented, the resident and the resident’s spouse, guardian, adult next of kin or friend, if any, shall be given an opportunity to participate in the development and review of the admission-discharge committee’s discharge plan.
2. If, after reasonable efforts have been exhausted, the resident or the resident’s spouse, guardian, adult next of kin or friend, if any, does not agree with the admission-discharge committee’s discharge plan, ninety (90) days prior to discharge, written notice shall be filed with the committing court, if any, and served by registered or certified mail upon the resident, resident’s attorney, and either the resident’s spouse, guardian, adult next of kin or friend, if any. The written notice must include a statement advising the resident of the right to request a hearing by the director and must also include a statement advising the resident of the right to judicial review.
3. Within fifteen (15) days from receipt of the notice of discharge, the resident may serve a written request for hearing upon the director. Upon receipt of such request, the director shall fix a date for hearing, which date shall not be more than thirty (30) days from receipt of the request, and shall give the resident at least fifteen (15) days’ written notice of said hearing date. Within thirty (30) days after the conclusion of the hearing, the director shall notify the resident in writing by registered or certified mail of his decision. A transfer shall not be implemented during any period in which a request for hearing is pending and undecided by the director. If no request for hearing is made within fifteen (15) days from receipt of the notice of discharge, the director may discharge the resident.
4. The director shall periodically monitor the adjustment of the former resident to his transfer to a community facility or private residence. If within ninety (90) days following a transfer to a community facility or private residence, an admission-discharge committee determines that the former resident is not adjusting to the transfer and there is no other available community facility or private residence least restrictive, appropriate and consistent with the needs of the former resident, the director may make the determination that the former resident be readmitted to the southwest Idaho treatment center in accordance with section 56-235A, Idaho Code.

§ 56-235D. Appeals.

If a former resident feels aggrieved by a decision of the director rendered pursuant to a hearing as provided in section 56-235C, Idaho Code, appeal may be taken to the committing court or the court of the county in which such former resident is present. Appeal must be taken in the manner and form set forth in chapter 52, title 67, Idaho Code, provided however, the filing of a notice of appeal with the court shall not, unless otherwise ordered, stay the resident’s discharge or the decision of the director.

§ 56-235E. Rulemaking authority.

The director, in addition to other duties imposed by law, is hereby authorized and directed through rulemaking to establish procedures necessary to implement these provisions. The rulemaking authority granted in this section shall be limited to the specific standards and procedures required by sections 56-234 through 56-235D, Idaho Code.

§ 56-236. Short title.

This act shall be known and may be cited as the “Idaho Health Insurance Access Card Act.”

§ 56-237. Purpose.

The purpose and intent of this act is to promote the availability of health insurance to children and families and to adults who are employed by small businesses in Idaho and their dependent spouses whose families’ modified adjusted gross incomes fall within one hundred eighty-five percent (185%) of the federal poverty guidelines.

§ 56-238. Definitions.

As used in sections 56-236 through 56-242, Idaho Code:

1. “CHIP Plan A” means the existing Idaho children’s health insurance program for children eligible under federal title XXI whose families’ modified adjusted gross incomes do not exceed one hundred fifty percent (150%) of the federal poverty guidelines.
2. “CHIP Plan B” means the program created in section 56-239, Idaho Code.
3. “Department” means the state department of health and welfare.
4. “Director” means the director of the state department of health and welfare.
5. “Eligible adult” means a person:
   1. Over eighteen (18) years of age living in Idaho;
   2. Whose family’s modified adjusted gross income is less than one hundred percent (100%) of the federal poverty guidelines;
   3. Who is employed full time by a small employer, meaning an employer with two (2) to fifty (50) employees and as such term is defined in section 41-4703, Idaho Code, and who is eligible for health insurance coverage under a small employer health benefit plan regulated under chapter 47, title 41, Idaho Code, or the dependent spouse of such employee; and
   4. Who does not qualify for comparable or greater assistance through other federal or state health insurance or premium assistance programs.
6. “Eligible child” means a child under nineteen (19) years of age living in Idaho whose family’s modified adjusted gross income falls within federal poverty guidelines for medicaid, CHIP Plan A or CHIP Plan B.
7. “Health benefit plan” means any hospital or medical policy or certificate, any subscriber contract provided by a hospital or professional service corporation, or managed care organization subscriber contract. Health benefit plan does not include policies or certificates of insurance for specific disease, hospital confinement indemnity, accident-only, credit, dental, vision, medicare supplement, long-term care, or disability income insurance, student health benefits only coverage issued as a supplement to liability insurance, worker’s compensation or similar insurance, automobile medical payment insurance or nonrenewable short-term coverage issued for a period of twelve (12) months or less.
8. “Modified adjusted gross income” means individual or family income as defined for state medicaid programs in the social security act and the Internal Revenue Code.
9. “Small business health insurance pilot program” means the program created in section 56-241, Idaho Code.

§ 56-239. CHIP Plan B.

1. There is hereby created in the department a CHIP Plan B that shall be made available by the department to eligible children, as defined in section 56-238, Idaho Code, whose family’s modified adjusted gross income is between one hundred fifty percent (150%) and one hundred eighty-five percent (185%) of the federal poverty guidelines. The director shall implement the program by adopting rules recommended by the board of the Idaho individual high risk reinsurance pool created in section 41-5502, Idaho Code, that authorize policies of health insurance for children enrolled in the CHIP Plan B.
2. There is hereby created a CHIP Plan B advisory board which shall advise the Idaho individual high risk reinsurance pool board concerning issues related to the CHIP Plan B. The board shall consist of eight (8) members, four (4) members to be appointed by the director and four (4) members to be appointed by the governor. At least two (2) members of the board shall be parents of children who are eligible to participate in the CHIP Plan B.

§ 56-240. Children’s access card program. [Repealed.]

Repealed by S.L. 2014, ch. 80, § 4, effective July 1, 2014.

§ 56-241. Small business health insurance pilot program.

1. There is hereby created in the department a small business health insurance pilot program that shall be made available for up to one thousand (1,000) eligible adults, as defined in section 56-238, Idaho Code, based on available funding. The director shall implement the program by adopting rules recommended by the board of the Idaho individual high risk reinsurance pool created in section 41-5502, Idaho Code, providing for the payment of the benefit authorized in subsection (2) of this section through the use of the Idaho health insurance access card.
2. The small business health insurance pilot program shall, through the Idaho health insurance access card program, pay to the insurance company providing insurance coverage through policies regulated under chapter 47, title 41, Idaho Code, for an adult enrolled in the small employer health insurance pilot program, for each month the insurance coverage is in effect, a one hundred dollar ($100) payment to be applied to the monthly insurance premium billed each month by the insurance company.
3. Participation in the small business health insurance pilot program by any employer shall be optional. Nothing in sections 56-236 through 56-242, Idaho Code, shall be construed to mandate or require that an employer participate in the pilot program. Small employers who choose to participate in the small business health insurance pilot program shall meet insurance carriers’ contribution and participation guidelines.
4. There is hereby created a small business health insurance advisory board which shall advise the Idaho individual high risk reinsurance pool board concerning issues related to the small business health insurance pilot program. The board shall consist of eight (8) members, four (4) members to be appointed by the director and four (4) members to be appointed by the governor. At least four (4) members of the board shall be representatives of small businesses, meaning those with two (2) to fifty (50) employees, that offer employee health benefit plans regulated under chapter 47, title 41, Idaho Code.
5. The department shall limit assistance under the small business health insurance pilot program to those who do not have access to comparable or better coverage under other federal or state programs.

§ 56-242. Idaho health insurance access card.

1. The director shall develop an Idaho health insurance access card program in the department to implement the small business health insurance pilot program.
2. 1. There is hereby created and established in the state treasury a fund to be known as the “Idaho health insurance access card fund.” Moneys in the fund shall be maintained in two (2) subaccounts, identified respectively as the “CHIP Plan B subaccount” and the “small business health insurance pilot program subaccount.” Appropriations, matching federal funds, grants, donations and moneys from other sources shall be paid into the fund. The department shall administer the fund. Any interest earned on the investment of idle moneys in the fund shall be returned to and deposited in the fund. (2)(a) There is hereby created and established in the state treasury a fund to be known as the “Idaho health insurance access card fund.” Moneys in the fund shall be maintained in two (2) subaccounts, identified respectively as the “CHIP Plan B subaccount” and the “small business health insurance pilot program subaccount.” Appropriations, matching federal funds, grants, donations and moneys from other sources shall be paid into the fund. The department shall administer the fund. Any interest earned on the investment of idle moneys in the fund shall be returned to and deposited in the fund.
   2. Moneys in the CHIP Plan B subaccount and the small business health insurance pilot program subaccount shall be expended pursuant to appropriation for the payment of benefits and capped administrative costs of the department.
3. The director shall manage waivers of federal title XXI and title XIX to subsidize health care coverage under the CHIP Plan B and the small business health insurance pilot program. Federal matching funds received by the department to provide coverage under CHIP Plan B and the small business health insurance pilot program shall be deposited in the appropriate subaccount.
4. The director is authorized to promulgate rules recommended by the board of the Idaho individual high risk reinsurance pool to implement the CHIP Plan B and the small business health insurance pilot program.
5. Insurers offering health benefit plans regulated under chapter 47, title 41, Idaho Code, shall accept payment for such plans under the small business health insurance pilot program pursuant to rules promulgated by the department.
6. The department shall limit assistance under the Idaho health insurance access card program to those who do not have access to comparable or better coverage under other federal or state programs.

§ 56-243, 56-244. Civil rights of residents — Individual treatment plan. [Repealed.]

§ 56-245 — 56-249. [Reserved.]

This act shall be known and may be cited as the “Idaho Medicaid Simplification Act.”

§ 56-251. Legislative intent.

1. The legislature finds that the current federal medicaid law and regulations have not kept pace with modern health care management practices, create obstacles to quality care and impose unnecessary costs on the delivery of effective and efficient health care. The legislature believes that the state of Idaho must strive to balance efforts to contain medicaid costs, improve program quality and improve access to services. The legislature further believes that the state of Idaho could achieve improved health outcomes for medicaid participants by simplifying eligibility and developing health benefits for medicaid participants according to their health needs, including appropriate preventive and wellness services.
2. The legislature supports development, at a minimum, of the following health-need categories:
   1. Low-Income Children and Working-Age Adults with No Special Health Needs. The broad policy goal for the medicaid program for low-income children and working-age adults with no special health needs is to achieve and maintain wellness by emphasizing prevention and by proactively managing health. Additional specific goals are:
      1. To emphasize preventive care and wellness;
      2. To increase participant ability to make good health choices; and
      3. To strengthen the employer-based health insurance system.
   2. Persons with Disabilities or Special Health Needs. The broad policy goal for the medicaid program for persons with disabilities or special health needs is to finance and deliver cost-effective individualized care. Additional specific goals are:
      1. To emphasize preventive care and wellness;
      2. To empower individuals with disabilities to manage their own lives;
      3. To provide opportunities for employment for persons with disabilities; and
      4. To provide and to promote family-centered, community-based, coordinated care for children with special health care needs.
   3. Persons with Medicare and Medicaid Coverage. The broad policy goal for the medicaid program for persons with medicare and medicaid coverage is to finance and deliver cost-effective individualized care which is integrated, to the greatest extent possible, with medicare coverage. Additional specific goals are:
      1. To emphasize preventive care and wellness;
      2. To improve coordination between medicaid and medicare coverage;
      3. To increase nonpublic financing options for long-term care; and
      4. To ensure participants’ dignity and quality of life.
3. To the extent practicable, the department shall achieve savings and efficiencies through use of modern care management practices, in areas such as network management, cost-sharing, benefit design and premium assistance.
4. The department’s duty to implement these changes in accordance with the intent of the legislature is contingent upon federal approval.

§ 56-252. Definitions.

As used in sections 56-250 through 56-255, Idaho Code:

1. “Benchmark plan” means a package of health benefits coverage that provides coverage for a specified population in accordance with section 6044 of the deficit reduction act of 2005.
2. “Benefit design” means selection of services, providers and beneficiary cost-sharing to create the scope of coverage for participants.
3. “Community supports” means services that promote the ability of persons with disabilities to be self-sufficient and live independently in their own communities.
4. “Cost-sharing” means participant payment for a portion of medicaid service costs such as deductibles, coinsurance or copayment amounts.
5. “Department” means the department of health and welfare.
6. “Director” means the director of the department of health and welfare.
7. “Health risk assessment” means a process of assessing the health status and health needs of participants.
8. “Medicaid” means Idaho’s medical assistance program.
9. “Medical assistance” means payments for part or all of the cost of services funded by titles XIX or XXI of the federal social security act as amended, as may be designated by department rule.
10. “Medical home” means a primary care case manager designated by the participant or the department to coordinate the participant’s care.
11. “Network management” means establishment and management of contracts between the department and limited groups of providers or suppliers of medical and other services to participants.
12. “Participant” means a person eligible for and enrolled in the Idaho medical assistance program.
13. “Premium assistance” means use of medicaid funds to pay part or all of the costs of enrolling eligible individuals into private insurance coverage.
14. “Primary care case manager” means a primary care physician who contracts with medicaid to coordinate the care of certain participants.
15. “Provider” means any individual, partnership, association, corporation or organization, public or private, which provides residential or assisted living services, certified family home services, nursing facility services or services offered pursuant to medical assistance.
16. “Self-determination” means medicaid services that allow persons with disabilities to exercise choice and control over the services and supports they receive.
17. “State plan” means the contract between the state and federal government under 42 U.S.C. section 1396a(a).

§ 56-253. Powers and duties of the director.

1. The director is hereby encouraged and empowered to obtain federal approval in order that Idaho design and implement changes to its medicaid program that advance the quality of services to participants while allowing access to needed services and containing excessive costs. The design of Idaho’s medicaid program shall incorporate the concepts expressed in section 56-251, Idaho Code.
2. The director may create health-need categories other than those stated in section 56-251(2)(a), Idaho Code, subject to legislative approval, and may develop a medicaid benchmark plan for each category.
3. Each benchmark plan shall include explicit policy goals for the covered population identified in the plan, as well as specific benefit packages, delivery system components and performance measures in accordance with section 67-1904, Idaho Code.
4. The director shall establish a mechanism to ensure placement of participants into the appropriate benchmark plan as allowed under section 6044 of the deficit reduction act of 2005. This mechanism shall include, but not be limited to, a health risk assessment. This assessment shall comply with federal requirements for early and periodic screening, diagnosis and treatment (EPSDT) services for children, in accordance with section 1905(a)(4)(B) of the social security act. The health risk assessment shall include questions related to substance use disorders to allow referral to treatment for such disorders by the department.
5. The director may require, subject to federal approval, participants to designate a medical home. Applicants for medical assistance shall receive information about primary care case management and, if required to so designate, shall select a primary care provider as part of the eligibility determination process.
6. The director may, subject to federal approval, enter into contracts for medical and other services when such contracts are beneficial to participant health outcomes as well as economically prudent for the medicaid program.
7. The director may obtain agreements from medicare, school districts and other entities to provide medical care if it is practical and cost-effective.
8. The director shall research options and apply for federal waivers to enable cost-efficient use of medicaid funds to pay for substance abuse and/or mental health services in institutions for mental disease.
9. The director shall, in cooperation with the director of the department of insurance, seek waivers from the federal government to provide that persons eligible for medicaid pursuant to section 56-267, Idaho Code, who have a modified adjusted gross income at or above one hundred percent (100%) of the federal poverty level shall receive the advance premium tax credit to purchase a qualified health plan through the Idaho health insurance exchange established by chapter 61, title 41, Idaho Code, instead of enrolling in medicaid, except as provided in paragraph (a) of this subsection.
   1. A person described in this subsection may choose to enroll in medicaid instead of receiving the advance premium tax credit to purchase a qualified health plan.
   2. If the waivers described in this subsection are not approved before January 1, 2020, then the persons described in this subsection shall be enrolled in medicaid. (10) The director shall seek a waiver from the federal government consistent with the provisions of this subsection.
      1. Working at least twenty (20) hours per week, averaged monthly, or earning wages equal to or greater than the federal minimum wage for twenty (20) hours of work per week;
      2. Participating in and complying with the requirements of a work training program at least twenty (20) hours per week, as determined by the department;
      3. Volunteering at least twenty (20) hours per week, as determined by the department;
      4. Enrolled at least half-time in postsecondary education or another recognized education program, as determined by the department, and remaining enrolled and attending classes during normal class cycles;
      5. Meeting any combination of working, volunteering, and participating in a work program for a total of at least twenty (20) hours per week, as determined by the department; or
      6. Subject to and complying with the requirements of the work program for temporary assistance for needy families (TANF) or participating and complying with the requirements of a workfare program in the supplemental nutrition assistance program (SNAP).
         1. Under the age of nineteen (19) years;
         2. Over the age of fifty-nine (59) years;
         3. Physically or intellectually unable to work;
         4. Pregnant;
         5. A parent or caretaker who is the primary caregiver of a dependent child under the age of eighteen (18) years, as determined by the department;
         6. A parent or caretaker personally providing care for a person with serious medical conditions or with a disability, as determined by the department;
         7. Applying for or receiving unemployment compensation and complying with work requirements that are part of the federal-state unemployment insurance program;
         8. Applying for social security disability benefits, until such time eligibility is determined;
         9. Participating in a drug addiction or alcohol treatment and rehabilitation program, as determined by the department; or
         10. An American Indian or Alaska native who is eligible for services through the Indian health service or through a tribal health program pursuant to the Indian self-determination and education assistance act and the Indian health care improvement act.
   3. The department shall verify a medicaid participant’s compliance with paragraph (a) of this subsection every six (6) months and shall promulgate rules based on federal final waiver approval relating to the requirements of this subsection. A person who fails to comply with paragraph (a) of this subsection shall:
      1. Be ineligible for medicaid but may reapply for medicaid two (2) months after such determination is made or earlier if in compliance; or
      2. If the provisions of subparagraph (i) of this paragraph are not federally approved or are found unlawful by a court of competent jurisdiction, be subject to the maximum allowable copayments on covered Idaho medicaid services for a period of six (6) months or until the person complies with paragraph (a) of this subsection, whichever is earlier.
   4. It is the intent of the legislature, in enacting the requirements of this subsection, to enable coverage of medicaid participants while also promoting the participants’ health and financial independence. (e) The department shall implement the waiver described in this subsection as soon as possible once federal approval has been obtained.

(a) A person participating in medicaid pursuant to section 56-267, Idaho Code, must be:

(b) A person is exempt from the provisions of paragraph (a) of this subsection if the person is:

(11) The director is given authority to promulgate rules consistent with this act.

§ 56-254. Eligibility for medical assistance.

The department shall make payments for medical assistance to, or on behalf of, the following persons eligible for medical assistance.

1. The benchmark plan for low-income children and working-age adults with no special health needs includes the following persons:
   1. Children in families whose family income does not exceed one hundred eighty-five percent (185%) of the federal poverty guideline and who meet age-related and other eligibility standards in accordance with department rule;
   2. Pregnant women of any age whose family income does not exceed one hundred thirty-three percent (133%) of the federal poverty guideline and who meet other eligibility standards in accordance with department rule, or who meet the presumptive eligibility guidelines in accordance with section 1920 of the social security act;
   3. Infants born to medicaid-eligible pregnant women. Medicaid eligibility must be offered throughout the first year of life as long as the infant remains in the mother’s household and she remains eligible, or would be eligible if she were still pregnant;
   4. Adults in families with dependent children as described in section 1931 of the social security act, who meet the requirements in the state’s assistance to families with dependent children (AFDC) plan in effect on July 16, 1996;
   5. Families who are provided six (6) to twelve (12) months of medicaid coverage following loss of eligibility under section 1931 of the social security act due to earnings, or four (4) months of medicaid coverage following loss of eligibility under section 1931 of the social security act due to an increase in child or spousal support;
   6. Employees of small businesses who meet the definition of “eligible adult” as described in section 56-238, Idaho Code, whose eligibility is limited to the medical assistance program described in section 56-241, Idaho Code;
   7. All other mandatory groups as defined in title XIX of the social security act, if not listed separately in subsection (2) or (3) of this section.
2. The benchmark plan for persons with disabilities or special health needs includes the following persons:
   1. Persons under age sixty-five (65) years eligible in accordance with title XVI of the social security act, as well as persons eligible for aid to the aged, blind and disabled (AABD) under titles I, X and XIV of the social security act;
   2. Persons under age sixty-five (65) years who are in need of the services of a licensed nursing facility, a licensed intermediate care facility for the developmentally disabled, a state mental hospital, or home-based and community-based care, whose income does not exceed three hundred percent (300%) of the social security income (SSI) standard and who meet the asset standards and other eligibility standards in accordance with federal law and regulation, Idaho law and department rule;
   3. Certain disabled children described in 42 CFR 435.225 who meet resource limits for aid to the aged, blind and disabled (AABD) and income limits for social security income (SSI) and other eligibility standards in accordance with department rules;
   4. Persons under age sixty-five (65) years who are eligible for services under both titles XVIII and XIX of the social security act;
   5. Children who are eligible under title IV-E of the social security act for subsidized board payments, foster care or adoption subsidies, and children for whom the state has assumed temporary or permanent responsibility and who do not qualify for title IV-E assistance but are in foster care, shelter or emergency shelter care, or subsidized adoption, and who meet eligibility standards in accordance with department rule;
   6. Eligible women under age sixty-five (65) years with incomes at or below two hundred percent (200%) of the federal poverty level, for cancer treatment pursuant to the federal breast and cervical cancer prevention and treatment act of 2000;
   7. Low-income children and working-age adults under age sixty-five (65) years who qualify under subsection (1) of this section and who require the services for persons with disabilities or special health needs listed in section 56-255(3), Idaho Code;
   8. Persons over age sixty-five (65) years who choose to enroll in this state plan; and
   9. Effective January 1, 2018, children under eighteen (18) years with serious emotional disturbance, as defined in section 16-2403, Idaho Code, in families whose income does not exceed three hundred percent (300%) of the federal poverty guideline and who meet other eligibility standards in accordance with department rule.
3. The benchmark plan for persons over twenty-one (21) years of age who have medicare and medicaid coverage includes the following persons:
   1. Persons eligible in accordance with title XVI of the social security act, as well as persons eligible for aid to the aged, blind and disabled (AABD) under titles I, X and XIV of the social security act;
   2. Persons who are in need of the services of a licensed nursing facility, a licensed intermediate care facility for the developmentally disabled, a state mental hospital, or home-based and community-based care, whose income does not exceed three hundred percent (300%) of the social security income (SSI) standard and who meet the assets standards and other eligibility standards in accordance with federal and state law and department rule;
   3. Persons who are eligible for services under both titles XVIII and XIX of the social security act who have enrolled in the medicare program; and
   4. Persons who are eligible for services under both titles XVIII and XIX of the social security act and who elect to enroll in this state plan.

§ 56-256. Preventive health assistance.

1. The department of health and welfare may establish preventive health assistance benefits available to a medicaid participant in order to provide incentives to promote healthy behavior and responsible use of health care services.
2. Preventive health assistance benefits are available when the participant complies with recommended preventive care and demonstrates healthy behaviors or conducts other activities as specified in department rule. Preventive health assistance benefits are only available during a participant’s period of eligibility.
3. The uses of preventive health assistance may include, but not be limited to, participant payments for preventive health products and services and participant cost-sharing payments as specified in department rule.
4. Preventive health assistance benefits may be used to cover delinquent cost-sharing obligations when participants have complied with recommended preventive care as described in department rule.

§ 56-257. Copayments.

1. Within the limits of federal medicaid law and regulations, the department of health and welfare shall establish enforceable cost sharing in order to increase the awareness and responsibility of medicaid participants for the cost of their health care and to encourage use of cost-effective care in the most appropriate setting. Copayments established by department rule may include, but not be limited to, the following:
   1. Medicaid services including, but not limited to, chiropractic visits, podiatrist visits, optometrist visits, physical therapy visits, occupational therapy visits, speech therapy visits, outpatient hospital visits and physician office visits;
   2. Inappropriate use of emergency medicaid reimbursed services, including hospital emergency room and emergency transportation; and
   3. Missed appointments with health care providers when it is the practice of the health care provider to charge such copayments to all of their patients regardless of payer.
2. The director may exempt, subject to federal approval, any group of medicaid participants from the cost-sharing provisions in this section.

§ 56-258, 56-259. [Reserved.]

Sections 56-260 through 56-266, Idaho Code, shall be known and may be cited as the “Medicaid Cost Containment and Health Care Improvement Act.”

§ 56-261. Legislative findings and intent.

1. The legislature finds that the current health care delivery system of payment to medicaid health care providers on a fee for service basis does not provide the appropriate incentives and can be improved by incorporating managed care tools, including capitation and selective contracting, with the objective of moving toward an accountable care system that results in improved health outcomes.
2. The legislature intends that the provisions of sections 56-260 through 56-266, Idaho Code, result in the improved health of public assistance recipients while, at the same time, increasing the choices and responsibilities of those recipients. The legislature further intends that these sections result in improved business practices of providers.
3. The legislature directs the department to pursue opportunities in the medicaid program that result in safe and appropriate discharge from public and private institutions including nursing homes, intermediate care facilities and psychiatric facilities into community settings and that such results should be financially sustainable.
4. Price increases should be implemented only through specific appropriation authority unless the adjustments are specified in federal law.

§ 56-262. Definitions.

The definitions contained in section 56-252, Idaho Code, shall apply to sections 56-260 through 56-266, Idaho Code.

§ 56-263. Medicaid managed care plan.

1. The department shall present to the legislature on the first day of the second session of the sixty-first Idaho legislature a plan for medicaid managed care with focus on high-cost populations including, but not limited to:
   1. Dual eligibles; and
   2. High-risk pregnancies.
2. The medicaid managed care plan shall include, but not be limited to, the following elements:
   1. Improved coordination of care through primary care medical homes.
   2. Approaches that improve coordination and provide case management for high-risk, high-cost disabled adults and children that reduce costs and improve health outcomes, including mandatory enrollment in special needs plans, and that consider other managed care approaches.
   3. Managed care contracts to pay for behavioral health benefits as described in executive order number 2011-01 and in any implementing legislation. At a minimum, the system should include independent, standardized, statewide assessment and evidence-based benefits provided by businesses that meet national accreditation standards.
   4. The elimination of duplicative practices that result in unnecessary utilization and costs.
   5. Contracts based on gain sharing, risk-sharing or a capitated basis.
   6. Medical home development with focus on populations with chronic disease using a tiered case management fee.
3. The department shall seek federal approval or a waiver to require that a medicaid participant who has a medical home as required in section 56-255(5)(b), Idaho Code, and who seeks family planning services or supplies from a provider outside the participant’s medical home, must have a referral to such outside provider. The provisions of this subsection shall apply to medicaid participants upon such approval or the granting of such a waiver.

§ 56-264. Rulemaking authority.

In addition to the rulemaking authority granted to the department in this chapter and elsewhere in Idaho Code regarding the medicaid program and notwithstanding any other Idaho law to the contrary, the department shall have the authority to promulgate rules regarding:

1. Medical services to:
   1. Change the primary case management paid to providers to a tiered payment based on the health needs of the populations that are managed. A lower payment is to be made for healthier populations and a higher payment is to be made for individuals with special needs, disabilities or are otherwise at risk. An incentive payment is to be provided to practices that provide extended hours beyond the normal business hours that help reduce unnecessary higher-cost emergency care;
   2. Provide that a healthy connections referral is no longer required for urgent care as an alternative to higher cost but unnecessary emergency services; and
   3. Eliminate payment for collateral contact;
2. Mental health services to:
   1. Eliminate administrative requirements for a functional and intake assessment and add a comprehensive diagnostic assessment addendum;
   2. Restrict duplicative skill training from being provided by a mental health provider when the individual has chosen to receive skill training from a developmental disability provider. Mental health providers may not provide training for skills included in the individual’s developmental disability plan, but may provide services related to the individual’s mental illness that require specialized expertise of mental health professionals, such as management of mental health symptoms, teaching coping skills related to mental health diagnosis, assisting with psychiatric medical appointments and educating individuals about their diagnosis and treatment;
   3. Increase the criteria for accessing the partial care benefit and restrict to those individuals who have a diagnosis of serious and persistent mental illness;
   4. Eliminate the requirement for new annual plans; and
   5. Direct the department to develop an effective management tool for psychosocial rehabilitation services;
3. In-home care services to:
   1. Eliminate personal care service coordination; and
   2. Restrict duplicative nursing services from a home health agency when nursing services are being provided through the aged and disabled waiver;
4. Vision services to:
   1. Align coverage requirements for contact lenses with commercial insurers and other state medicaid programs; and
   2. Limit coverage for adults based on chronic care criteria;
5. Audiology services to eliminate audiology benefits for adults;
6. Developmental disability services to:
   1. Eliminate payment for collateral contact;
   2. Eliminate supportive counseling benefit;
   3. Reduce annual assessment hours from twelve (12) to four (4) hours and exclude psychological and neuropsychological testing services within these limits;
   4. Reduce plan development payment from twelve (12) to six (6) hours and reduce requirements related to adult developmental disabilities plan development;
   5. Restrict duplicative skill training from being provided by a developmental disabilities provider when an individual has chosen to receive skill training from his mental health provider. The individual may receive skill development services from a developmental disability provider only for skills that are not addressed by the mental health service provider’s plan and that relate directly to the individual’s developmental disability, such as skills related to activities of daily living and functional independence;
   6. Implement changes to certified family homes pursuant to chapter 35, title 39, Idaho Code, to:
      1. Create approval criteria and process for approving new certified family homes;
      2. Recertify current certified family homes; and
      3. Develop applicant and licensing fees to cover certifying and recertifying costs; and
7. Institutional care services to discharge individuals from institutional settings where such services are no longer necessary.

§ 56-265. Provider payment.

1. Where there is an equivalent, the payment to medicaid providers:
   1. May be up to but shall not exceed one hundred percent (100%) of the current medicare rate for primary care procedure codes as defined by the centers for medicare and medicaid services; and
   2. Shall be ninety percent (90%) of the current medicare rate for all other procedure codes.
2. Where there is no medicare equivalent, the payment rate to medicaid providers shall be prescribed by rule.
3. Notwithstanding any other provision of this chapter, if the services are provided by a private, freestanding mental health hospital facility that is an institution for mental disease as defined in 42 U.S.C. 1396d(i), the department shall reimburse for inpatient services at a rate not to exceed ninety-one percent (91%) of the current medicare rate within federally allowed reimbursement under the medicaid program. The reimbursement provided for in this subsection shall be effective until July 1, 2021.
4. The department shall, through the annual budget process, include a line-item request for adjustments to provider rates. All changes to provider payment rates shall be subject to approval of the legislature by appropriation.
5. Notwithstanding any other provision of this chapter, the department may enter into agreements with providers to pay for services based on their value in terms of measurable health care quality and positive impacts to participant health.
   1. Any such agreement shall be designed to be cost-neutral or cost-saving compared to other payment methodologies.
   2. The department is authorized to pursue waiver agreements with the federal government as needed to support value-based payment arrangements, up to and including fully capitated provider-based managed care.
6. Medicaid reimbursement for critical access, out-of-state, and state-owned hospitals shall be as follows:
   1. In-state, critical access hospitals as designated according to 42 U.S.C. 1395i-4(c)(2)(B) shall be reimbursed at one hundred one percent (101%) of cost;
   2. Out-of-state hospitals shall be reimbursed at eighty-seven percent (87%) of cost;
   3. State-owned hospitals shall be reimbursed at one hundred percent (100%) of cost; and
   4. Out-of-state hospital institutions for mental disease as defined in 42 U.S.C. 1396d(i) shall be reimbursed at a per diem equivalent to ninety-five percent (95%) of cost.
7. The department shall equitably reduce net reimbursements for all hospital services, including in-state institutions for mental disease but excluding all hospitals and institutions described in subsection (6) of this section, by amounts targeted to reduce general fund needs for hospital payments by three million one hundred thousand dollars ($3,100,000) in state fiscal year 2020 and eight million seven hundred twenty thousand dollars ($8,720,000) in state fiscal year 2021.
8. The department shall work with all Idaho hospitals, including institutions for mental disease as defined in 42 U.S.C. 1396d(i), to establish value-based payment methods for inpatient and outpatient hospital services to replace existing cost-based reimbursement methods for in-state hospitals, other than those hospitals and institutions described in subsection (6) of this section, effective July 1, 2021. Budgets for hospital payments shall be subject to prospective legislative approval. (9) The department shall work with Idaho hospitals to establish a quality payment program for inpatient and outpatient adjustment payments described in section 56-1406, Idaho Code. Inpatient and outpatient adjustment payments shall be subject to increase or reduction based on hospital service quality measures established by the department in consultation with Idaho hospitals.

§ 56-267. Medicaid eligibility expansion.

1. Notwithstanding any provision of law or federal waiver to the contrary, the state shall amend its state plan to expand medicaid eligibility to include those persons under sixty-five (65) years of age whose modified adjusted gross income is one hundred thirty-three percent (133%) of the federal poverty level or below and who are not otherwise eligible for any other coverage under the state plan, in accordance with sections 1902(a)(10)(A)(i)(VIII) and 1902(e)(14) of the social security act.
2. No later than ninety (90) days after approval of this act, the department shall submit any necessary state plan amendments to the United States department of health and human services, centers for medicare and medicaid services to implement the provisions of this section. The department is required and authorized to take all actions necessary to implement the provisions of this section as soon as practicable.
3. Eligibility for medicaid as described in this section shall not be delayed if the centers for medicare and medicaid services fail to approve any waivers of the state plan for which the department applies, nor shall such eligibility be delayed while the department is considering or negotiating any waivers to the state plan. The department shall not implement any waiver that would result in a reduction in federal financial participation for persons identified in subsection (1) of this section below the ninety percent (90%) commitment described in section 1905(y) of the social security act.
4. If section 1905(y) of the social security act is held unlawful or unconstitutional by the United States supreme court, then the legislature shall declare this section to be null, void, and of no force and effect.
5. If federal financial participation for persons identified in subsection (1) of this section is reduced below the ninety percent (90%) commitment described in section 1905(y) of the social security act, then the senate and house of representatives health and welfare committees shall, as soon as practicable, review the effects of such reduction and make a recommendation to the legislature as to whether medicaid eligibility expansion should remain in effect. The review and recommendation described in this subsection shall be conducted by the date of adjournment of the regular legislative session following the date of reduction in federal financial participation.
6. The department:
   1. Shall place all persons participating in medicaid pursuant to this section in a care management program authorized under section 56-265(5), Idaho Code, or in another managed care program to improve the quality of their care, to the extent possible; and
   2. Is authorized to seek any federal approval necessary to implement the provisions of this subsection.
7. No later than January 31 in the 2023 legislative session, the senate and house of representatives health and welfare committees shall review all fiscal, health, and other impacts of medicaid eligibility expansion pursuant to this section and shall make a recommendation to the legislature as to whether such expansion should remain in effect.

§ 56-301. County council of public assistance — Appointment of members — Term — Organization.

There is hereby created in each county of this state a council to be known as County Council of Public Assistance. Said council shall consist of five (5) members to be appointed as follows: one (1) member to be a county commissioner to be selected and appointed by the board of county commissioners of his county and to serve at the pleasure of the board of county commissioners, but under such appointment to serve only while he is a county commissioner; four (4) members of the council to be appointed by the governor, not more than two (2) of whom shall be members of the same political faith. The members appointed by the governor shall be for the following terms: one (1) member for one (1) year; one (1) for two (2) years; and two (2) for three (3) years. All appointments by the governor after the first board shall be for a term of three (3) years. Each member so appointed shall serve until his successor is appointed and qualifies and shall receive no compensation for his services. In the event of a vacancy, except as to the member appointed by the board of county commissioners, the same shall be filled by appointment of the governor, which appointee shall be of the same political faith as his predecessor. The appointment to fill a vacancy shall be for the unexpired term of his predecessor. The council shall organize by the election of a chairman and the county supervisor of public assistance shall be the secretary of said council.

§ 56-302. Meetings — Quorum.

The council shall meet in regular session at least once each month at a time and place within the county to be fixed by resolution of the council. Special meetings may be had at any time upon call of the chairman and notice thereof given by the secretary to the members of the said council. The time and method of giving such notice of special meetings shall be fixed by resolution of the council. A quorum of said council shall consist of three (3) members and a quorum at any meeting legally called may exercise all the powers vested in the council.

§ 56-303. Powers and duties.

The county council of public assistance shall review, in accordance with plans, rules and regulations approved by the board of health and welfare of the state of Idaho, the administration of public assistance and social services of the state department of health and welfare in the several counties. In the performance of its duties said council shall:

1. Make periodic reviews of all cases approved for public assistance within the county, for the purpose of determining the continuing eligibility for public assistance of the recipient.
2. Review all cases heretofore approved for public assistance within the county by the department for the purpose of determining the continuing eligibility of the recipient in regard thereto.
3. Furnish information to applicants and the public in general, as to who is eligible for public assistance, and the rules and regulations promulgated by the board in regard thereto, to the end that there may be more widespread knowledge of the real purpose of the public assistance program and the administration thereof.
4. To recommend to the board such rules, regulations, policies and procedure, as in the judgment of the council, shall increase efficiency, effect economy and generally improve the administration of public assistance.
5. The board shall promulgate all necessary and proper rules and regulations governing the procedure of the county council of public assistance.
6. Nothing herein is intended, nor shall be interpreted, to prevent the right of appeal or limit opportunity for a fair hearing before the board; nor as preventing the director of the department of health and welfare from administering the public assistance laws of this state as a single state agency.

§ 56-401. Creation of cooperative welfare fund — Purpose.

There is hereby created a trust fund in the state treasury to be known as the cooperative welfare fund, and all money deposited therein is perpetually appropriated for public welfare purposes.

§ 56-402. Sources of cooperative welfare fund.

There shall be placed in the cooperative welfare fund all federal grants-in-aid made to the state of Idaho under titles I, IV and X, and part 3 of title V of the act of congress known as the Social Security Act, as amended; all cooperative funds received from the counties under the provisions of the public assistance law; and any funds received from federal, state, personal, or other sources, subject to administration by the director of the department of health and welfare for public assistance and welfare purposes.

§ 56-403. Budget estimate — Requisition for funds.

At the beginning of each calendar quarter, or oftener, the director of the department of health and welfare shall make and file with the state board of examiners for examination a claim upon the general fund for funds appropriated to the department of health and welfare in an amount estimated to be sufficient to meet the needs of such department for the period. Such claim shall be supported by such estimates of anticipated expenditures as the board may require.

§ 56-404. Transfer of funds from general fund to welfare fund.

Upon the approval of the claim upon the general fund by the state board of examiners, the state controller and the state treasurer shall transfer the approved amount from the general fund to the cooperative welfare fund. Any unexpended balance in the cooperative welfare fund at the end of any month shall be subject to disbursement in accordance with the terms of this act in any subsequent month.

§ 56-405. Administration and disbursement of funds.

1. Disbursements from the cooperative welfare fund, involving the participation of federal funds, which may be made available only upon condition that they are to be administered by a single state agency, shall be made upon claims approved by the director of the department of health and welfare.
2. All other disbursements from the cooperative welfare fund shall be made upon claims submitted to and approved by the state board of examiners as are other claims against the state.

§ 56-406. Procedure for making disbursements.

For disbursements as described in section 56-405(a), Idaho Code, the director shall make requisition to the state controller upon vouchers, showing the director’s approval of such disbursements, and certifying to the participation therein of federal funds as described in said section 56-405(a), Idaho Code. Upon the presentation of such vouchers, the state controller shall issue warrants on the state treasury against the cooperative welfare fund, payable to the persons named by the director in the amounts allowed by it, as indicated upon the vouchers. Such warrants shall be transmitted by the state controller to the director of the department of health and welfare for distribution. Requisitions and vouchers for disbursements described in section 56-405(a), Idaho Code, shall be subject to examination by the state controller in order to determine that the account is in proper form, that the totals carried thereon are correct, and that there are funds in the state treasury out of which the same may lawfully be paid.

§ 56-407. Transfer of funds from cooperative emergency revenue fund.

All money in the cooperative emergency revenue fund on the effective date of this act are hereby transferred and appropriated to the cooperative welfare fund; and all obligations incurred against the cooperative emergency revenue fund which are outstanding on such date shall be payable from the cooperative welfare fund; and all references to the cooperative emergency revenue fund shall hereafter be construed to apply to the cooperative welfare fund.

§ 56-408 — 56-449. [Reserved.]

The director of the department of health and welfare may receive, on behalf of the department, any money or real or personal property donated, bequeathed, devised, or conditionally granted to the department. Such moneys received directly or derived from the sale of such property shall be deposited by the state treasurer in a special account to be known as the “Health and Welfare Trust Account”, which is hereby established, reserved, set aside, appropriated and made available until expended, used, and administered to carry out the terms or conditions of such donation, bequest, devise, or grant. Pending such expenditure or use, surplus moneys in the health and welfare trust account shall be invested by the state treasurer in the manner provided for idle state moneys in the state treasury by section 67-1210, Idaho Code. Interest received on all such investments shall be paid into the health and welfare trust account.

The director shall provide annually, to the legislative council through the director of legislative services, an accounting of the health and welfare trust account setting forth the sources, applications and balance of moneys within the account.

§ 56-460. County medical indigency suspense account. [Repealed.]

§ 56-501. Food stamp revolving fund created — Appropriation.

There is hereby perpetually appropriated to the division of public assistance in the department of public welfare, or any successor thereto, out of any moneys in the general fund not otherwise appropriated, the sum of $100,000.00 to be deposited in the cooperative emergency revenue fund [cooperative welfare fund] for the creation of a permanent revolving fund to be known as the food stamp revolving fund, to be administered by the division of public assistance, or any successor thereto, for the purpose of enabling the state of Idaho to cooperate with the Surplus Marketing Administration in the United States Department of Agriculture, or any successor thereto, in distributing surplus agricultural products to needy persons and families under an arrangement known as the stamp plan.

§ 56-502. Defining and limiting use of fund.

All moneys in the food stamp revolving fund shall be used exclusively for the purchase of food order stamps from the United States Department of Agriculture; such stamps to be sold to needy persons or families subject to the provisions of the food stamp plan entered into with the Surplus Marketing Administration, or any successor thereto. All moneys received from the sale of such stamps or from the redemption of such stamps by the United States Department of Agriculture shall be deposited with the state treasurer and the amount thereof credited to such revolving fund.

§ 56-503. Bonding and insurance of fund — Costs.

Such bonds and insurance as may be deemed necessary or advisable for preserving and safeguarding the funds herein appropriated shall be secured, and the costs of such bonds and insurance shall be paid out of funds appropriated to the division of public assistance, or any successor thereto, for administrative expenses.

§ 56-504. Reversion of food stamp revolving fund to general fund.

If and when the need for the food stamp revolving fund shall no longer exist, the division of public assistance, or its successor, shall so advise the state board of examiners, which said board shall thereupon order that the funds herein appropriated revert to the general fund and said funds shall thereupon be so transferred.

§ 56-601. Policy.

It is hereby declared to be the policy of this state to conserve and develop the youth resources thereof, which is the source of our state’s future citizens and taxpayers, and likewise to conserve and develop the natural resources of our state as a trust held by us for these future citizens, and it is the urgent duty of the state to conserve the youth as well as the natural resources thereof.

§ 56-602. Idaho youth conservation project created.

There is hereby created the Idaho youth conservation project, which shall be placed under the jurisdiction and supervision of the Idaho park and recreation board.

§ 56-603. Requirements for participants — Summer camp.

1. Participants in the Idaho youth conservation project shall be citizens of the United States and the state of Idaho, of good character and health who are not less than fourteen (14) years nor more than seventeen (17) years of age.
2. In order to participate in the project an individual must agree to comply with the rules and regulations as set up by the park [and recreation] board for the government of those taking part in the project.
3. Participation shall be for the duration of one (1) summer camp as set by the park and recreation board.

§ 56-604. Duties of park and recreation board.

It shall be the duty of the park and recreation board to expend such funds as it deems necessary to provide staff, select workers, equip, supply and maintain all phases of said project as funds are available.

§ 56-605. Purposes of project.

Purpose of such project shall be twofold; (1) the conservation of youth in the most positive way by introducing them to the satisfactions of constructive work and outdoor life, the rewards of which they can witness and evaluate for themselves; (2) to promote the conservation of our natural resources within an effective framework specifically tailored to the needs of Idaho for future programs to conserve timber, water, soil, forage and recreation resources through the use of our youth resources.

§ 56-606. Authority of the park and recreation board.

In order to carry out the purposes of this act the park and recreation board shall have the authority to:

1. Formulate rules and regulations for operation of the project.
2. Appoint, in accordance with the policy and regulations of the department, such qualified personnel as it deems necessary for the efficient and economic discharge of the functions of the project. Compensation and benefits of all such appointees to be fixed as may be provided by law and the policies and regulations of the department.
3. Establish adequate standards of safety, health, and morals for participants.
4. To enter into such agreements with and otherwise cooperate with such other governmental agencies, departments and instrumentalities as may be necessary in carrying out the purposes of this act.
5. To formulate such other rules and regulations, establish such other procedures, and enter into such contracts and agreements and generally perform such functions as it may deem necessary or desirable to carry out the provisions of this act.
6. To provide a regular schedule of work, on-the-job training and recreation as falls naturally within the philosophy and program scope of the youth conservation project.

§ 56-607. Compensation of participants.

A.(1) The base compensation of participants shall be set by the park and recreation board.

(2) The park and recreation board shall establish procedures whereby each participant may make an allotment to his parent, dependent, legal guardian, or any fund established for his benefit, of part of the periodic compensation to which he is entitled by this act, and such allotment shall be paid directly to the person or fund in which favor it is made.

B. In addition to compensation authorized in subsection A, participants shall be furnished with such quarters, subsistence, transportation, equipment, clothing, medical services, and hospital services as the park and recreation board may deem necessary or appropriate for their needs.

§ 56-608. Laws inapplicable to participants.

Existing provisions of law with respect to hours of work, rate of compensation, sick leave, vacation and unemployment compensation shall not be applicable to any individual because of participation in the project.

§ 56-609. Worker’s compensation benefits.

Participants shall, for the purpose of the administration of the worker’s compensation law, be deemed to be civil employees of the state.

§ 56-701. Policy of state.

It is the policy of this state to encourage and enable individuals with disabilities to participate fully in the social and economic life of the state and to engage in remunerative employment.

§ 56-702. Right to full and free use of streets, highways, public buildings and public facilities.

Individuals with disabilities have the same rights and privileges as the general public to the full and free use of the streets, highways, sidewalks, walkways, public buildings, public facilities, and other places of public accommodations.

§ 56-703. Right to full and equal accommodations in all common carriers, hotels, lodging houses, places of public accommodations or other public places.

Individuals with disabilities are entitled to full and equal accommodations, advantages, facilities, and privileges of all common carriers, airplanes, motor vehicles, and railroad trains, motor buses, streetcars, boats, or any other public conveyances or modes of transportation, hotels, lodging places, places of public accommodations, amusement, or resort, and other places to which the general public is invited, subject only to the conditions and limitations established by law and applicable alike to all persons.

§ 56-704. Right to use of service dog — Liability.

An individual with a disability shall have the right to be accompanied by a service dog in any of the places described in section 56-703, Idaho Code, without being required to pay an extra charge for the service dog; provided that the individual shall be liable for any damage done to the premises or facilities by the service dog.

§ 56-704A. Rights of individuals with service dogs.

1. General. A place of public accommodation shall modify its policies, practices, or procedures to permit the use of a service dog by an individual with a disability or an authorized handler.
2. Exceptions. A place of public accommodation may ask an individual with a disability to remove a service dog from the premises if:
   1. The service dog is out of control and the service dog’s handler does not take effective action to control it; or
   2. The service dog is not housebroken.
3. If a service dog is excluded from a place of public accommodation pursuant to subsection (2) of this section, then the place of public accommodation shall give the individual with a disability the opportunity to participate in the service, program, or activity being offered without having the service dog on the premises.
4. A service dog shall be under the control of its handler. A service dog shall have a harness, leash, or other tether, unless the handler is unable because of a disability to use a harness, leash, or other tether, or the use of a harness, leash, or other tether would interfere with the service dog’s safe, effective performance of work or a task, in which case the service dog must otherwise be under the handler’s control through voice control or other effective means.
5. Inquiries. A place of public accommodation shall not ask about the nature or extent of a person’s disability but may make two (2) inquiries to determine whether an animal qualifies as a service dog. A place of public accommodation may ask: if the service dog is required because of a disability; and what work or task the service dog has been trained to perform. A place of public accommodation shall not require documentation, such as proof that the service dog has been certified, trained, or licensed as a service dog. A place of public accommodation may not make inquiries about a service dog when it is readily apparent that the service dog is trained to do work or perform tasks for an individual with a disability, such as: the dog is observed guiding an individual who is blind or has low vision, pulling an individual’s wheelchair, or providing assistance with stability or balance to an individual with an observable mobility disability.
6. Access. Individuals with disabilities shall be permitted to be accompanied by their service dog in all areas of a place of public accommodation including, but not limited to, a common carrier, hotel, lodging house, or place where members of the public, participants in services, programs or activities, or invitees, as relevant, are allowed to go.
7. Surcharges. A place of public accommodation, including, but not limited to, a common carrier, hotel, lodging house, or other public place, shall not ask or require an individual with a disability to pay a surcharge, even if people accompanied by pets are required to pay fees or to comply with other requirements generally not applicable to people without pets. If a place of public accommodation normally charges individuals for the damage they cause, an individual with a disability may be charged for damage caused by the individual’s service dog.

§ 56-704B. Rights of individuals with dogs-in-training — Liability.

1. Every individual with a disability who is specifically training or socializing a dog for the purpose of being a service dog shall have the right to be accompanied by the dog in any of the places described in section 56-703, Idaho Code, without being required to pay an extra charge for the dog if the accompaniment is part of the dog’s training or socialization to become a service dog.
2. Every individual who is not an individual with a disability but who is specifically training or socializing a dog for the purpose of being a service dog shall have the privilege to be accompanied by the dog in any of the places described in section 56-703, Idaho Code, without being required to pay an extra charge for the dog if the accompaniment is part of the dog’s training or socialization to become a service dog. The individual accompanying the dog-in-training shall carry and upon request display an identification card issued by a recognized school for service dogs or training dogs or an organization that serves individuals with disabilities. The dog-in-training shall be visually identified as a dog-in-training as provided in section 56-701A, Idaho Code. The school or organization as identified on the identification card shall be fully liable for any damages done to the premises or facilities by the dog, and no liability to other persons shall be attached to the owner, lessor, or manager of the property arising out of activities permitted by this chapter.

§ 56-705. Civil liability for intentional violation of statutes protecting disabled persons.

Civil action may be brought against any person intentionally violating the provisions of section 18-5811, 18-5811A, 18-5812 or 18-5812A, Idaho Code, with judgment awarded upon proof of the elements to a preponderance of the evidence. As a part of any such civil judgment, a successful plaintiff shall be awarded punitive damages in an amount equal to all other damages suffered by the plaintiff, but in no event less than five hundred dollars ($500). The failure of a disabled person to use an assistance device or a service dog shall not be held to constitute nor be evidence of contributory negligence in any civil action.

§ 56-706. Interference with rights or activities — Penalty.

Any person or persons, firm or corporation, or the agent of any person or persons, firm or corporation, who denies or interferes with admittance to or enjoyment of the public facilities enumerated in this chapter or otherwise interferes with the rights of an individual with a disability under this chapter shall be guilty of a misdemeanor.

§ 56-707. Right to be employed in employment supported in whole or in part by public funds — Restriction — Use of sick leave.

1. Individuals with disabilities shall be employed in the state service, the service of the political subdivisions of the state, in the public schools, and in all other employment supported in whole or in part by public funds on the same terms and conditions as individuals without disabilities, unless it is shown that the particular disability prevents the performance of the work involved.
2. Persons employed as provided in subsection (1) of this section may use accrued sick leave for the purpose of obtaining service dogs and necessary training.

§ 56-708. ABLE accounts.

1. Findings and intent. The federal achieving a better life experience (ABLE) act, public law 113-295, 26 U.S.C. 529A, provides that a state may establish a program under which certain individuals with disabilities may open accounts in order to save money to pay for qualified disability expenses, such as expenses relating to education, housing, transportation, employment training and assistive technology. These accounts may be opened by qualified Idahoans in any state having an ABLE account program, and are to be disregarded when determining an individual’s eligibility for assistance programs established by federal law, including medicaid and supplemental security income. Though Idaho has not implemented its own ABLE account program, the legislature finds that ABLE accounts promote dignified personal independence and opportunities for individuals with disabilities. It is therefore the intent of the legislature to ensure that the state provide technical assistance to Idahoans interested in opening ABLE accounts in other states, and to protect the eligibility of individuals who have such ABLE accounts when applying for state or local assistance.
2. Eligibility. Notwithstanding any provision of state law or local ordinance to the contrary, if an applicant for a state or local assistance program or a need-based state or local grant has an ABLE account in another state, the account, and any activity related thereto, shall be disregarded when determining the applicant’s eligibility for the assistance program or grant to the extent that the account and any activity related thereto would be disregarded in determining the applicant’s eligibility for an assistance program established by federal law.
3. Technical assistance. Subject to appropriation, there is hereby established a function to provide individuals with disabilities, and those assisting them, technical assistance relating to the ABLE act. Such function shall be within the Idaho state independent living council until such time as it might be assigned to another appropriate agency. Such technical assistance shall include information and assistance with respect to setting up ABLE accounts in other states, whether through or in conjunction with databases and websites operated by or under the auspices of organizations or government agencies, or otherwise, and the provision of information related to financial literacy.

§ 56-801. Legislative intent.

The purpose and intent of this act is to benefit hard-to-place children residing in foster or institutional homes at state expense by providing the stability and security of permanent homes, and in so doing, achieve a decrease of total state expense by the reduction of costly foster and institutional care. Accordingly this act shall apply only to hard-to-place children.

§ 56-802. Definitions.

For the purposes of this act:

1. “Hard-to-place child” means a child who is difficult to place for adoption or guardianship because of ethnic background, race, color, age, sibling grouping, or physical or emotional disability.
2. “Department” means the department of health and welfare.

§ 56-803. Establishment of program — Promulgation of rules and regulations.

The department is responsible for establishing and implementing the provisions of this act. The board of health and welfare is authorized to promulgate such rules and regulations as are necessary to administer this act.

The department shall keep records for purposes of evaluating the effectiveness of this act’s implementation.

§ 56-804. Dissemination of information to families.

The department shall disseminate information to prospective adoptive families and families who wish to be appointed legal guardians of a child in the state’s custody, as to the availability of hard-to-place children, adoption and guardianship procedures, and of the existence of financial aid to adoptive families and guardians of hard-to-place children.

§ 56-805. Financial aid — Period.

Financial aid to families adopting or becoming guardians of hard-to-place children shall be awarded by the department as follows:

1. Persons who have applied to adopt the hard-to-place child and to receive subsidies for the care and support of the hard-to-place child shall be evaluated as to their suitability as adoptive parents by means of an adoptive home study. Persons who are caring for a hard-to-place child in the state’s custody for whom reunification or adoption is not an option, and who wish to be appointed legal guardians of the child and to receive subsidies for the care and support of the child, shall be evaluated as to their suitability as guardians by means of a guardianship study.
2. Financial assistance shall be not more than the amount that would be paid for foster or institutional care for the child if the placement for adoption or guardianship had not taken place. Assistance may be provided families adopting or becoming guardians for hard-to-place children until such child is eighteen (18) years of age, parents are no longer legally responsible for the child, or until the parents are no longer providing support for the child.
3. Payment of the costs of medical services shall be made directly to the physician or provider of the services according to the department’s established procedures.
4. Payment of the cost of nonrecurring adoption or guardianship expenses is limited to the following: reasonable and necessary adoption or guardianship fees, court costs, attorney’s fees, and other expenses which are directly related to the legal adoption or guardianship of a child with special needs and which are not incurred in violation of state or federal laws.
5. Eligibility for the benefits payable and amounts thereof shall be determined on a case-by-case basis by the department as set forth in the rules promulgated by the state board of health and welfare.

After an adoption with a subsidy is finalized or a guardianship with subsidy has been ordered by the court and the court has released the child from the state’s legal custody, the family is independent of the department except for an annual evaluation by the department of the need for continued subsidy and the amount of the subsidy.

§ 56-806. Use of gifts or grants.

All gifts or grants received from private sources for the purpose of this bill shall be used to offset state costs incurred pursuant to this act.

§ 56-901. Telecommunications service assistance program — Definitions.

1. A telecommunications service assistance program is hereby established within the department of health and welfare to provide eligible recipients with a reduction in costs of telecommunications services to promote universal service. The program shall be administered by the department of health and welfare in accordance with the provisions of this chapter and rules and regulations promulgated in compliance with chapter 52, title 67, Idaho Code, to administer the program. The telecommunications service assistance program adopted shall grant limited federal “lifeline” contributions to Idaho’s low-income customers.
2. For the purposes of this chapter, a “telecommunications carrier” means a telephone corporation providing telecommunication services for compensation within this state, and shall include municipal, cooperative, or mutual nonprofit telephone companies, and telecommunication corporations providing wireless, cellular, personal communications services and mobile radio services for compensation.

§ 56-902. Assistance rate discount — Form — Applicable services — Amount — Application.

1. Telecommunication carriers providing residential basic local service shall provide assistance in the form of a monthly discount to eligible subscribers of residential basic local service of two dollars and fifty cents ($2.50). In no case will the discount exceed the rate charged for the grade of residential basic local service subscribed to by each eligible individual. The Idaho telecommunications service assistance plan shall only be used to provide for a single line at the subscriber household.
2. The providers of residential basic local service and the Idaho department of health and welfare shall comply with all requirements expressly provided by federal order, regulation and statute for eligible subscribers to qualify for the federal “lifeline” telephone assistance program. In accordance with federal law, the Idaho public utilities commission may grant waivers to carriers of residential basic local service from providing certain services to eligible subscribers.

§ 56-903. Assistance eligibility.

1. In order to be eligible for the telecommunications service assistance program, an applicant shall be the head of a household and shall meet narrowly targeted eligibility criteria based solely on income or factors directly related to income established by the department of health and welfare. The department of health and welfare shall develop procedures for taking applications for assistance and for determining and certifying program eligibility. Such applications shall contain the disclosure of information authorization necessary to process the assistance discounts. Individuals who qualify for assistance under this chapter must be periodically recertified by the department of health and welfare.
2. At least once each year the department shall provide an electronic list of names, addresses and, if applicable, telephone numbers of all eligible recipients to each telecommunications carrier designated as an eligible telecommunications carrier by the public utilities commission. The eligible telecommunications carrier shall determine from the list those recipients to whom the company provides service.

§ 56-904. Recovery of telecommunications service revenue reductions — Administration.

1. The Idaho public utilities commission shall determine and impose a uniform statewide monthly surcharge on each end user’s business, residential and wireless access service. The surcharge shall be an amount sufficient to reimburse each carrier of residential basic local exchange service for the total amount of telephone assistance discounts provided as well as the carrier’s and the administrator’s expenses of administering the plan. Such surcharge shall be effective concurrent with the discounts given eligible subscribers. The surcharge shall be explicitly stated on end user billings but shall not be imposed on eligible subscribers.
2. The Idaho public utilities commission may adopt rules or issue orders necessary to receive matching federal low income telephone assistance and to implement the Idaho telephone assistance program, including procedures for adjustment and true-up of the subscriber surcharge. The commission may contract with a neutral third party to collect the surcharge, distribute assistance revenues, and perform other tasks as assigned.
3. All carriers of telecommunications services shall remit the assistance surcharge revenues to the fund administrator designated by the commission on a monthly basis, unless less frequent remittances are authorized by order of the public utilities commission. The administrator shall distribute telecommunication service assistance program revenues monthly to eligible telecommunication carriers in an amount that equals their costs of administering the program and the monthly discount provided to eligible subscribers.
4. The surcharge imposed in subsection (1) of this section, when collected from customers of mobile wireless carriers, shall be imposed only on customers with a place of primary use in Idaho. As used in this section and as defined in 4 U.S.C. section 124, “place of primary use” means the residential street address or the primary business street address in Idaho where the customer’s use of the wireless service primarily occurs.

§ 56-905. Severability.

The provisions of this act are hereby declared to be severable and if any provision of this act or the application of such provision to any person or circumstance is declared invalid for any reason, such declaration shall not affect the validity of remaining portions of this act.

§ 56-1001. Definitions.

Whenever used or referred to in this chapter, unless a different meaning clearly appears from the context, the following terms shall have the following meanings:

1. “Board” means the board of health and welfare as created in section 56-1005, Idaho Code.
2. “Department” means the department of health and welfare.
3. “Director” means the director of the department of health and welfare.
4. “Isolation” means the separation of infected persons, or of persons suspected to be infected, from other persons to such places, under such conditions, and for such time as will prevent transmission of the infectious agent.
5. “Laboratory” means not only facilities for biological, serological, biophysical, cytological and pathological tests, but also facilities for the chemical or other examination of materials from water, air or other substances.
6. “Person” means any individual, association, partnership, firm, joint stock company, trust, estate, political subdivision, public or private corporation, state or federal governmental department, agency or instrumentality, or any other legal entity which is recognized by law as the subject of rights and duties.
7. “Public swimming pool” means an artificial structure, and its appurtenances, which contains water more than two (2) feet deep which is used or intended to be used for swimming or recreational bathing, and which is for the use of any segment of the public pursuant to a general invitation but not an invitation to a specific occasion or occasions. The term does not include a swimming pool operated solely for and in conjunction with a hotel, motel or other place of lodging, or a trailer park, apartment, condominium or any other residential facility containing multiple dwellings.
8. “Quarantine” means the restriction placed on the entrance to and exit from the place or premises where an infectious agent or hazardous material exists.
9. “State” means the state of Idaho.
10. “Substantive” means that which creates, defines or regulates the rights of any person or implements, interprets or prescribes law or policy, but does not include statements concerning only the internal management of the department and not affecting private rights or procedures available to the public.

§ 56-1002. Department of health and welfare — Creation — Administrative regions.

1. There is created and established in the state government a department of health and welfare which shall, for the purposes of section 20, article IV of the constitution of the state of Idaho, be an executive department of the state government. The executive and administrative power of this department shall be vested in the director of the department who shall be appointed by and serve at the pleasure of the governor, with the advice and consent of the senate.
2. The department shall be organized into such administrative and general services divisions as may be necessary in order to efficiently administer the department. Each division shall be headed by a division administrator who shall be appointed by and serve at the pleasure of the director with the concurrence of the board.
3. In order to provide more effective and economical access to the state health and social services by the people of Idaho, the governor is hereby authorized to establish substate administrative regions. In the designation of these regions specific consideration shall be given to the geographic and economic convenience of the citizens included therein. Each substate administrative region shall be headed by a regional director who shall be appointed by and serve at the pleasure of the director with the concurrence of the board.

§ 56-1003. Powers and duties of the director.

The director shall have the following powers and duties:

1. All of the powers and duties of the department of public health, the department of health, the board of health and all nonenvironmental protection duties of the department of health and welfare are hereby vested to the director of the department of health and welfare. Provided however, that oversight of the department and rulemaking and hearing functions relating to public health and licensure and certification standards shall be vested in the board of health and welfare. Except when the authority is vested in the board of health and welfare under law, the director shall have all such powers and duties as may have been or could have been exercised by his predecessors in law, including the authority to adopt, promulgate, and enforce rules, and shall be the successor in law to all contractual obligations entered into by predecessors in law. All rulemaking proceedings and hearings of the director shall be governed by the provisions of chapter 52, title 67, Idaho Code.
2. The director shall, pursuant and subject to the provisions of the Idaho Code, and the provisions of this chapter, formulate and recommend to the board rules, codes and standards, as may be necessary to deal with problems related to personal health, and licensure and certification requirements pertinent thereto, which shall, upon adoption by the board, have the force of law relating to any purpose which may be necessary and feasible for enforcing the provisions of this chapter including, but not limited to, the maintenance and protection of personal health. Any such rule or standard may be of general application throughout the state or may be limited as to times, places, circumstances or conditions in order to make due allowance for variations therein.
3. The director, under the rules, codes or standards adopted by him, shall have the general supervision of the promotion and protection of the life, health and mental health of the people of this state. The powers and duties of the director shall include, but not be limited to, the following:
   1. The issuance of licenses and permits as prescribed by law and by the rules of the board;
   2. The supervision and administration of laboratories and the supervision and administration of standards of tests for environmental pollution, chemical analyses and communicable diseases. The director may require that laboratories operated by any city, county, institution, person, firm or corporation for health or environmental purposes conform to standards set by the board of health and welfare and the board of environmental quality;
   3. The supervision and administration of a mental health program, which shall include services for the evaluation, screening, custody and treatment of the mentally ill and those persons suffering from a mental defect or mental defects, and services for the prevention of suicide;
   4. The enforcement of minimum standards of health, safety and sanitation for all public swimming pools within the state;
   5. The supervision and administration of the various schools, hospitals and institutions that were the responsibility of the board of health;
   6. The supervision and administration of services dealing with the problems of alcoholism including, but not limited to, the care and rehabilitation of persons suffering from alcoholism;
   7. The establishment of liaison with other governmental departments, agencies and boards in order to effectively assist other governmental entities with the planning for the control of or abatement of health problems. All of the rules and standards adopted by the board shall apply to state institutions;
   8. The supervision and administration of an emergency medical service program including, but not limited to, assisting other governmental agencies and local governmental units, in providing first aid emergency medical services and for transportation of the sick and injured;
   9. The supervision and administration of administrative units whose responsibility shall be to assist and encourage counties, cities, other governmental units, and industries in the control of and/or abatement of health problems; and
   10. The enforcement of all laws, rules, codes and standards relating to health.
4. The director, when so designated by the governor, shall have the power to apply for, receive on behalf of the state, and utilize any federal aid, grants, gifts, gratuities, or moneys made available through the federal government.
5. The director shall have the power to enter into and make contracts and agreements with any public agencies or municipal corporations for facilities, land, and equipment when such use will have a beneficial, recreational, or therapeutic effect or be in the best interest in carrying out the duties imposed upon the department.
6. The director is authorized to adopt an official seal to be used on appropriate occasions, in connection with the functions of the department or the board, and such seal shall be judicially noticed. Copies of any books, records, papers and other documents in the department shall be admitted in evidence equally with the originals thereof when authenticated under such seal.
7. The director, under rules adopted by the board of health and welfare, shall have the power to impose and enforce orders of isolation and quarantine to protect the public from the spread of infectious or communicable diseases or from contamination from chemical or biological agents, whether naturally occurring or propagated by criminal or terrorist act.
   1. An order of isolation or quarantine issued pursuant to this section shall be a final agency action for purposes of judicial review. However, this shall not prevent the director from reconsidering, amending or withdrawing the order. Judicial review of orders of isolation or quarantine shall be de novo. The court may affirm, reverse or modify the order and shall affirm the order if it appears by a preponderance of the evidence that the order is reasonably necessary to protect the public from a substantial and immediate danger of the spread of an infectious or communicable disease or from contamination by a chemical or biological agent.
   2. If the director has reasonable cause to believe a chemical or biological agent has been released in an identifiable place, including a building or structure, an order of quarantine may be imposed to prevent the movement of persons into or out of that place, for a limited period of time, for the purpose of determining whether a person or persons at that place have been contaminated with a chemical or biological agent which may create a substantial and immediate danger to the public.
   3. Any person who violates an order of isolation or quarantine shall be guilty of a misdemeanor.

The director shall also have the power to enter into contracts for the expenditure of state matching funds for local purposes. This subsection will constitute the authority for public agencies or municipal corporations to enter into such contracts and expend money for the purposes delineated in such contracts.

§ 56-1004. Director — Additional powers and duties.

1. The director shall exercise the following powers and duties in addition to all other powers and duties inherent in the position:
   1. Prescribe such rules as may be necessary for the administration of the department, the conduct and duties of the employees, the orderly and efficient management of department business, and the custody, use and preservation of department records, papers, books and property belonging to the state;
   2. Employ such personnel as may be deemed necessary, prescribe their duties and fix their compensation within the limits provided by the state personnel system law;
   3. Administer oaths for all purposes required in the discharge of his duties;
   4. Prescribe the qualifications of all personnel of the department on a nonpartisan merit basis, in accordance with the Idaho personnel system law, provided however, that the administrators in charge of any division of the department, and the administrators in charge of the state hospital north, state hospital south, and southwest Idaho treatment center shall serve at the pleasure of the director;
   5. Create such units, sections and subdivisions as are or may be necessary for the proper and efficient functioning of the department.
2. The department is empowered to acquire, by purchase, lease or exchange, any property which in the judgment of the department is needful for the operation of the facilities and programs for which it is responsible and to dispose of, by sale, lease or exchange, any property which in the judgment of the department is not needful for the operation of the same.

§ 56-1004A. Criminal history and background checks.

1. To assist in the protection of children and vulnerable adults, the legislature hereby authorizes the department of health and welfare to conduct criminal history and background checks of individuals who provide care or services to vulnerable adults or children and are identified in rule as being required to have a criminal history and background check.
2. To further assist in the protection of vulnerable adults, the department of health and welfare may:
   1. Conduct criminal history and background checks of those seeking guardianship or conservatorship and those who reside in an incapacitated person’s proposed residence;
   2. Make the findings of such criminal history and background checks available to visitors, guardians ad litem and evaluation committees appointed pursuant to chapter 5, title 15 or chapter 4, title 66, Idaho Code; and
   3. Promulgate such rules as are necessary to carry out the provisions of this section.
3. Criminal history and background checks will be conducted by the department of health and welfare when:
   1. Required or ordered by the court pursuant to chapter 5, title 15 or chapter 4, title 66, Idaho Code;
   2. Requested by those required to undergo such checks; and
   3. Paid for in full by those required to undergo such checks.
4. The criminal history and background check will be a fingerprint-based check of state and national records and may include information from the following:
   1. Statewide criminal identification bureau;
   2. Federal bureau of investigation (FBI);
   3. Statewide sex offender registry;
   4. Idaho transportation department driving records;
   5. Adult and child protection registries;
   6. Nurse aide registry; and
   7. Department of health and human services office of the inspector general list of excluded individuals and entities.
5. The department of health and welfare shall promulgate rules to further define those individuals who are required to have a criminal history and background check and the effective date. Each individual shall complete an application, which includes a notarized signature, on forms provided by the department. The completed application authorizes the department to obtain and release information in accordance with state and federal law. The applicant must disclose all information requested, including information on past convictions, driver’s license revocations, and known adult or child protection findings. Once an application has been completed, the employer, at its discretion, may allow the individual to provide care or services prior to the individual completing fingerprinting and pending completion of the criminal history and background check by the department. The department shall promulgate rules defining the time frame for submitting the application. Under no circumstances may the individual be allowed to provide care or services where the employer has reviewed the completed application and the individual has disclosed a designated crime as set forth in rule.
6. The department shall review the information received from the criminal history and background check and determine whether the applicant has a criminal or other relevant record that would disqualify the individual. The department shall determine which crimes disqualify the applicant and for what period of time according to promulgated rules. The process for the check and the issuance of a clearance or denial is set forth in department rules. The applicant shall be provided an opportunity for a formal review of a denial. The department shall communicate clearance or denial to the applicant and the applicant’s employer.
7. Applicants are responsible for the cost of the criminal history and background check except where otherwise provided by department rules.
8. The department, or an employer of an applicant, who acts in reasonable reliance on the results of the criminal history and background check in making an employment decision, is immune from liability for that decision when it is based on such results.
9. The department, its officers and employees are immune from liability for the consequences of including or excluding classes of individuals in the criminal history and background check process.
10. Clearance through the criminal history and background check process is not a determination of suitability for employment.

The provisions of subsection (6) of this section shall not apply to criminal history and background checks conducted pursuant to this subsection.

§ 56-1005. Board — Composition — Officers — Compensation — Powers — Subpoena — Depositions — Review — Rules.

1. The board of health and welfare shall consist of eleven (11) members, seven (7) members of which shall be appointed by the governor, with the advice and consent of the senate. The members appointed by the governor may be removed by the governor for cause. Each member of the board appointed by the governor shall be a citizen of the United States, a resident of the state of Idaho, and a qualified elector. Not more than four (4) members of the board appointed by the governor shall be from any one (1) political party. Of the members of the board appointed by the governor, four (4) members shall be chosen with due regard to their knowledge and interest in health and social services, two (2) members shall be chosen based on their experience in business or finance, and one (1) member shall be selected as a representative of the public at large. The voting members shall be appointed to assure appropriate geographic representation of the state of Idaho. The other four (4) members of the board, who shall be nonvoting members, shall be:
   1. The chairperson of the senate health and welfare committee, or the chair’s designee;
   2. The chairperson of the house of representatives health and welfare committee, or the chair’s designee;
   3. The director of the department of health and welfare, who shall serve as the board’s secretary; and
   4. A representative of the office of the governor, as designated by the governor.
2. The members of the board of health and welfare appointed by the governor, serving on the effective date of this act shall continue in office as members of the board of health and welfare. All members of the board of health and welfare appointed by the governor shall serve four (4) year terms.
3. The voting members of the board annually shall elect a chairman and a vice chairman, who shall be voting members of the board. The board shall hold meetings no less than once every quarter. Special meetings of the board may be called by the chairman of the board, by a majority of the voting members of the board or, on written request, by the director of the department of health and welfare. A majority of the voting members shall be necessary to constitute a quorum at any regular or special meeting and the action of the majority of members present shall be the action of the board. The members of the board shall be compensated as provided in section 59-509(p), Idaho Code.
4. The board, in furtherance of its duties under law and under its rules, shall have the power to administer oaths, certify to official acts, and to issue subpoenas for the attendance of witnesses and the production of papers, books, accounts, documents and testimony. The board may, if a witness refuses to attend or testify, or to produce any papers required by such subpoenas, report to the district court in and for the county in which the proceeding is pending, by petition, setting forth that due notice has been given of the time and place of attendance of said witnesses, or the production of said papers, that the witness has been properly summoned, and that the witness has failed and refused to attend or produce the papers required by this subpoena before the board, or has refused to answer questions propounded to him in the course of said proceedings, and ask an order of said court compelling the witness to attend and testify and produce said papers before the board. The court, upon the petition of the board, shall enter an order directing the witness to appear before the court at a time and place to be fixed by the court in such order, the time to be not more than ten (10) days from the date of the order, and then and there shall show cause why he has not attended and testified or produced said papers before the board. A copy of said order shall be served upon said witness. If it shall appear to the court that said subpoena was regularly issued by the board and regularly served, the court shall thereupon order that said witness appear before the board at the time and place fixed in said order, and testify or produce the required papers. Upon failure to obey said order, said witness shall be dealt with for contempt of court.
5. The director, his designee, or any party to the action may, in an investigation or hearing before the board, cause the deposition or interrogatory of witnesses or parties residing within or without the state, to be taken in the manner prescribed by law for like depositions and interrogatories in civil actions in the district court of this state, and to that end may compel the attendance of said witnesses and production of books, documents, papers and accounts.
6. Any person aggrieved by an action or inaction of the department of health and welfare shall be afforded an opportunity for a fair hearing upon request therefor in writing pursuant to chapter 52, title 67, Idaho Code, and the rules promulgated thereunder. In those cases where the board has been granted the authority to hold such a hearing pursuant to a provision of the Idaho Code, the hearing may be conducted by the board at a regular or special meeting, or the board may designate hearing officers, who shall have the power and authority to conduct hearings in the name of the board at any time and place. In any hearing, a member of the board or hearing officer designated by it, shall have the power to administer oaths, examine witnesses, and issue in the name of the board subpoenas requiring the testimony of witnesses and the production of evidence relevant to any matter in the hearing.
7. Any person adversely affected by a final determination of the board, may secure judicial review by filing a petition for review as prescribed under the provisions of chapter 52, title 67, Idaho Code. The petition for review shall be served upon the chairman of the board, the director of the department, and upon the attorney general of the state of Idaho. Such service shall be jurisdictional and the provisions of this section shall be the exclusive procedure for appeal.
8. The board, by the affirmative vote of four (4) of its voting members, may adopt, amend or repeal the rules, codes, and standards of the department, that are necessary and feasible in order to carry out its duties and responsibilities and to enforce the laws of this state.
9. All rulemaking proceedings and hearings of the board shall be governed by the provisions of chapter 52, title 67, Idaho Code.
10. In addition to any other powers and duties granted to the board under law, the board shall:
    1. Advise the director and the governor on department fiscal, policy and administrative matters;
    2. Review and advise the director regarding the department’s strategic plan and performance measures;
    3. Develop goals and standards to measure department efficiency and effectiveness; and (d) Review and advise the director and the governor on department initiatives.
11. The board shall provide an annual report to the governor and to the legislature prior to the start of each legislative session, addressing:
    1. The key department fiscal and policy issues;
    2. The department’s managerial and overall performance; and
    3. The major proposed and ongoing departmental initiatives.

The rules and orders so adopted and established shall have the force and effect of law and may deal with any matters deemed necessary and feasible for protecting the health of the state.

§ 56-1006. Title superseded.

Except with respect to environmental protection functions, wherever the words “board of health” appear in the Idaho Code, they shall mean the board of health and welfare, and wherever the words “administrator of health” appear in the Idaho Code, they shall mean the director of the department of health and welfare, and wherever the words “department of health” appear in the Idaho Code, they shall mean the department of health and welfare.

§ 56-1007. Collection of fees for services.

The department of health and welfare is hereby authorized to charge and collect reasonable fees, established by rule, for any service rendered by the department. The fee may be determined by a sliding scale according to income or available assets. The department is hereby authorized to require information concerning the total income and assets of each person receiving services in order to determine the amount of the fee to be charged.

§ 56-1008. Criminal violation — Penalty.

Any person who willfully or negligently violates any of the provisions of the public health laws or the terms of any lawful notice, order, permit, standard, or rule issued pursuant thereto, shall be guilty of a misdemeanor.

§ 56-1009. Investigation — Inspection — Right of entry — Violation — Enforcement — Penalty — Injunctions.

1. The director shall cause investigations to be made upon receipt of information concerning an alleged violation of this chapter or of any rule, permit or order promulgated thereunder, and may cause to be made such other investigations as the director shall deem advisable.
2. For the purpose of enforcing any provision of this chapter or any rule authorized in this chapter, the director or the director’s designee shall have the authority to:
   1. Conduct a program of continuing surveillance and of regular or periodic inspection of actual or potential health hazards;
   2. Enter at all reasonable times upon any private or public property, upon presentation of appropriate credentials, for the purpose of inspecting or investigating to ascertain possible violations of this chapter or of rules, permits or orders adopted and promulgated by the director or the board;
   3. All inspections and investigations conducted under the authority of this chapter shall be performed in conformity with the prohibitions against unreasonable searches and seizures contained in the fourth amendment to the constitution of the United States and section 17, article I, of the constitution of the state of Idaho. The state shall not, under the authority granted by this chapter, conduct warrantless searches of private property in the absence of either consent from the property owner or occupier or exigent circumstances such as a public health emergency;
   4. Any district court in and for the county in which the subject property is located is authorized to issue a search warrant to the director upon a showing of (i) probable cause to suspect a violation, or (ii) the existence of a reasonable program of inspection. Any search warrant issued under the authority of this chapter shall be limited in scope to the specific purposes for which it is issued and shall state with specificity the manner and the scope of the search authorized.
3. Whenever the director determines that any person is in violation of any provision of this chapter or any rule, permit or order issued or promulgated pursuant to this chapter, the director may commence either of the following:
   1. Administrative enforcement action.
      1. Notice. The director may commence an administrative enforcement action by issuing a written notice of violation. The notice of violation shall identify the alleged violation with specificity, shall specify each provision of the chapter, rule, regulation, permit or order which has been violated, and shall state the amount of civil penalty claimed for each violation. The notice of violation shall inform the person to whom it is directed of an opportunity to confer with the director or the director’s designee in a compliance conference concerning the alleged violation. A written response may be required within fifteen (15) days of receipt of the notice of violation by the person to whom it is directed.
      2. Scheduling compliance conference. If a recipient of a notice of violation contacts the department within fifteen (15) days of the receipt of the notice, the recipient shall be entitled to a compliance conference. The conference shall be held within twenty (20) days of the date of receipt of the notice, unless a later date is agreed upon between the parties. If a compliance conference is not requested, the director may proceed with a civil enforcement action as provided in paragraph (b) of this subsection. (iii) Compliance conference. The compliance conference shall provide an opportunity for the recipient of a notice of violation to explain the circumstances of the alleged violation and, where appropriate, to present a proposal for remedying damage caused by the alleged violation and assuring future compliance.
      3. Consent order. If the recipient and the director agree on a plan to remedy damage caused by the alleged violation and to assure future compliance, they may enter into a consent order formalizing their agreement. The consent order may include a provision providing for payment of any agreed civil penalty.
      4. Effect of consent order. A consent order shall be effective immediately upon signing by both parties and shall preclude any civil enforcement action for the same alleged violation. If a party does not comply with the terms of the consent order, the director may seek and obtain, in any appropriate district court, specific performance of the consent order and such other relief as authorized in this chapter.
      5. Failure to reach consent order. If the parties cannot reach agreement on a consent order within sixty (60) days after the receipt of the notice of violation or if the recipient does not request a compliance conference pursuant to paragraph (a)(ii) of this section, the director may commence and prosecute a civil enforcement action in district court, in accordance with subsection (b) of this section.
   2. Civil enforcement action. The director may initiate a civil enforcement action through the attorney general as provided in section 56-1010, Idaho Code. Civil enforcement actions shall be commenced and prosecuted in the district court in and for the county in which the alleged violation occurred, and may be brought against any person who is alleged to have violated any provision of this chapter or any rule, permit or order which has become effective pursuant to this chapter. Such action may be brought to compel compliance with any provision of this chapter or with any rule, permit or order promulgated hereunder and for any relief or remedies authorized in this chapter. The director shall not be required to initiate or prosecute an administrative action before initiating a civil enforcement action.
4. No civil or administrative proceeding may be brought to recover for a violation of any provision of this chapter or a violation of any rule, permit or order issued or promulgated pursuant to this chapter, more than two (2) years after the director had knowledge or ought reasonably to have had knowledge of the violation.
5. Monetary penalties.
   1. Any person determined in a civil enforcement action to have violated any provision of this chapter or any rule, permit or order promulgated pursuant to this chapter shall be liable for a civil penalty not to exceed ten thousand dollars ($10,000) per violation or one thousand dollars ($1,000) for each day of a continuing violation, whichever is greater. The method of recovery of said penalty shall be by a civil enforcement action in the district court in and for the county where the violation occurred. All civil penalties collected under this chapter shall be paid into the general fund of the state. Parties to an administrative enforcement action may agree to a civil penalty as provided in this subsection.
   2. The imposition or computation of monetary penalties may take into account the seriousness of the violation and any good faith efforts by the person to comply with the law.
6. In addition to such civil penalties, any person who has been determined to have violated the provisions of this chapter or the rules, permits or orders promulgated thereunder, shall be liable for any expense incurred by the state in enforcing the chapter, or in enforcing or terminating any nuisance, cause of sickness or health hazard.
7. No action taken pursuant to the provisions of this chapter or of any other health law shall relieve any person from any civil action and damages that may exist for injury or damage resulting from any violation of this chapter or of the rules, permits and orders promulgated thereunder.
8. In addition to, and notwithstanding other provisions of this chapter, in circumstances of emergency creating conditions of imminent and substantial danger to the public health, the prosecuting attorney or the attorney general may institute a civil action for an immediate injunction to halt any activity in violation of the provisions of this chapter or rules, permits and orders promulgated thereunder. In such action the court may issue an ex parte restraining order.

§ 56-1010. Commencement of civil enforcement actions — Criminal actions authorized — Duties of attorney general.

Upon request of the director, it shall be the duty of the attorney general to institute and prosecute civil enforcement actions or injunctive actions as provided in section 56-1009, Idaho Code, and to prosecute actions or proceedings for the enforcement of any criminal provisions of this chapter. In addition, when deemed by the director to be necessary, the director may retain or employ private counsel. The attorney general may delegate the authority and duty under this section to prosecute criminal actions to the prosecuting attorney of the county in which such a criminal action may arise.

§ 56-1011. Emergency medical services — Statement of intent.

It is the purpose of the legislature of the state of Idaho in the adoption of sections 56-1011 through 56-1023, Idaho Code, to recognize the importance of the delivery of emergency medical services and to provide reasonable regulation of the same. For this purpose, the provisions of section 54-1804, Idaho Code, shall not be so construed as to prohibit or penalize emergency medical services rendered by a person authorized to render emergency medical services by sections 56-1011 through 56-1023, Idaho Code, if such emergency medical service is rendered under the responsible supervision and control of a licensed physician.

§ 56-1012. Definitions.

As used in sections 56-1011 through 56-1023, Idaho Code:

1. “Advanced emergency medical technician” means a person who has met the qualifications for licensure as set forth in sections 56-1011 through 56-1023, Idaho Code, is licensed by the EMS bureau under sections 56-1011 through 56-1023, Idaho Code, carries out the practice of emergency care within the scope of practice determined by the commission and practices under the supervision of an Idaho licensed physician.
2. “Agency” means any organization licensed by the EMS bureau that operates an air medical service, ambulance service or nontransport service.
3. “Air ambulance” means any privately or publicly owned fixed wing aircraft or rotary wing aircraft used for, or intended to be used for, the transportation of persons experiencing physiological or psychological illness or injury who may need medical attention during transport. This may include dual or multipurpose vehicles which otherwise comply with sections 56-1011 through 56-1023, Idaho Code, and specifications established by board rule.
4. “Air medical service” means an agency licensed by the EMS bureau that responds to requests for patient care and transportation from hospitals and EMS agencies using a fixed wing aircraft or rotary wing aircraft.
5. “Ambulance” means any privately or publicly owned motor vehicle or nautical vessel used for, or intended to be used for, the transportation of sick or injured persons who may need medical attention during transport. This may include dual or multipurpose vehicles which otherwise comply with sections 56-1011 through 56-1023, Idaho Code, and specifications established by board rule.
6. “Ambulance service” means an agency licensed by the EMS bureau operated with the intent to provide personnel and equipment for medical treatment at an emergency scene, during transportation or during transfer of persons experiencing physiological or psychological illness or injury who may need medical attention during transport.
7. “Applicant” means any organization that is requesting an agency license under this chapter and includes the following:
   1. An organization seeking a new license;
   2. An existing agency that intends to change the level of licensed personnel it utilizes;
   3. An existing agency that intends to change its geographic coverage area, except by agency annexation;
   4. An existing nontransport service that intends to provide ambulance service;
   5. An existing ambulance service that intends to discontinue transport and become a nontransport service.
8. “Board” means the Idaho board of health and welfare.
9. “Commission” means the Idaho emergency medical services physician commission.
10. “Community emergency medical technician” or “community EMT” means an emergency medical technician or advanced emergency medical technician with additional standardized training who works within a designated community health emergency medical services program under local medical control as part of a community-based team of health and social services providers.
11. “Community health emergency medical services” or “community health EMS” means the evaluation, advice or treatment of an eligible recipient outside of a hospital setting, which is specifically requested for the purpose of preventing or improving a particular medical condition, and which is provided by a licensed emergency medical services agency. Community health EMS involving or related to emergency response must be provided by or in coordination with the primary 911 response agency for that area. (12) “Community paramedic” means a paramedic with additional standardized training who works within a designated community health emergency medical services program under local medical control as part of a community-based team of health and social services providers.
    1. Respond to a perceived need for medical care in order to prevent loss of life or aggravation of physiological or psychological illness or injury;
    2. Are prepared to provide interventions that are within the scope of practice as defined by the commission;
    3. Use an alerting mechanism to initiate a response to requests for medical care; and
    4. Offer, advertise or attempt to respond as described in paragraphs (a) through (c) of this subsection.

(13) “Department” means the Idaho department of health and welfare.

(14) “Eligible recipient” means an individual eligible to receive community health emergency medical services, as determined by rule of the EMS bureau or a local community health emergency medical services program.

(15) “Emergency medical responder” means a person who has met the qualifications for licensure as set forth in sections 56-1011 through 56-1023, Idaho Code, is licensed by the EMS bureau under sections 56-1011 through 56-1023, Idaho Code, carries out the practice of emergency care within the scope of practice determined by the commission and practices under the supervision of an Idaho licensed physician.

(16) “Emergency medical services” or “EMS” means aid rendered by an individual or group of individuals who do the following:

(17) “EMS bureau” means the bureau of emergency medical services of the department.

(18) “Emergency medical technician” means a person who has met the qualifications for licensure as set forth in sections 56-1011 through 56-1023, Idaho Code, is licensed by the EMS bureau under sections 56-1011 through 56-1023, Idaho Code, carries out the practice of emergency care within the scope of practice determined by the commission and practices under the supervision of an Idaho licensed physician.

(19) “Licensed personnel” means those individuals who are emergency medical responders, emergency medical technicians, advanced emergency medical technicians and paramedics.

(20) “National emergency medical services information system technical assistance center” means an organization that validates software for compliance with the EMS data set defined by the United States department of transportation national highway traffic safety administration.

(21) “Nontransport service” means an agency licensed by the EMS bureau, operated with the intent to provide personnel or equipment for medical stabilization at an emergency scene, but not intended to be the service that will actually transport sick or injured persons.

(22) “Nontransport vehicle” means any vehicle operated by an agency with the intent to provide personnel or equipment for medical stabilization at an emergency scene, but not intended as the vehicle that will actually transport sick or injured persons.

(23) “Paramedic” means a person who has met the qualifications for licensure as set forth in sections 56-1011 through 56-1023, Idaho Code, is licensed by the EMS bureau under sections 56-1011 through 56-1023, Idaho Code, carries out the practice of emergency care within the scope of practice determined by the commission and practices under the supervision of an Idaho licensed physician. (24) “Supervision” means the medical direction by a licensed physician of activities provided by licensed personnel affiliated with a licensed ambulance, air medical or nontransport service, including, but not limited to: establishing standing orders and protocols, reviewing performance of licensed personnel, providing instructions for patient care via radio or telephone, and other oversight.

(25) “Transfer” means the transportation of a patient from one (1) medical care facility to another.

§ 56-1013. Authorized actions.

Persons licensed by the EMS bureau shall be authorized to perform such acts under written or oral authorization of a licensed physician as shall be established by rules of the commission, including, but not limited to, administration of intravenous solutions and drugs, cardiac defibrillation, airway management, endotracheal intubation, community health emergency medical services and other patient care.

§ 56-1013A. Idaho emergency medical services physician commission — Terms and operation.

1. There is hereby created in the department an Idaho emergency medical services physician commission for the purpose of establishing standards for scope of practice and medical supervision for licensed personnel and agencies licensed by the EMS bureau, and for making disciplinary action recommendations to the EMS bureau against licensed personnel. Notwithstanding any other provision of law to the contrary, the commission shall exercise its powers and duties in accordance with the provisions of sections 56-1011 through 56-1023, Idaho Code, relative to scope of practice and medical supervision of licensed personnel.
2. The commission shall be composed of eleven (11) voting members appointed by the governor upon assurance of equitable geographic and rural representation. Six (6) members shall be physicians currently licensed in Idaho and appointed as follows: one (1) member representing the Idaho board of medicine as provided in chapter 18, title 54, Idaho Code, one (1) member representing the Idaho medical association, one (1) member representing the EMS bureau, one (1) member representing the Idaho chapter of the American college of emergency physicians, one (1) member representing the Idaho chapter of the American academy of pediatrics and one (1) member representing the Idaho chapter of the American college of surgeons committee on trauma. Three (3) members shall be physicians currently licensed in Idaho and practicing as an EMS medical director representing the following associations: one (1) member representing the Idaho association of counties, one (1) member representing the Idaho fire chiefs association and one (1) member representing the Idaho hospital association. Two (2) members shall be Idaho citizens representing the public interest.
3. Except as provided in this subsection, members of the commission shall be appointed for a term of three (3) years. The following four (4) members shall be appointed to an initial term of two (2) years: the member representing the board of medicine, the member representing the Idaho chapter of the American college of emergency physicians, the member representing the Idaho chapter of the American college of surgeons committee on trauma and the member representing the Idaho fire chiefs association. The remaining seven (7) members shall be appointed for an initial term of three (3) years. Thereafter, all terms shall be for a period of three (3) years.
4. The commission shall elect a chair and such officers as it may deem necessary and appropriate. The commission shall meet at least annually and at the call of the chair. Members of the commission shall be compensated as provided in section 59-509(b), Idaho Code.
5. Prior to the expiration of the regular term of a member of the commission or upon the occurrence or declaration of a vacancy in the membership of the commission, the EMS bureau shall notify the represented entity of that fact in writing and the represented entity shall, within sixty (60) days thereafter, nominate at least three (3) persons to fill the vacancy in a manner as shall be determined by the rules and bylaws of the represented entity and shall forward the nominations to the governor, who shall appoint from among the nominees a person to be a member of the commission to fill the vacancy. Persons nominated for a seat held by a physician must be licensed by the state of Idaho to practice medicine.
6. Moneys collected pursuant to rules promulgated by the board for initial applications and renewal of EMS personnel licenses are hereby continuously appropriated and shall be utilized exclusively for the purposes set forth in this section as determined by the commission.
7. The commission shall prepare a budget on an annual basis indicating that portion of the funds necessary for the continuous operation of the commission to achieve the purposes of this section.

§ 56-1013B. Recognition of EMS Personnel Licensure Interstate Compact (REPLICA).

The recognition of EMS personnel licensure interstate compact (REPLICA) is hereby enacted into law and entered into with all other jurisdictions legally joining therein, in the form substantially as follows in sections 56-1013C through 56-1013Q, Idaho Code.

§ 56-1013C. Purpose.

In order to protect the public through verification of competency and ensure accountability for patient care related activities all states license emergency medical services (EMS) personnel, such as emergency medical technicians (EMTs), advanced EMTs and paramedics. This compact is intended to facilitate the day-to-day movement of EMS personnel across state boundaries in the performance of their EMS duties as assigned by an appropriate authority and authorize state EMS offices to afford immediate legal recognition to EMS personnel licensed in a member state. This compact recognizes that states have a vested interest in protecting the public’s health and safety through their licensing and regulation of EMS personnel and that such state regulation shared among the member states will best protect public health and safety. This compact is designed to achieve the following purposes and objectives:

1. Increase public access to EMS personnel;
2. Enhance the states’ ability to protect the public’s health and safety, especially patient safety;
3. Encourage the cooperation of member states in the areas of EMS personnel licensure and regulation;
4. Support licensing of military members who are separating from an active duty tour and their spouses;
5. Facilitate the exchange of information between member states regarding EMS personnel licensure, adverse action and significant investigatory information;
6. Promote compliance with the laws governing EMS personnel practice in each member state; and
7. Invest all member states with the authority to hold EMS personnel accountable through the mutual recognition of member state licenses.

§ 56-1013D. Definitions.

As used in this compact:

1. “Advanced emergency medical technician” (AEMT) means an individual licensed with cognitive knowledge and a scope of practice that corresponds to that level in the national EMS education standards and national EMS scope of practice model.
2. “Adverse action” means any administrative, civil, equitable or criminal action permitted by a state’s laws that may be imposed against licensed EMS personnel by a state EMS authority or state court including, but not limited to, actions against an individual’s license such as revocation, suspension, probation, consent agreement, monitoring or other limitation or encumbrance on the individual’s practice, letters of reprimand or admonition, fines, criminal convictions and state court judgments enforcing adverse actions by the state EMS authority.
3. “Alternative program” means a voluntary, nondisciplinary substance abuse recovery program approved by a state EMS authority.
4. “Certification” means the successful verification of entry-level cognitive and psychomotor competency using a reliable, validated and legally defensible examination.
5. “Commission” means the national administrative body of which all states that have enacted the compact are members.
6. “Emergency medical technician” (EMT) means an individual licensed with cognitive knowledge and a scope of practice that corresponds to that level in the national EMS education standards and national EMS scope of practice model.
7. “Home state” means a member state where an individual is licensed to practice emergency medical services.
8. “License” means the authorization by a state for an individual to practice as an EMT, AEMT, paramedic or a level in between EMT and paramedic.
9. “Medical director” means a physician licensed in a member state who is accountable for the care delivered by EMS personnel.
10. “Member state” means a state that has enacted this compact.
11. “Privilege to practice” means an individual’s authority to deliver emergency medical services in remote states as authorized under this compact.
12. “Paramedic” means an individual licensed with cognitive knowledge and a scope of practice that corresponds to that level in the national EMS education standards and national EMS scope of practice model.
13. “Remote state” means a member state in which an individual is not licensed.
14. “Restricted” means the outcome of an adverse action that limits a license or the privilege to practice.
15. “Rule” means a written statement by the commission promulgated pursuant to section 56-1013N, Idaho Code, of this compact that is of general applicability; implements, interprets or prescribes a policy or provision of the compact; or is an organizational, procedural or practice requirement of the commission and has the force and effect of statutory law in a member state and includes the amendment, repeal or suspension of an existing rule.
16. “Scope of practice” means defined parameters of various duties or services that may be provided by an individual with specific credentials. Whether regulated by rule, statute or court decision, it tends to represent the limits of services an individual may perform.
17. “Significant investigatory information” means: (a) Investigative information that a state EMS authority, after a preliminary inquiry that includes notification and an opportunity to respond if required by state law, has reason to believe, if proved true, would result in the imposition of an adverse action on a license or privilege to practice; or
18. “State” means any state, commonwealth, district or territory of the United States.
19. “State EMS authority” means the board, office or other agency with the legislative mandate to license EMS personnel.

(b) Investigative information that indicates that the individual represents an immediate threat to public health and safety regardless of whether the individual has been notified and had an opportunity to respond.

§ 56-1013E. Home state licensure.

1. Any member state in which an individual holds a current license shall be deemed a home state for purposes of this compact.
2. Any member state may require an individual to obtain and retain a license to be authorized to practice in the member state under circumstances not authorized by the privilege to practice under the terms of this compact.
3. A home state’s license authorizes an individual to practice in a remote state under the privilege to practice only if the home state:
   1. Currently requires the use of the national registry of emergency medical technicians (NREMT) examination as a condition of issuing initial licenses at the EMT and paramedic levels;
   2. Has a mechanism in place for receiving and investigating complaints about individuals;
   3. Notifies the commission, in compliance with the terms herein, of any adverse action or significant investigatory information regarding an individual;
   4. No later than five (5) years after activation of the compact, requires a criminal background check of all applicants for initial licensure, including the use of the results of fingerprint or other biometric data checks compliant with the requirements of the federal bureau of investigation with the exception of federal employees who have suitability determination in accordance with 5 CFR 731.202 and submit documentation of such as promulgated in the rules of the commission; and
   5. Complies with the rules of the commission.

§ 56-1013F. Compact privilege to practice.

1. Member states shall recognize the privilege to practice of an individual licensed in another member state that is in conformance with section 56-1013E, Idaho Code.
2. To exercise the privilege to practice under the terms and provisions of this compact, an individual must:
   1. Be at least eighteen (18) years of age;
   2. Possess a current unrestricted license in a member state as an EMT, AEMT, paramedic or state recognized and licensed level with a scope of practice and authority between EMT and paramedic; and
   3. Practice under the supervision of a medical director.
3. An individual providing patient care in a remote state under the privilege to practice shall function within the scope of practice authorized by the home state unless and until modified by an appropriate authority in the remote state as may be defined in the rules of the commission.
4. Except as provided in this section, an individual practicing in a remote state will be subject to the remote state’s authority and laws. A remote state may, in accordance with due process and that state’s laws, restrict, suspend or revoke an individual’s privilege to practice in the remote state and may take any other necessary actions to protect the health and safety of its citizens. If a remote state takes action it shall promptly notify the home state and the commission.
5. If an individual’s license in any home state is restricted or suspended, the individual shall not be eligible to practice in a remote state under the privilege to practice until the individual’s home state license is restored.
6. If an individual’s privilege to practice in any remote state is restricted, suspended or revoked, the individual shall not be eligible to practice in any remote state until the individual’s privilege to practice is restored.

§ 56-1013G. Conditions of practice in a remote state.

An individual may practice in a remote state under a privilege to practice only in the performance of the individual’s EMS duties as assigned by an appropriate authority, as defined in the rules of the commission, and under the following circumstances:

1. The individual originates a patient transport in a home state and transports the patient to a remote state;
2. The individual originates in the home state and enters a remote state to pick up a patient and provide care and transport of the patient to the home state;
3. The individual enters a remote state to provide patient care and/or transport within that remote state;
4. The individual enters a remote state to pick up a patient and provide care and transport to a third member state;
5. Other conditions as determined by rules promulgated by the commission.

§ 56-1013H. Relationship to Emergency Management Assistance Compact.

Upon a member state’s governor’s declaration of a state of emergency or disaster that activates the emergency management assistance compact (EMAC), all relevant terms and provisions of EMAC shall apply and to the extent any terms or provisions of this compact conflict with EMAC, the terms of EMAC shall prevail with respect to any individual practicing in the remote state in response to such declaration.

§ 56-1013I. Veterans, service members separating from active duty military and their spouses.

1. Member states shall consider a veteran, active military service member, and member of the national guard and reserves separating from an active duty tour, and a spouse thereof, who holds a current valid and unrestricted NREMT certification at or above the level of the state license being sought as satisfying the minimum training and examination requirements for such licensure.
2. Member states shall expedite the processing of licensure applications submitted by veterans, active military service members, and members of the national guard and reserves separating from an active duty tour, and their spouses.
3. All individuals functioning with a privilege to practice under this section remain subject to the adverse actions provisions of section 56-1013J, Idaho Code.

§ 56-1013J. Adverse actions.

1. A home state shall have exclusive power to impose adverse action against an individual’s license issued by the home state.
2. If an individual’s license in any home state is restricted or suspended, the individual shall not be eligible to practice in a remote state under the privilege to practice until the individual’s home state license is restored.
   1. All home state adverse action orders shall include a statement that the individual’s compact privileges are inactive. The order may allow the individual to practice in remote states with prior written authorization from both the home state and remote state’s EMS authority.
   2. An individual currently subject to adverse action in the home state shall not practice in any remote state without prior written authorization from both the home state and remote state’s EMS authority.
3. A member state shall report adverse actions and any occurrences that the individual’s compact privileges are restricted, suspended or revoked to the commission in accordance with the rules of the commission.
4. A remote state may take adverse action on an individual’s privilege to practice within that state.
5. Any member state may take adverse action against an individual’s privilege to practice in that state based on the factual findings of another member state, so long as each state follows its own procedures for imposing such adverse action.
6. A home state’s EMS authority shall investigate and take appropriate action with respect to reported conduct in a remote state as it would if such conduct had occurred within the home state. In such cases, the home state’s law shall control in determining the appropriate adverse action.
7. Nothing in this compact shall override a member state’s decision that participation in an alternative program may be used in lieu of adverse action and that such participation shall remain nonpublic if required by the member state’s laws. Member states must require individuals who enter any alternative programs to agree not to practice in any other member state during the term of the alternative program without prior authorization from such other member state.

§ 56-1013K. Additional powers invested in a member state’s EMS authority.

A member state’s EMS authority, in addition to any other powers granted under state law, is authorized under this compact to:

1. Issue subpoenas for both hearings and investigations that require the attendance and testimony of witnesses and the production of evidence. Subpoenas issued by a member state’s EMS authority for the attendance and testimony of witnesses, and/or the production of evidence from another member state, shall be enforced in the remote state by any court of competent jurisdiction, according to that court’s practice and procedure in considering subpoenas issued in its own proceedings. The issuing state EMS authority shall pay any witness fees, travel expenses, mileage and other fees required by the service statutes of the state where the witnesses and/or evidence are located; and
2. Issue cease and desist orders to restrict, suspend or revoke an individual’s privilege to practice in the state.

§ 56-1013L. Establishment of the interstate commission for EMS personnel practice.

1. The compact states hereby create and establish a joint public agency known as the interstate commission for EMS personnel practice.
   1. The commission is a body politic and an instrumentality of the compact states.
   2. Venue is proper and judicial proceedings by or against the commission shall be brought solely and exclusively in a court of competent jurisdiction where the principal office of the commission is located. The commission may waive venue and jurisdictional defenses to the extent it adopts or consents to participate in alternative dispute resolution proceedings.
   3. Nothing in this compact shall be construed to be a waiver of sovereign immunity.
2. Membership, voting, and meetings.
   1. Each member state shall have and be limited to one (1) delegate. The responsible official of the state EMS authority or his designee shall be the delegate to this compact for each member state. Any delegate may be removed or suspended from office as provided by the law of the state from which the delegate is appointed. Any vacancy occurring in the commission shall be filled in accordance with the laws of the member state in which the vacancy exists. In the event that more than one (1) board, office or other agency with the legislative mandate to license EMS personnel at and above the level of EMT exists, the governor of the state will determine which entity will be responsible for assigning the delegate.
   2. Each delegate shall be entitled to one (1) vote with regard to the promulgation of rules and creation of bylaws and shall otherwise have an opportunity to participate in the business and affairs of the commission. A delegate shall vote in person or by such other means as provided in the bylaws. The bylaws may provide for delegates’ participation in meetings by telephone or other means of communication.
   3. The commission shall meet at least once during each calendar year. Additional meetings shall be held as set forth in the bylaws.
   4. All meetings shall be open to the public, and public notice of meetings shall be given in the same manner as required under the rulemaking provisions in section 56-1013N, Idaho Code.
   5. The commission may convene in a closed, nonpublic meeting if the commission must discuss noncompliance of a member state with its obligations under the compact; the employment, compensation, discipline or other personnel matters, practices or procedures related to specific employees or other matters related to the commission’s internal personnel practices and procedures; current, threatened or reasonably anticipated litigation; negotiation of contracts for the purchase or sale of goods, services or real estate; accusing any person of a crime or formally censuring any person; disclosure of trade secrets or commercial or financial information that is privileged or confidential; disclosure of information of a personal nature where disclosure would constitute a clearly unwarranted invasion of personal privacy; disclosure of investigatory records compiled for law enforcement purposes; disclosure of information related to any investigatory reports prepared by or on behalf of or for use of the commission or other committee charged with responsibility of investigation or determination of compliance issues pursuant to the compact; or matters specifically exempted from disclosure by federal or member state statute.
   6. If a meeting, or portion of a meeting, is closed pursuant to this provision, the commission’s legal counsel or designee shall certify that the meeting may be closed and shall reference each relevant exempting provision. The commission shall keep minutes that fully and clearly describe all matters discussed in a meeting and shall provide a full and accurate summary of actions taken, and the reasons therefore, including a description of the views expressed. All documents considered in connection with an action shall be identified in such minutes. All minutes and documents of a closed meeting shall remain under seal, subject to release by a majority vote of the commission or order of a court of competent jurisdiction. (3) The commission shall, by a majority vote of the delegates, prescribe bylaws and/or rules to govern its conduct as may be necessary or appropriate to carry out the purposes and exercise the powers of the compact including, but not limited to:
   7. Providing a mechanism for winding up the operations of the commission and the equitable disposition of any surplus funds that may exist after the termination of the compact after the payment and/or reserving of all of its debts and obligations;
   8. The commission shall publish its bylaws and file a copy thereof, and a copy of any amendment thereto, with the appropriate agency or officer in each of the member states, if any;
   9. The commission shall maintain its financial records in accordance with the bylaws; and
   10. The commission shall meet and take such actions as are consistent with the provisions of this compact and the bylaws.
       1. To establish a budget and make expenditures;
   11. To appoint committees, including advisory committees comprised of members, state regulators, state legislators or their representatives, and consumer representatives, and such other interested persons as may be designated in this compact and the bylaws;
   12. To provide and receive information from, and to cooperate with, law enforcement agencies;
   13. To adopt and use an official seal; and
   14. To perform such other functions as may be necessary or appropriate to achieve the purposes of this compact consistent with the state regulation of EMS personnel licensure and practice.

(a) Establishing the fiscal year of the commission;

(b) Providing reasonable standards and procedures for the establishment and meetings of other committees; and governing any general or specific delegation of any authority or function of the commission;

(c) Providing reasonable procedures for calling and conducting meetings of the commission, ensuring reasonable advance notice of all meetings, and providing an opportunity for attendance of such meetings by interested parties, with enumerated exceptions designed to protect the public’s interest, the privacy of individuals, and proprietary information, including trade secrets. The commission may meet in closed session only after a majority of the membership votes to close a meeting in whole or in part. As soon as practicable, the commission must make public a copy of the vote to close the meeting revealing the vote of each member with no proxy votes allowed;

(d) Establishing the titles, duties and authority, and reasonable procedures for the election of the officers of the commission;

(e) Providing reasonable standards and procedures for the establishment of the personnel policies and programs of the commission. Notwithstanding any civil service or other similar laws of any member state, the bylaws shall exclusively govern the personnel policies and programs of the commission;

(f) Promulgating a code of ethics to address permissible and prohibited activities of commission members and employees;

(4) The commission shall have the following powers:

(a) The authority to promulgate uniform rules to facilitate and coordinate implementation and administration of this compact. The rules shall have the force and effect of law and shall be binding in all member states;

(b) To bring and prosecute legal proceedings or actions in the name of the commission, provided that the standing of any state EMS authority or other regulatory body responsible for EMS personnel licensure to sue or be sued under applicable law shall not be affected;

(c) To purchase and maintain insurance and bonds;

(d) To borrow, accept or contract for services of personnel including, but not limited to, employees of a member state;

(e) To hire employees, elect or appoint officers, fix compensation, define duties, grant such individuals appropriate authority to carry out the purposes of the compact, and to establish the commission’s personnel policies and programs relating to conflicts of interest, qualifications of personnel, and other related personnel matters;

(f) To accept any and all appropriate donations and grants of money, equipment, supplies, materials and services, and to receive, utilize and dispose of the same; provided that at all times the commission shall strive to avoid any appearance of impropriety and/or conflict of interest;

(g) To lease, purchase, accept appropriate gifts or donations of, or otherwise to own, hold, improve or use, any property, real, personal or mixed; provided that at all times the commission shall strive to avoid any appearance of impropriety;

(h) To sell, convey, mortgage, pledge, lease, exchange, abandon, or otherwise dispose of any property, real, personal or mixed;

(j) To borrow money;

(5) Financing of the commission.

(a) The commission shall pay, or provide for the payment of, the reasonable expenses of its establishment, organization and ongoing activities.

(b) The commission may accept any and all appropriate revenue sources, donations, and grants of money, equipment, supplies, materials and services.

(c) The commission may levy on and collect an annual assessment from each member state or impose fees on other parties to cover the cost of the operations and activities of the commission and its staff, which must be in a total amount sufficient to cover its annual budget as approved each year for which revenue is not provided by other sources. The aggregate annual assessment amount shall be allocated based upon a formula to be determined by the commission, which shall promulgate a rule binding upon all member states.

(d) The commission shall not incur obligations of any kind prior to securing the funds adequate to meet the same; nor shall the commission pledge the credit of any of the member states, except by and with the authority of the member state.

(e) The commission shall keep accurate accounts of all receipts and disbursements. The receipts and disbursements of the commission shall be subject to the audit and accounting procedures established under its bylaws. However, all receipts and disbursements of funds handled by the commission shall be audited yearly by a certified or licensed public accountant, and the report of the audit shall be included in and become part of the annual report of the commission.

(6) Qualified immunity, defense, and indemnification. (a) The members, officers, executive director, employees and representatives of the commission shall be immune from suit and liability, either personally or in their official capacity, for any claim for damage to or loss of property or personal injury or other civil liability caused by or arising out of any actual or alleged act, error or omission that occurred, or that the person against whom the claim is made had a reasonable basis for believing occurred within the scope of commission employment, duties or responsibilities; provided that nothing in this paragraph shall be construed to protect any such person from suit and/or liability for any damage, loss, injury or liability caused by the intentional or willful or wanton misconduct of that person.

(b) The commission shall defend any member, officer, executive director, employee or representative of the commission in any civil action seeking to impose liability arising out of any actual or alleged act, error or omission that occurred within the scope of commission employment, duties or responsibilities, or that the person against whom the claim is made had a reasonable basis for believing occurred within the scope of commission employment, duties or responsibilities; provided that nothing herein shall be construed to prohibit that person from retaining his or her own counsel; and provided further, that the actual or alleged act, error or omission did not result from that person’s intentional or willful or wanton misconduct.

(c) The commission shall indemnify and hold harmless any member, officer, executive director, employee or representative of the commission for the amount of any settlement or judgment obtained against that person arising out of any actual or alleged act, error or omission that occurred within the scope of commission employment, duties or responsibilities, or that such person had a reasonable basis for believing occurred within the scope of commission employment, duties or responsibilities, provided that the actual or alleged act, error or omission did not result from the intentional or willful or wanton misconduct of that person.

§ 56-1013M. Coordinated database.

1. The commission shall provide for the development and maintenance of a coordinated database and reporting system containing licensure, adverse action and significant investigatory information on all licensed individuals in member states.
2. Notwithstanding any other provision of state law to the contrary, a member state shall submit a uniform data set to the coordinated database on all individuals to whom this compact is applicable as required by the rules of the commission, including:
   1. Identifying information;
   2. Licensure data;
   3. Significant investigatory information;
   4. Adverse actions against an individual’s license;
   5. An indicator that an individual’s privilege to practice is restricted, suspended or revoked;
   6. Nonconfidential information related to alternative program participation;
   7. Any denial of application for licensure, and the reason(s) for such denial; and
   8. Other information that may facilitate the administration of this compact, as determined by the rules of the commission.
3. The coordinated database administrator shall promptly notify all member states of any adverse action taken against, or significant investigative information on, any individual in a member state.
4. Member states contributing information to the coordinated database may designate information that may not be shared with the public without the express permission of the contributing state.
5. Any information submitted to the coordinated database that is subsequently required to be expunged by the laws of the member state contributing the information shall be removed from the coordinated database.

§ 56-1013N. Rulemaking.

1. The commission shall exercise its rulemaking powers pursuant to the criteria set forth in this section and the rules adopted thereunder. Rules and amendments shall become binding as of the date specified in each rule or amendment.
2. If a majority of the legislatures of the member states rejects a rule, by enactment of a statute or resolution in the same manner used to adopt the compact, then such rule shall have no further force and effect in any member state.
3. Rules or amendments to the rules shall be adopted at a regular or special meeting of the commission.
4. Prior to promulgation and adoption of a final rule or rules by the commission, and at least sixty (60) days in advance of the meeting at which the rule will be considered and voted upon, the commission shall file a notice of proposed rulemaking:
   1. On the website of the commission; and
   2. On the website of each member state EMS authority or the publication in which each state would otherwise publish proposed rules.
5. The notice of proposed rulemaking shall include:
   1. The proposed time, date and location of the meeting in which the rule will be considered and voted upon;
   2. The text of the proposed rule or amendment and the reason for the proposed rule;
   3. A request for comments on the proposed rule from any interested person; and
   4. The manner in which interested persons may submit notice to the commission of their intention to attend the public hearing and any written comments.
6. Prior to adoption of a proposed rule, the commission shall allow persons to submit written data, facts, opinions and arguments, which shall be made available to the public.
7. The commission shall grant an opportunity for a public hearing before it adopts a rule or amendment if a hearing is requested by:
   1. At least twenty-five (25) persons;
   2. A governmental subdivision or agency; or
   3. An association having at least twenty-five (25) members.
8. If a hearing is held on the proposed rule or amendment, the commission shall publish the place, time and date of the scheduled public hearing.
   1. All persons wishing to be heard at the hearing shall notify the executive director of the commission or other designated member in writing of their desire to appear and testify at the hearing not less than five (5) business days before the scheduled date of the hearing.
   2. Hearings shall be conducted in a manner providing each person who wishes to comment a fair and reasonable opportunity to comment orally or in writing.
   3. No transcript of the hearing is required, unless a written request for a transcript is made, in which case the person requesting the transcript shall bear the cost of producing the transcript. A recording may be made in lieu of a transcript under the same terms and conditions as a transcript. This subsection (8)(c) shall not preclude the commission from making a transcript or recording of the hearing if it so chooses.
   4. Nothing in this section shall be construed as requiring a separate hearing on each rule. Rules may be grouped for the convenience of the commission at hearings required by this section. (9) Following the scheduled hearing date, or by the close of business on the scheduled hearing date if the hearing was not held, the commission shall consider all written and oral comments received.

(10) The commission shall, by majority vote of all members, take final action on the proposed rule and shall determine the effective date of the rule, if any, based on the rulemaking record and the full text of the rule.

(11) If no written notice of intent to attend the public hearing by interested parties is received, the commission may proceed with promulgation of the proposed rule without a public hearing.

(12) Upon determination that an emergency exists, the commission may consider and adopt an emergency rule without prior notice, opportunity for comment, or hearing, provided that the usual rulemaking procedures provided in the compact and in this section shall be retroactively applied to the rule as soon as reasonably possible, in no event later than ninety (90) days after the effective date of the rule. For the purposes of this provision, an emergency rule is one that must be adopted immediately in order to:

(a) Meet an imminent threat to public health, safety or welfare;

(b) Prevent a loss of commission or member state funds;

(c) Meet a deadline for the promulgation of an administrative rule that is established by federal law or rule; or

(d) Protect public health and safety.

(13) The commission or an authorized committee of the commission may direct revisions to a previously adopted rule or amendment for purposes of correcting typographical errors, errors in format, errors in consistency, or grammatical errors. Public notice of any revisions shall be posted on the website of the commission. The revision shall be subject to challenge by any person for a period of thirty (30) days after posting. The revision may be challenged only on grounds that the revision results in a material change to a rule. A challenge shall be made in writing, and delivered to the chair of the commission prior to the end of the notice period. If no challenge is made, the revision will take effect without further action. If the revision is challenged, the revision may not take effect without the approval of the commission.

§ 56-1013O. Oversight, dispute resolution and enforcement.

1. Oversight.
   1. The executive, legislative and judicial branches of state government in each member state shall enforce this compact and take all actions necessary and appropriate to effectuate the compact’s purposes and intent. The provisions of this compact and the rules promulgated hereunder shall have standing as statutory law.
   2. All courts shall take judicial notice of the compact and the rules in any judicial or administrative proceeding in a member state pertaining to the subject matter of this compact which may affect the powers, responsibilities or actions of the commission.
   3. The commission shall be entitled to receive service of process in any such proceeding, and shall have standing to intervene in such a proceeding for all purposes. Failure to provide service of process to the Commission shall render a judgment or order void as to the commission, this compact, or promulgated rules.
2. Default, technical assistance, and termination.
   1. If the commission determines that a member state has defaulted in the performance of its obligations or responsibilities under this compact or the promulgated rules, the commission shall provide written notice to the defaulting state and other member states of the nature of the default, the proposed means of curing the default and/or any other action to be taken by the commission; and provide remedial training and specific technical assistance regarding the default.
   2. If a state in default fails to cure the default, the defaulting state may be terminated from the compact upon an affirmative vote of a majority of the member states, and all rights, privileges and benefits conferred by this compact may be terminated on the effective date of termination. A cure of the default does not relieve the offending state of obligations or liabilities incurred during the period of default.
   3. Termination of membership in the compact shall be imposed only after all other means of securing compliance have been exhausted. Notice of intent to suspend or terminate shall be given by the commission to the governor, the majority and minority leaders of the defaulting state’s legislature, and each of the member states.
   4. A state that has been terminated is responsible for all assessments, obligations and liabilities incurred through the effective date of termination, including obligations that extend beyond the effective date of termination.
   5. The commission shall not bear any costs related to a state that is found to be in default or that has been terminated from the compact, unless agreed upon in writing between the commission and the defaulting state.
   6. The defaulting state may appeal the action of the commission by petitioning the United States district court for the District of Columbia or the federal district where the commission has its principal offices. The prevailing member shall be awarded all costs of such litigation, including reasonable attorney’s fees.
3. Dispute Resolution.
   1. Upon request by a member state, the commission shall attempt to resolve disputes related to the compact that arise among member states and between member and nonmember states.
   2. The commission shall promulgate a rule providing for both mediation and binding dispute resolution for disputes as appropriate. (4) Enforcement.
   3. The remedies herein shall not be the exclusive remedies of the commission. The commission may pursue any other remedies available under federal or state law.

(a) The commission, in the reasonable exercise of its discretion, shall enforce the provisions and rules of this compact.

(b) By majority vote, the commission may initiate legal action in the United States district court for the District of Columbia or the federal district where the commission has its principal offices against a member state in default to enforce compliance with the provisions of the compact and its promulgated rules and bylaws. The relief sought may include both injunctive relief and damages. In the event judicial enforcement is necessary, the prevailing member shall be awarded all costs of such litigation, including reasonable attorney’s fees.

§ 56-1013P. Date of implementation of the interstate commission for EMS personnel practice and associated rules, withdrawal and amendment.

1. The compact shall come into effect on the date on which the compact statute is enacted into law in the tenth member state. The provisions, which become effective at that time, shall be limited to the powers granted to the commission relating to assembly and the promulgation of rules. Thereafter, the commission shall meet and exercise rulemaking powers necessary to the implementation and administration of the compact.
2. Any state that joins the compact subsequent to the commission’s initial adoption of the rules shall be subject to the rules as they exist on the date on which the compact becomes law in that state. Any rule that has been previously adopted by the commission shall have the full force and effect of law on the day the compact becomes law in that state.
3. Any member state may withdraw from this compact by enacting a statute repealing the same.
   1. A member state’s withdrawal shall not take effect until six (6) months after enactment of the repealing statute.
   2. Withdrawal shall not affect the continuing requirement of the withdrawing state’s EMS authority to comply with the investigative and adverse action reporting requirements of this act prior to the effective date of withdrawal.
4. Nothing contained in this compact shall be construed to invalidate or prevent any EMS personnel licensure agreement or other cooperative arrangement between a member state and a nonmember state that does not conflict with the provisions of this compact.
5. This compact may be amended by the member states. No amendment to this compact shall become effective and binding upon any member state until it is enacted into the laws of all member states.

§ 56-1013Q. Construction and severability.

This compact shall be liberally construed so as to effectuate the purposes thereof. If this compact shall be held contrary to the constitution of any state member thereto, the compact shall remain in full force and effect as to the remaining member states. Nothing in this compact supersedes state law or rules related to licensure of EMS agencies.

§ 56-1014. Liability.

1. No act or omission of any person who is duly licensed under sections 56-1011 through 56-1023, Idaho Code, by the EMS bureau done or omitted in good faith while rendering emergency medical services to a person or persons who are perceived to need immediate care in order to prevent loss of life or aggravation of physiological or psychological illness or injury shall impose any liability upon those personnel, the supervising physician, the hospital, the organization providing the service, or upon a federal, state, county, city or other local governmental unit, or upon employees of such governmental unit, unless such provider of care or such personnel be shown to have caused injury and damages to such person or persons as a proximate result of his, her or their reckless or grossly negligent misconduct, which shall be the sole grounds for civil liability of such persons in the provision of care or assistance under sections 56-1011 through 56-1023, Idaho Code, regardless of the circumstance under which such care or assistance may be provided. This section shall not relieve the organization or agency operating the service from the duty of securing, maintaining and operating, the equipment and licensure designated for use in performing the emergency medical services.
2. The provisions of subsection (1) of this section shall apply to licensed personnel of another state of the United States who enter this state in response to an emergency to render emergency medical services to a person who is perceived to need immediate care in order to prevent loss of life or aggravation of physiological or psychological illness or injury.
3. No act or omission of any person authorized under this chapter to provide community health emergency medical services shall impose any liability upon such person or the person’s agency or supervising physician where the act or omission occurs in the course of providing authorized services and is done or omitted in good faith, unless the person is shown to have caused injury as a result of reckless or grossly negligent misconduct.

§ 56-1015. Failure to obtain consent.

No person licensed under sections 56-1011 through 56-1023, Idaho Code, or physician or hospital licensed in this state shall be subject to civil liability, based solely upon failure to obtain consent in rendering emergency medical, surgical, hospital or health services to any individual regardless of age where that individual is unable to give this consent for any reason and there is no other person reasonably available who is legally authorized to consent to the providing of such care, provided, however, that such person, physician, or hospital has acted in good faith and without knowledge of facts negating consent. The provision or refusal of consent under sections 56-1011 through 56-1023, Idaho Code, shall be governed by chapter 45, title 39, Idaho Code.

§ 56-1016. Agency minimum standards.

Each ambulance service, air medical service and nontransport service shall be licensed by the EMS bureau based on the level of licensed personnel it utilizes, transport capability and self-declared geographic coverage area and shall meet the following standards:

1. Personnel during transport or transfer — There shall be at least two (2) crew members on each patient transport or transfer, with the crew member delivering patient care being, at a minimum, a licensed emergency medical technician (EMT) or a licensed emergency medical responder (EMR) with a valid ambulance certification issued by the EMS bureau.
2. Dispatch — Each licensed EMS agency shall have a twenty-four (24) hour dispatch arrangement and shall respond to calls on a twenty-four (24) hour basis.
3. Agency inspections and licensing — The EMS bureau shall conduct inspections at least annually related to agency licensing or shall contract to have the inspections carried out. Each agency shall have a current state license in order to operate.
4. Ambulance service minimum standards waiver — The controlling authority providing ambulance services may petition the board for waiver of the ambulance standards of section 56-1016(2), Idaho Code, if compliance with these standards would cause undue hardship on the community being served, or would result in abandonment of ambulance services.
5. Nontransport service minimum standards waiver — The controlling authority providing nontransport services may petition the EMS bureau for waiver of the twenty-four (24) hour response requirement of this section if the petition demonstrates that the community, setting, industrial site or event is not populated on a twenty-four (24) hour basis or does not exist on a three hundred sixty-five (365) day per year basis or if compliance with these standards would cause undue hardship on the community being served, or would result in abandonment of nontransport services.
6. Supervision — A licensed physician shall supervise the medical activities provided by licensed personnel affiliated with the licensed agency including, but not limited to: establishing standing orders and protocols, reviewing performance of licensed personnel, approving methods for licensed personnel to receive instructions for patient care via radio, telephone or in person, and other oversight as provided in the rules of the commission.
7. Applicants must submit the following information with their applications and agree to meet the following requirements as a condition of licensure:
   1. A declaration of anticipated applicant agency costs and revenues; a statement of projected changes in response time; and a narrative describing projected clinical benefits to patients resulting from licensure using methods defined in board rules concerning such matters on an application provided by the EMS bureau; and
   2. Collect and report data to the EMS bureau upon receiving a license using a data collection system that is validated as compliant by the national emergency medical services information system technical assistance center in accordance with board rules.
8. The EMS bureau will provide notice of any such application to all cities, counties and other units of local government that have any geographic coverage area in common with the applicant in accordance with board rules. Such notice will include a summary of the applicant data supplied to the EMS bureau. Any other EMS bureau use of the cost and revenue data supplied by applicants is limited exclusively to informational purposes. (9) Appeal of a denial of an applicant’s license will be governed by IDAPA 16.05.03, rules governing contested case proceedings and declaratory rulings.

§ 56-1017. [Amended and Redesignated.]

§ 56-1018. Emergency medical services fund.

There is hereby created in the dedicated fund of the state treasury a fund known as the “Emergency Medical Services Fund.” Subject to appropriation by the legislature, moneys in the fund shall be used exclusively for the purposes of emergency medical services training, communications, vehicle and equipment grants, and other programs furthering the goals of highway safety and emergency response providing medical services at motor vehicle accidents.

§ 56-1018A. Emergency medical services fund II.

There is hereby created in the dedicated fund of the state treasury a fund known as the emergency medical services fund II. Subject to appropriation by the legislature, moneys in the fund shall be used exclusively for the purposes of emergency medical services.

§ 56-1018B. Emergency medical services fund III.

1. There is hereby created in the dedicated fund of the state treasury a fund known as the emergency medical services fund III. Subject to appropriation by the legislature, moneys in the fund shall be used exclusively for the purpose of acquiring vehicles and equipment for use by emergency medical services personnel in the performance of their duties, which include highway safety and emergency response to motor vehicle accidents.
2. The bureau of emergency medical services of the department of health and welfare shall be responsible for distributing moneys from the fund to qualifying nonprofit and governmental entities that submit an application for a grant from the fund. The bureau shall approve grants based on the following criteria:
   1. The requesting entity is a nonprofit or governmental entity that holds a current license as an ambulance or nontransport service issued by the state of Idaho;
   2. The requesting entity has demonstrated need based on criteria established by the bureau;
   3. The requesting entity has provided verification that it has received the approval and endorsement of a fire district or city or county within its service area;
   4. The requesting entity has certified that the title to any vehicle purchased with funds from the fund shall be in the name of the fire district or city or county that endorsed the application and shall submit proof of titling as soon as practicable;
   5. The state of Idaho shall retain a security interest in the vehicle to secure the performance of the grant recipient to utilize the vehicle consistent with the intent described in the application.
3. Notwithstanding the requirements of subsection (2)(c) and (d) of this section, the bureau of emergency medical services is authorized to approve and issue a grant to an applicant in the absence of an endorsement if the endorsement is withheld without adequate justification.

§ 56-1019. Services to victims of cystic fibrosis.

The department of health and welfare shall establish, through the crippled children’s program, a program of services to persons suffering from cystic fibrosis who are twenty-one (21) years or more of age. The department shall establish uniform standards of financial eligibility for services provided under this section.

§ 56-1020. Penalties for personnel license violations.

Any person who practices or attempts to practice EMS as a licensed provider of emergency care as provided for in sections 56-1011 through 56-1023, Idaho Code, without having at the time of so doing a valid, unexpired, unrestricted, unrevoked and unsuspended license issued by the EMS bureau under sections 56-1011 through 56-1023, Idaho Code, shall be guilty of a misdemeanor and shall be subject to a fine of not more than five hundred dollars ($500) or imprisonment for not more than six (6) months, or both, for each violation. In the event that the prosecuting attorney in the county where the alleged violation occurred fails or refuses to act within sixty (60) days of notification of the alleged violation, the attorney general is authorized to prosecute the alleged violation.

§ 56-1021. Penalties for agency license violations.

Any person establishing, conducting, managing or operating any agency as provided for in sections 56-1011 through 56-1023, Idaho Code, without a license issued by the EMS bureau under sections 56-1011 through 56-1023, Idaho Code, shall be guilty of a misdemeanor and shall be subject to a fine of not more than one thousand dollars ($1,000) or imprisonment for not more than six (6) months, or both. Each day of continuing violation shall constitute a separate offense. In the event that the prosecuting attorney in the county where the alleged violation occurred fails or refuses to act within sixty (60) days of notification of the alleged violation, the attorney general is authorized to prosecute the alleged violation.

§ 56-1022. Personnel and agencies licensure actions — Grounds — Procedure.

1. Subject to the provisions of chapter 52, title 67, Idaho Code, the EMS bureau, upon recommendation of the commission, may deny a license or refuse to renew a license for a person, or may suspend or revoke a license or may impose probationary conditions if the holder of a license or the applicant for a license has engaged in unprofessional conduct which has endangered or is likely to endanger the health, welfare or safety of the public. Such unprofessional conduct includes, but is not limited to:
   1. Obtaining a license by means of fraud, misrepresentation or concealment of a material fact;
   2. Being found guilty of unprofessional conduct as defined by rule established by the board;
   3. Being convicted of a crime which would have a direct and adverse bearing on the licensee’s ability to practice or perform emergency medical care competently;
   4. The unauthorized practice of medicine;
   5. Violating any provisions of sections 56-1011 through 56-1023, Idaho Code, or any of the rules established by the board or the commission thereunder; or
   6. Being found mentally incompetent by a court of competent jurisdiction.
2. Subject to the provisions of chapter 52, title 67, Idaho Code, the EMS bureau may deny, revoke or refuse to renew a license of an agency, or may impose probationary conditions or fines as a condition of an agency’s ability to retain a license in accordance with board rule.
3. A denial, refusal to renew, suspension, revocation or imposition of probationary conditions upon a license may be ordered by the EMS bureau after opportunity for a hearing in a manner provided by rule established by the board. An application for reinstatement may be filed with the EMS bureau one (1) year from the date of license revocation. In the event a timely application is filed, the EMS bureau shall:
   1. Hold a hearing to consider such reinstatement; and
   2. Accept or reject the application for reinstatement.

§ 56-1023. Rules.

1. The commission is authorized and directed to adopt appropriate rules defining the allowable scope of practice and acts and duties which can be performed by persons licensed by the EMS bureau and the required level of supervision by a licensed physician.
2. The board is authorized and directed to adopt appropriate rules and standards concerning the administration of sections 56-1011 through 56-1022 and this section, Idaho Code, including criteria for educational programs, certification and licensure of personnel, certification of EMS instructors, licensure of ambulance, air medical and nontransport services, manufacturing standards for ambulances and nontransport vehicles, criteria for the use of air medical services by licensed EMS personnel at emergency scenes, establishment of fees for training, inspections and licensure, appropriate requirements for renewal of licensure of personnel and agencies and the management of complaints, investigations and license actions against licensed EMS personnel and agencies. The rules of the board must be consistent with the rules adopted by the commission.
3. Additionally, the department shall develop guidelines, standards and procedures for reducing exposure to pathogens from human blood, tissue or fluids. Such guidelines, standards and procedures shall be made available to all law enforcement personnel, all emergency medical services personnel and agencies, and such other emergency personnel who request such information.

§ 56-1024. Idaho time sensitive emergency system of care — Statement of intent.

Time sensitive emergencies, specifically blunt trauma injuries, strokes and heart attacks, were three (3) of the top five (5) causes of deaths in Idaho in 2011. Numerous studies throughout the United States have demonstrated that organized systems of care improve patient outcomes, thus reducing the frequency of preventable death and improving the functional status of the patient. The institute of medicine’s report “Hospital-Based Emergency Care: At the Breaking Point” recommended improving the care of critical illness through regionalization by transporting critically ill patients to designated specialized care centers when appropriate. Early treatment and transfer when necessary will save the lives of Idahoans stricken with these emergency conditions. Trauma systems of care are well understood as they have existed in many other states for decades. It is the intent of this legislation to create an integrated and responsive system of care for Idaho citizens. The trauma component will serve as the initial framework in a deliberate, incremental implementation approach for a comprehensive system of care for time sensitive emergencies in Idaho. The time sensitive emergency system in Idaho is intended to be voluntary and inclusive. The system will be designed such that all facilities, and in particular critical access hospitals, have the opportunity to participate. No facility shall be excluded from receiving medically appropriate patients based solely on the facility’s decision of not seeking designation.

§ 56-1025. Definitions.

As used in sections 56-1024 through 56-1030, Idaho Code:

1. “EMS agency” means any organization licensed by the EMS bureau that operates an air medical service, ambulance service or nontransport service.
2. “EMS bureau” means the bureau of emergency medical services of the department of health and welfare.
3. “Council” means the Idaho time sensitive emergency system council.
4. “TSE” means time sensitive emergency, specifically trauma, stroke and heart attack.

§ 56-1026. Idaho time sensitive emergency system — Creation.

There is hereby created a voluntary time sensitive emergency system within the department of health and welfare.

§ 56-1027. Idaho time sensitive emergency system council — Creation — Composition.

1. There is hereby created the Idaho time sensitive emergency system council hereinafter known as the “council.” Council members shall be appointed by the governor with the approval of the board of health and welfare. Council members shall be selected to assure equitable geographic, rural and clinical specialty representation.
2. The membership of the council shall include the following:
   1. One (1) representative from a facility that either holds or is seeking designation as an Idaho trauma center. The representative shall be the medical director, the coordinator or the program manager responsible for the respective facility’s trauma program;
   2. One (1) representative from a facility that either holds or is seeking designation as an Idaho stroke facility. The representative shall be the medical director, the coordinator or the program manager responsible for the respective facility’s stroke program;
   3. One (1) representative from a facility that either holds or is seeking designation as an Idaho heart attack center. The representative shall be the medical director, the coordinator or the program manager responsible for the respective facility’s heart attack program;
   4. One (1) representative from an EMS agency licensed by the department that serves a primarily urban response area;
   5. One (1) representative from an EMS agency licensed by the department that serves a primarily rural response area;
   6. One (1) representative from an air medical EMS agency licensed by the department;
   7. One (1) administrator of an Idaho hospital that either holds or is seeking Idaho trauma, stroke or heart attack designation;
   8. One (1) chief executive officer or administrator of an Idaho critical access hospital that either holds or is seeking Idaho trauma, stroke or heart attack designation;
   9. One (1) licensed health care provider who routinely works in the emergency department of a hospital that serves a primarily urban area that either holds or is seeking trauma, stroke or heart attack designation;
   10. One (1) licensed health care provider who routinely works in the emergency department of a hospital that serves a primarily rural area that either holds or is seeking trauma, stroke or heart attack designation; and
   11. One (1) Idaho citizen with an interest in furthering the quality of trauma, stroke and heart attack care in Idaho.
3. The chair of each regional TSE committee shall be added as a voting member of the council when the regional TSE committee is implemented and the chair is selected.
4. Members of the council shall serve four (4) year terms with half of the members initially appointed, as determined by lot, serving two (2) year terms. If a vacancy occurs, the governor shall appoint a replacement to fill the unexpired term. Members may be reappointed and shall serve at the pleasure of the governor.

§ 56-1028. Idaho time sensitive emergency system council — Duties — Rulemaking.

The duties of the council shall be as follows:

1. Develop, implement and monitor a voluntary statewide system that includes trauma, stroke and heart attack facilities;
2. Provide oversight of the system, assuring adherence to standards established by the council;
3. Establish substate system regions that provide more effective access to the system. In the designation of these regions, specific consideration shall be given to geography and patient referral patterns for the facilities and agencies included therein;
4. Establish a regional TSE committee in each substate region;
5. Develop the standards and criteria that each participating facility that voluntarily applies is required to meet concerning personnel, equipment, resources, data collection and organizational capabilities to obtain or maintain designation;
6. Develop procedures for and the duration of the designation of a trauma, stroke or heart attack facility, including application procedures, verification procedures, investigation of complaints pertaining to designation and emergency suspension or revocation of designation;
7. Develop operational procedures for the regional TSE committees;
8. Facilitate the implementation of nationally accepted standards throughout the voluntary system;
9. Set procedures for the acquisition of data needed to successfully manage the system;
10. Promulgate rules to fulfill the purpose of this act; and
11. Collaborate and cooperate with the EMS bureau, the EMS physician commission, local governments, local EMS agencies and associations to address recruitment and retention concerns of local EMS providers.

§ 56-1029. Idaho trauma, stroke and heart attack centers — Designation.

1. The council shall designate a hospital as a trauma, stroke or heart attack center when such hospital, upon proper application and verification, has been found by the council to meet the applicable level of trauma, stroke or heart attack center criteria as established by the council.
2. In developing trauma, stroke and heart attack center designation criteria, the council shall use, as is practicable, appropriate peer-reviewed or evidence-based research including, but not limited to, the most recent guidelines of the American college of surgeons committee on trauma, American college of cardiology and American heart association for heart attack centers, or the joint commission’s primary stroke center certification program criteria for stroke centers, or primary and comprehensive stroke center recommendations as published by the American stroke association or other nationally recognized authoritative standards.
3. Participation criteria shall be published in rules promulgated by the council.
4. The council shall conduct a periodic verification review of every trauma, heart attack and stroke facility. Verification reviews shall be coordinated for the different types of centers to the extent practicable with hospital resources. No person who has a substantial conflict of interest in the operation of any trauma, stroke and heart attack center under review shall participate in the verification review of the facility.
5. The council shall coordinate an on-site review as necessary to assure that a hospital meets the criteria for the desired designation. The council may waive an on-site review when a hospital has been verified by a nationally recognized accrediting body to meet or exceed standards established by the council.
6. The council may deny, place on probation, suspend or revoke any designation when it has reasonable cause to believe that there has been misrepresentation or falsification of information or a substantial failure to comply with the criteria for designation promulgated by the council. If the council has reasonable cause to believe that a hospital is not in compliance with such provisions, it may require the facility to submit additional documentation or undergo additional site reviews to verify compliance.
7. No hospital may hold itself out to the public as an Idaho designated trauma center, Idaho designated stroke facility or Idaho designated heart attack facility unless it is designated as such by the council.
8. A hospital aggrieved because of the council’s decision shall be entitled to appeal to the council in the manner prescribed by the council and shall be afforded reasonable notice and opportunity for a fair hearing.
9. Actions of the council relating to adoption of rules, notice, hearings, appeals from decisions of the department or the director, and review shall be governed by the provisions of chapter 52, title 67, Idaho Code, the administrative procedure act.

§ 56-1030. Regional time sensitive emergency committees — Membership — Duties.

1. Pursuant to section 56-1028(4), Idaho Code, each substate region designated by the council shall have a time sensitive emergency committee.
2. Membership of each regional TSE committee shall be based on the needs of the region and can be modified as the regional TSE committee determines, but each regional committee shall be initially comprised as follows:
   1. Each facility that is designated or is seeking designation by the council as a trauma center, stroke facility or heart attack facility may appoint one (1) representative for each of the designations that the facility holds or is seeking to hold to the regional committee for the region in which the facility is located;
   2. Each air medical EMS agency that provides patient transport within the region may appoint one (1) representative;
   3. Each hospital that either holds or is seeking Idaho trauma, stroke or heart attack designation may appoint the hospital administrator;
   4. Each EMS agency with a response area in the region may appoint one (1) representative; and
   5. The regional committee shall include a pediatrician or an expert in children’s trauma.
3. Members of a regional committee shall elect a chair to serve a term of two (2) years.
4. The duties of each regional committee shall be as follows:
   1. Implement care guidelines, policies, procedures and protocols for the regional TSE system;
   2. Conduct regional quality improvement, including receipt of reports prepared by the council containing trauma, stroke and heart attack data and making recommendations to facilities within the region based upon those reports;
   3. Advise the council concerning the statewide system;
   4. Establish trauma, stroke and heart attack education and prevention programs;
   5. Provide advice concerning trauma, stroke and heart attack care to health care facilities and other providers of health care;
   6. Perform other duties required by Idaho code and council rules; and
   7. Conduct other activities needed to ensure optimal delivery of trauma, stroke and heart attack care services within the region.

§ 56-1031. Effect on insurance

Patient’s decision. [Repealed.]

§ 56-1032. Preservation of existing rights. [Repealed.]

§ 56-1033. Prior and out-of-state DNR orders and identification

Validity. [Repealed.]

§ 56-1034. Application to mass casualties. [Repealed.]

§ 56-1035. Rulemaking authority. [Repealed.]

§ 56-1036. Legislative intent.

1. The legislature finds that accidental poisoning is a serious public health problem in the state of Idaho and is a problem that disproportionately affects Idaho’s children. It further finds that a significant reduction in the morbidity and mortality resulting from such accidental poisonings has occurred as a result of the services provided by the poison control center.
2. The purpose of sections 56-1036 through 56-1040, Idaho Code, is to declare legislative support for the important work of the poison control center and to assure, by statute, the continued existence of the poison control center.
3. The legislature finds that the poison control center has saved lives and reduced suffering associated with poisoning by providing emergency telephone assistance and treatment referral to victims of such incidents, by providing immediate treatment information to health care professionals, and by providing public education and prevention programs.
4. The legislature recognizes that enhanced cooperation between the emergency medical system and poison control centers will aid in responding to emergencies resulting from exposure to poisons and that, by providing telephone assistance to individuals with possible exposure to poisons, the need for emergency room and professional office visits will be reduced. As a result, the cost of health care to those who may have been poisoned will be avoided or reduced and appropriate treatment will be assured.

§ 56-1037. Poison control center established — Services offered.

The director of the department of health and welfare (for purposes of sections 56-1036 through 56-1040, Idaho Code, “director”) shall establish, and provide support in a manner consistent with sections 56-1036 through 56-1040, Idaho Code, a statewide poison control center. The poison control center shall offer the following services:

1. Provide twenty-four (24) hour emergency telephone management and treatment referral of victims of poisoning to include determining whether treatment can be accomplished at the scene of the incident or transport to an emergency treatment or other facility is required, and carrying out telephone follow-up to families and other individuals to assure that adequate care is provided;
2. Provide information to health professionals involved in management of poisoning and overdose victims; and
3. Provide coordination and development of community education programs designed to inform the public and members of the health professions of poison prevention and treatment methods and to improve awareness of poisoning problems, occupational risks and environmental exposures.

§ 56-1038. Coordination with other agencies.

The director shall establish a system for consulting with other state agency programs concerned with poisons and poisonings, incidents involving exposures to potentially poisonous substances, and other toxicological matters to develop the most coordinated and consistent response to such situations as is reasonably possible.

§ 56-1039. Power to accept federal funds and gifts.

The director may accept federal funds granted by congress or executive order, as well as gifts, grants, endowments and/or donations from individuals and private organizations or foundations for all or any of the purposes of the poison control center.

§ 56-1040. Rulemaking authority.

The director shall adopt rules necessary to administer sections 56-1036 through 56-1040, Idaho Code, pursuant to chapter 52, title 67, Idaho Code.

§ 56-1041. State x-ray control agency.

1. The state department of health and welfare is designated as the state agency having the responsibility for administration of the regulatory, licensing and radiation control provisions associated with x-ray producing machines, as defined in section 56-1042, Idaho Code.
2. The director of the department of health and welfare shall be administrator of the agency, hereinafter referred to as the director, who shall perform the functions vested in the agency pursuant to the provisions of sections 56-1041 through 56-1053, Idaho Code.
3. In accordance with the laws of the state, the director may appoint, fix the compensation, and prescribe the powers and duties of such individuals, including consultants, advisory councils, emergency teams and committees as may be necessary to carry out the provisions of sections 56-1041 through 56-1053, Idaho Code. The personnel engaged in field activities of evaluation and inspection shall at least have a baccalaureate degree in the physical and/or life sciences, or the equivalent, and be trained in health physics.
4. The agency shall for the protection of the occupational and public health and safety:
   1. Develop programs for evaluation of hazards associated with use of radiation;
   2. Formulate and recommend that the board of health and welfare adopt, promulgate and repeal codes, rules and standards relating to control of x-ray producing machines;
   3. Advise, consult, and cooperate with other agencies of the state, and federal government, other states and interstate agencies, political subdivisions, and with groups concerned with control of x-ray producing machines;
   4. Encourage, participate in, or conduct studies, investigations, training, research and demonstrations relating to x-ray producing machines;
   5. Collect and disseminate information relating to control of x-ray producing machines, including:
      1. Maintenance of a file of all license applications, issuances, denials, amendments, transfers, renewals, modifications, suspensions and revocations; and
      2. Maintenance of a file of registrants possessing x-ray producing machines requiring registration under the provisions of sections 56-1041 through 56-1053, Idaho Code, and any administrative or judicial action pertaining thereto;
   6. Have the authority to accept and administer loans, grants, or other funds or gifts, conditional or otherwise, in furtherance of its functions from the federal government and from other sources, public or private;
   7. Issue subpoenas in order to compel the attendance of necessary witnesses and/or the production of records and documents.

§ 56-1042. Definitions.

As used in sections 56-1041 through 56-1053, Idaho Code:

1. “Board” means the Idaho board of health and welfare.
2. “Department” means the Idaho department of health and welfare.
3. “Electronic product” means any manufactured product or device or component part of such a product or device that has an electronic circuit which during operation can generate or emit a physical field of radiation.
4. “Person” means any individual, corporation, partnership, firm, association, trust, estate, public or private institution, group, agency, political subdivision of this state, any other state or political subdivision or agency thereof, and any legal successor, representative, agent or agency of the foregoing.
5. “Registration” means registration by any person possessing an x-ray producing machine in accordance with rules and standards adopted by the state board of health and welfare.
6. “X-ray producing machine” means any type of device which is capable of producing or emitting x-rays.

§ 56-1043. Rules — Licensing requirements and procedure — Registration of x-ray producing machines — Exemptions from registration or licensing.

1. The board of health and welfare shall provide, by rule, for general or specific licensing of x-ray producing machines. Such rule shall provide for amendment, suspension or revocation of licenses. Such rule shall provide that:
   1. Each application for a specific license shall be in writing and shall state such information as the board, by rule, may determine to be necessary to decide the technical, insurance and financial qualifications, or any other qualification of the applicant as the department may deem reasonable and necessary to protect the occupational and public health and safety. The department may at any time after the filing of the application, and before the expiration of the license, require further written statements and shall make such inspections as the department deems necessary in order to determine whether the license should be granted or denied or whether the license should be modified, suspended or revoked. In no event shall the department grant a specific license to any applicant who has never possessed a specific license issued by a recognized state or federal authority until the department has conducted an inspection or review which insures that the applicant can meet the rules and standards adopted pursuant to sections 56-1041 through 56-1053, Idaho Code. All applications and statements shall be signed by the applicant or licensee. The department may require any applications or statements to be made under oath or affirmation;
   2. Each license shall be in such form and contain such terms and conditions as the board may by rule prescribe;
   3. No license issued under the authority of sections 56-1041 through 56-1053, Idaho Code, and no right to process or utilize x-ray producing machines granted by any license shall be assigned or in any manner disposed of; and
   4. The terms and conditions of all licenses shall be subject to amendment, revision or modification by rules or orders issued in accordance with the provisions of sections 56-1041 through 56-1053, Idaho Code.
2. The board of health and welfare may require licensing of those persons installing or repairing x-ray producing machines which the board has determined to present a potential hazard to the occupational and public health and safety. Such licensing requirements shall provide that:
   1. Each application for a license shall be in writing and shall state such information as the board, by rule, may determine to be necessary to decide the technical, insurance and financial qualifications, or any other qualification of the applicant as the department may deem reasonable and necessary. The department may at any time after the filing of the application, and before the expiration of the license, require further written statements and shall make such inspections as the department deems necessary in order to determine whether the license should be granted or denied or whether the license should be modified, suspended or revoked. All applications and statements shall be signed by the applicant or licensee. The department may require any applications or statements to be made under oath or affirmation;
   2. Each license shall be in such form and contain such terms and conditions as the board of health and welfare may by rule prescribe;
   3. No license issued under the authority of sections 56-1041 through 56-1053, Idaho Code, and no right to possess or utilize x-ray producing machines granted by any license shall be assigned or in any manner disposed of; and (d) The terms and conditions of all licenses shall be subject to amendment, revision or modification by rules or orders issued in accordance with the provisions of sections 56-1041 through 56-1053, Idaho Code.
3. The board of health and welfare may require registration of all x-ray producing machines which the department has determined to present a potential hazard to the occupational and public health and safety.
4. The board of health and welfare may exempt certain x-ray producing machines or kinds of uses or users from the registration or licensing requirements set forth in this section when the department makes a finding that the exemption of such x-ray producing machines or kinds of uses or users will not constitute a significant risk to the health and safety of the public.
5. In promulgating rules pursuant to sections 56-1041 through 56-1053, Idaho Code, the board of health and welfare shall, insofar as practical, strive to avoid requiring dual licensing, and shall provide for such recognition of other state or federal licenses as the department shall deem desirable, subject to such registration requirements as the board of health and welfare may prescribe.

§ 56-1044. Radiation machines used to perform mammography.

1. No person shall use a radiation machine to perform mammography unless the radiation machine is registered with the department of health and welfare under department rules for registration of radiation machines and is specifically authorized under this section for use for mammography.
2. The department shall authorize a radiation machine for use for mammography if the radiation machine meets the current criteria of the American college of radiology mammography accreditation program, published by the American college of radiology, or meets an equivalent standard adopted by the department. The department shall make copies of those criteria available to the public.
3. The department may withdraw the mammography authorization for a radiation machine if it does not meet the standards set forth in subsection (2) of this section.
4. The department shall provide an opportunity for a hearing in connection with a denial or withdrawal of mammography authorization.
5. Upon a finding that a deficiency in a radiation machine used for mammography or a violation of the rules promulgated under this section seriously affects the health, safety, and welfare of individuals upon whom the radiation machine is used for mammography, the department may issue an emergency order summarily withdrawing the mammography authorization of the radiation machine. The department shall incorporate its findings in the order and shall provide an opportunity for a hearing within five (5) working days after issuance of the order. The order shall be effective during the proceedings.
6. If the department withdraws the mammography authorization of a radiation machine, the radiation machine shall not be used for mammography until reauthorized by the department.
7. If a person violates the provisions of subsection (1) of this section, the department shall post a conspicuous notice on the unauthorized radiation machine and at the entry to the facility where the radiation machine is located warning the public that the facility is performing mammography using a radiation machine that is a substantial hazard to the public health.

§ 56-1045. Inspection.

The department or its duly authorized representative shall have the power to enter at all reasonable times upon any private or public property for the purpose of determining whether or not there is compliance with or violation of the provisions of sections 56-1041 through 56-1053, Idaho Code, and rules issued thereunder, except that entry into areas under the exclusive jurisdiction of the federal government, or security areas under the direct or indirect jurisdiction of the federal government, shall be effected only with the concurrence of the federal government or its duly designated representative.

§ 56-1046. Records.

1. The department shall require each person who possesses or uses an x-ray producing machine to maintain necessary records relating to its receipt, use, storage, transfer, or disposal and such other records as the department may require which will permit the determination of the extent of occupational and public exposure from the x-ray producing machine. Copies of these records shall be submitted to the department on request. These requirements are subject to such exemptions as may be provided by rule.
2. The department may by rule establish standards requiring that personnel monitoring be provided for any employee potentially exposed to x-rays and may provide for the reporting to any employee of his x-ray exposure record.

§ 56-1047. Federal-state agreements — Authorized — Effect as to federal licenses.

1. The governor, on behalf of this state, is authorized to enter into agreements with the federal government providing for discontinuance of certain of the federal government’s responsibilities with respect to x-ray producing machines and the assumption thereof by this state pursuant to sections 56-1041 through 56-1053, Idaho Code.
2. Any person who, on the effective date of an agreement under subsection (1) of this section, possesses a license issued by the federal government, shall be deemed to possess the same pursuant to a license issued under sections 56-1041 through 56-1053, Idaho Code, which shall expire either ninety (90) days after the receipt from the department of a notice of expiration of such license or on the date of expiration specified in the federal license, whichever is earlier.

§ 56-1048. Inspection agreements and training programs.

1. The department is authorized to enter into an agreement or agreements with the federal government, other states, or interstate agencies, whereby this state will perform on a cooperative basis with the federal government, other states, or interstate agencies, inspections or other functions relating to control of x-ray producing machines.
2. The department may institute training programs for the purpose of qualifying personnel to carry out the provisions of sections 56-1041 through 56-1053, Idaho Code, and may make said personnel available for participation in any program or programs of the federal government, other states, or interstate agencies in furtherance of the purposes of such sections.

§ 56-1049. Administrative procedure.

In any proceeding under sections 56-1041 through 56-1053, Idaho Code, for the issuance or modification or repeal of rules relating to control of x-ray producing machines, the department shall comply with the requirements of chapter 52, title 67, Idaho Code.

Notwithstanding any other provision of sections 56-1041 through 56-1053, Idaho Code, whenever the department finds that an emergency exists requiring immediate action to protect the public health, safety or general welfare, the department may, without notice or hearing, issue a rule or order reciting the existence of such emergency and require that such action be taken as is necessary to meet the emergency. Such rules or orders shall be effective immediately.

§ 56-1050. Injunction proceedings.

Notwithstanding the existence or use of any other remedy, whenever any person has engaged in, or is about to engage in, any acts or practices which constitute or will constitute a violation of any provision of sections 56-1041 through 56-1053, Idaho Code, or any rule or order issued thereunder, the attorney general, upon the request of the department, after notice to such person and opportunity to comply, may make application to the appropriate court for an order enjoining such acts or practices, or for an order directing compliance, and upon a showing by the department that such person has engaged in, or is about to engage in, any such acts or practices, a permanent or temporary injunction, restraining order, or other order may be granted.

§ 56-1051. Prohibited uses.

1. It shall be unlawful for any person to use, manufacture, produce, transport, transfer, receive, acquire, own or possess any x-ray producing machine unless licensed by or registered with, or exempted by the department in accordance with the provisions of sections 56-1041 through 56-1053, Idaho Code.
2. It shall be unlawful for any person to use, manufacture, produce, transport, transfer, receive, acquire, own or possess any other x-ray producing machine that has been identified by the department as presenting a potential hazard unless such x-ray producing machine is licensed by or registered by the department in accordance with the provisions of sections 56-1041 through 56-1053, Idaho Code.

§ 56-1052. Impounding of materials.

The department shall have the authority in the event of an emergency to impound or order the impounding of x-ray producing machines in the possession of any person who is not equipped to observe or fails to observe the provisions of sections 56-1041 through 56-1053, Idaho Code, or any rules issued thereunder.

§ 56-1053. Penalties.

Any person who violates any of the provisions of sections 56-1041 through 56-1053, Idaho Code, or rules or orders in effect pursuant thereto shall be guilty of a misdemeanor.

§ 56-1054. Health quality planning.

1. It is the intent of the legislature that the department of health and welfare (“the department”) promote improved quality of care and improved health outcomes through investment in health information technology and in patient safety and quality initiatives in the state of Idaho.
   1. Coordinated implementation of health information technology in Idaho will establish widespread use of networked electronic health information or health records to allow quick, reliable and secure access to that information in order to promote patient safety and best practices in health care. This goal is consistent with the mission of the office of the national coordinator for health information technology, established by the president of the United States in 2004, to provide leadership for the development and nationwide implementation of an interoperable health information technology infrastructure to improve the quality and efficiency of health care and the ability of consumers to manage their care and safety.
   2. Coordinated implementation of statewide patient safety standards will identify uniform indicators of and standards for clinical quality and patient safety as well as uniform requirements for reporting provider achievement of those indicators and standards.
2. There is hereby created and established within the department a health quality planning commission (“the commission”).
   1. By May 1, 2006, and as needed after that date, the governor shall appoint eleven (11) voting members upon assurance of equitable geographic and rural representation, comprising members of the public and private sectors with expertise in health information technology and clinical quality and patient safety. The membership shall represent all major participants in the health care delivery and financing systems. A majority of the commission shall be health care providers or employees of health care providers. One (1) member shall be an Idaho resident representing the public interest. The commission chairperson shall be appointed by the director of the department.
   2. Members of the commission shall be appointed for a term of two (2) years. The term of office shall commence on July 1, 2006. As terms of commission members expire, the governor shall appoint each new member or reappointed member to a term of two (2) years in a manner that is consistent with subsection (a) of this section.
   3. The commission shall meet quarterly and at the call of the chairperson.
   4. Each member of the commission shall be compensated as provided by section 59-509(d), Idaho Code.
   5. Upon the occurrence or declaration of a vacancy in the membership of the commission, the department shall notify the represented entity of that fact in writing and the represented entity shall, within sixty (60) days thereafter, nominate at least one (1) and not more than three (3) persons to fill the vacancy and shall forward the nominations to the governor, who shall appoint from among the nominees a person to be a member of the commission to fill the vacancy. Such appointments shall be for a term of two (2) years.
   6. Members of the commission may be removed by the governor for substantial neglect of duty, gross misconduct in office, or the inability to discharge the duties described in this section, after written notice and opportunity for response. (g) A majority of the members of the commission shall constitute a quorum for the transaction of all business and the carrying out of commission duties.
3. The department may dedicate funding to the operations of the commission, subject to appropriation from the legislature. The department shall seek federal matching funds and additional private sector funding for commission operations.
4. The commission shall perform the following duties related to health information technology planning:
   1. Monitor the effectiveness of the Idaho health data exchange; and
   2. Make recommendations to the legislature and the department on opportunities to improve the capabilities of health information technology in the state.
5. The commission may use the information generated by the Idaho health data exchange and other data sources to promote health and patient safety planning. The commission may perform the following duties related to health quality and patient safety planning, provided that performance of these duties may include contracting with and supervising independent entities for the performance of some or all of these duties:
   1. Analyze existing clinical quality assurance and patient safety standards and reporting;
   2. Identify best practices in clinical quality assurance and patient safety standards and reporting;
   3. Recommend a mechanism or mechanisms for the uniform adoption of certain best practices in clinical quality assurance and patient safety standards and reporting including, but not limited to, the creation of regulatory standards;
   4. Monitor and report appropriate indicators of quality and patient safety;
   5. Recommend a sustainable structure for leadership of ongoing clinical quality and patient safety reporting in Idaho;
   6. Recommend a mechanism or mechanisms to promote public understanding of provider achievement of clinical quality and patient safety standards;
   7. Provide quarterly progress reports to the director of the department. An annual report shall be due to the director and the senate and house of representatives health and welfare committees on June 30 of each year; and
   8. In regard to the commission’s duties provided for in this section, the commission is directed to ensure that such duties are developed and implemented in such a manner and in such forms or formats as to result in health care data that will be readily understood by the citizens of this state.

§ 56-1055. Cytomegalovirus information.

1. The department shall make available the following information to the public, particularly pregnant women and women who may become pregnant:
   1. Incidence of cytomegalovirus (CMV);
   2. Transmission of CMV;
   3. Birth defects caused by congenital CMV;
   4. Available preventive measures; and
   5. Other information relating to CMV deemed pertinent by the department.
2. The department shall make available the information described in subsection (1) of this section to:
   1. Health care providers licensed under title 54, Idaho Code, offering care to pregnant women and infants;
   2. Daycare and child care programs and facilities licensed under title 39, Idaho Code, and persons employed by such programs or facilities;
   3. School districts and persons offering health care or health education in a school district;
   4. Religious, ecclesiastical or denominational organizations offering children’s programs as part of their services, and persons employed or volunteering for such programs; and
   5. Other persons and entities that would benefit from such information, as determined by the department.

§ 56-1101. Definitions.

As used in this chapter, unless the context requires otherwise:

1. “Account holder” means a member of a low-income household who is the named depositor of an individual development account.
2. “Board” means the individual development account advisory board as established pursuant to the provisions of this chapter.
3. “Fiduciary organization” means a nonprofit, fundraising organization that is exempt from taxation under section 501(c)(3) of the Internal Revenue Code, approved by the state, including any Indian tribe as defined in section 4(12) of the native American housing assistance and self-determination act of 1996 (25 U.S.C. section 4103(12)) [4103(13)] and any tribal subsidiary, subdivision, or other wholly owned tribal entity.
4. “Financial institution” means any state bank, national bank, savings bank, savings and loan association, credit union, insurance company, brokerage firm or other similar entity that insures the deposits of its investors and is authorized to do business in this state.
5. “Individual development account” means a contract between an account holder and a fiduciary organization, for the deposit of funds into a financial institution by the account holder, and the deposit of matching funds into the financial institution by the fiduciary organization from private and public contributions made to the fiduciary organization for such purpose, to allow the account holder to accumulate assets for use toward achieving a specific purpose approved by the fiduciary organization.
6. “Low-income household” means a single person or family whose adjusted annual income is less than two hundred percent (200%) of the annual federal poverty guideline.

§ 56-1102. Legislative findings.

The legislature finds that:

1. The problem of poverty will not be solved solely by government programs and income subsidies.
2. It is in the best interest of all Idahoans to structure incentives in a way that will result in a greater likelihood that low-income and working-poor individuals will attain self-sufficiency.
3. It is in the best interest of all Idahoans to encourage low-income individuals, neighborhoods and communities to benefit from the developments achieved through the growth in assets and investments.
4. Achieving self-sufficiency and assessing economic opportunity for low-income and working-poor individuals can be addressed through public policy that invests in asset accumulation and is supported by private sector philanthropy.
5. Providing a structured savings situation for low-income and working-poor individuals enhances their chances of fulfilling major life goals and opportunities and incorporates them into the economic mainstream.
6. The state has an opportunity to take advantage of private and public resources by making the transition to an asset-based antipoverty strategy. Those resources include, but are not limited to, the assets for independence act (42 U.S.C. section 604) and the workforce investment act (P.L. 105-220).
7. Investment through an individual development account program will help lower-income households obtain the assets they need to succeed. Communities and this state will experience resultant economic and social benefits accruing from the promotion of job training and higher education, home ownership and small business development.
8. It is desirable for this state to enact legislation that enables an authorized fiduciary organization sufficient flexibility to receive private, state and federal moneys for individual development accounts. The legislature should periodically review the provisions of this chapter to ensure that this state maximizes the receipt of available federal moneys for individual development accounts.

§ 56-1103. Persons qualifying as account holders.

1. A person who qualifies to become an account holder may enter into an agreement with a fiduciary organization for the establishment of an individual development account.
2. A person is qualified to become an account holder if the person is a member of a low-income household.
3. A person applying to establish an account must enroll in a personal development plan developed by the person and the fiduciary organization. The plan must provide the person with financial training and counseling, career or business planning and other services designed to increase the independence of the person and the person’s household through achievement of the account’s approved purpose.

§ 56-1104. Approved purpose of account — Emergency withdrawal — Removal of account holder from program.

1. A person may establish an individual development account only for a purpose approved by a fiduciary organization. Disbursements from an account for an approved purpose shall be made directly by the fiduciary organization on behalf of the account holder but in no event shall the fiduciary organization make a disbursement for an approved purpose directly to the account holder. Purposes that the fiduciary organization may approve are:
   1. Educational costs for any family member eighteen (18) years of age or older, at an accredited institution of postsecondary education.
   2. The purchase of a primary residence. In addition to payment on the purchase price of the residence, account moneys may be used to pay any usual or reasonable settlement, financing or other closing costs. The account holder must not have owned or held any interest in a residence during the three (3) years prior to making the purchase. However, this three (3) year period shall not apply to displaced homemakers or other individuals who have lost home ownership as a result of divorce.
   3. The capitalization of a small business. Account moneys may be used for capital, plant, equipment and inventory expenses or for working capital pursuant to a business plan. The business plan must have been developed through a financial institution, nonprofit microenterprise program or other qualified agent demonstrating business expertise and have been approved by the fiduciary organization. The business plan must include a description of the services or goods to be sold, a marketing plan and projected financial statements.
2. 1. If an emergency occurs, an account holder may withdraw all or part of the account holder’s deposits to an individual development account for a purpose not described in subsection (1) of this section. As used in this paragraph, an approved emergency includes making payments for necessary medical expenses, to avoid eviction of the account holder from the account holder’s residence and for necessary living expenses following a loss of employment. (2)(a) If an emergency occurs, an account holder may withdraw all or part of the account holder’s deposits to an individual development account for a purpose not described in subsection (1) of this section. As used in this paragraph, an approved emergency includes making payments for necessary medical expenses, to avoid eviction of the account holder from the account holder’s residence and for necessary living expenses following a loss of employment.
   2. The account holder must reimburse the account for the amount withdrawn under this subsection within twelve (12) months after the date of the withdrawal. Failure of an account holder to make a timely reimbursement to the account is grounds for removing the account holder from the individual development account program. Until the reimbursement has been made in full, an account holder shall not be approved for matching funds or accrued interest on matching funds.
3. If an account holder withdraws, or directs the withdrawal, of moneys from an individual development account for other than an approved purpose, the fiduciary organization may remove the account holder from the program.
4. If an account holder moves from the area where the program is conducted or is otherwise unable to continue in the program, the fiduciary organization may remove the account holder from the program.

§ 56-1105. Required account features — Matching moneys.

1. The fiduciary organization shall structure the accounts to have the following features:
   1. The fiduciary organization matches amounts deposited by the account holder according to a formula established by the fiduciary organization. The fiduciary organization shall deposit not less than one dollar ($1.00) nor more than five dollars ($5.00) into the account for each one dollar ($1.00) deposited by the account holder.
   2. The matching deposits by the fiduciary organization to the individual development account are placed in a savings account that is controlled by the fiduciary organization and held separately from the savings account of the account holder.
2. Deposits by a fiduciary organization to an account shall not exceed three thousand dollars ($3,000) in any twelve (12) month period.
3. The total amount paid into an individual development account during its existence, including amounts from deposits, matching deposits and interest or investment earnings, may not exceed twenty thousand dollars ($20,000).
4. Nothing in this chapter shall be construed to create an entitlement to matching moneys. The number of individuals who may receive disbursement of matching philanthropic moneys by sponsoring organizations pursuant to the provisions of this chapter shall necessarily be limited by the amount of philanthropic moneys available in any given year for such purpose.

§ 56-1106. Individual development account advisory board — Powers and duties.

There is hereby created the individual development account advisory board. The board shall consist of the administrator of the division of financial management or his designee who shall serve as chair, the director of the department of finance or designee, the director of the department of health and welfare or designee, the director of the department of commerce or designee, the chairman of the Idaho state tax commission or designee, and the superintendent of public instruction or designee. A quorum shall be necessary to transact business. Members of the board shall be compensated by their appointing entity. The individual development account board shall:

1. Develop and administer the individual development account program in a manner consistent with this chapter through the adoption of guidelines and procedures, and rules adopted in compliance with chapter 52, title 67, Idaho Code;
2. Retain professional services, if necessary, including accountants, auditors, consultants and other experts;
3. Seek rulings and other guidance, as necessary, from the United States department of the treasury, the internal revenue service and the state tax commission relating to the program;
4. Make changes to the program required for the participants in the program to obtain the federal income tax benefits or treatment provided by section 529 of the Internal Revenue Code of 1986, as amended.
5. Interpret, in rules, policies, guidelines and procedures, the provisions of this chapter broadly in light of its purpose and objectives; and
6. Approve fiduciary organizations to implement the individual development account program and administer moneys for individual development account purposes. In making the selections, the board shall consider factors including, but not limited to:
   1. The ability of the fiduciary organization to implement and administer the individual development account program, including the ability to verify account holder eligibility, certify that matching deposits are used only for approved purposes and exercise general fiscal accountability;
   2. The capacity of the fiduciary organization to provide or raise matching funds for the deposits of account holders;
   3. The capacity of the fiduciary organization to provide financial counseling and other related services to account holders;
   4. The links that the fiduciary organization has to other activities and programs designed to increase the independence of this state’s lower-income households through education and training, home ownership and small business development; and
   5. The ability to meet criteria established by the federal government relating to individual development account programs.

§ 56-1107. Fiduciary organizations — Authority and duties.

1. Subject to rules of the individual development account advisory board, a fiduciary organization has sole authority over, and responsibility for, the administration of individual development accounts. The responsibility of the fiduciary organization extends to all aspects of the account program, including marketing to participants, soliciting matching contributions, counseling account holders, providing financial training, and conducting required verification and compliance activities. The fiduciary organization may establish program provisions as the organization believes necessary to ensure account holder compliance with the provisions of this chapter.
2. A fiduciary organization may act in partnership with other entities, including businesses, government agencies, nonprofit organizations, community development corporations, community action programs, housing authorities and congregations to assist in the fulfillment of fiduciary organization responsibilities under this chapter.
3. A fiduciary organization may use a reasonable portion of moneys allocated to the individual development account program for administration, operation and evaluation purposes.
4. A fiduciary organization selected to administer moneys for individual development account purposes or to receive tax deductible contributions shall provide the board with an annual report of the fiduciary organization’s individual development account program activity. The report shall be filed no later than ninety (90) days after the end of the fiscal year of the fiduciary organization, or November 1 of each year, whichever occurs first. The report shall include, but not be limited to, the following information for the preceding year:
   1. The number of individual development accounts administered by the fiduciary organization;
   2. The amount of deposits and matching deposits for each account;
   3. The purpose of each account;
   4. The amount of withdrawals made for approved purposes, and the amount of withdrawals made for nonapproved purposes;
   5. The determination of whether certain donors are corporations; and
   6. Any other information the board may require for the purpose of making a return on investment analysis.

§ 56-1108. Public assistance — Eligibility determination.

Moneys in an individual development account established pursuant to the provisions of this chapter, or moneys withdrawn from an individual development account on behalf of an account holder for an approved purpose, shall not be counted as an asset of the account holder for the purpose of eligibility determination for any public assistance offered by the state of Idaho or a political subdivision of the state of Idaho.

§ 56-1201. Idaho state independent living council — Legislative intent.

The Idaho state independent living council, as hereby created and as provided for in this chapter, is not a single department of state government unto itself, nor is it a part of any of the twenty (20) departments of state government authorized by section 20, article IV, of the constitution of the state of Idaho, or of the departments prescribed in section 67-2402, Idaho Code.

It is legislative intent that the Idaho state independent living council operate and be recognized not as a state agency or department, but as a governmental entity whose creation has been authorized by the state, much in the same manner as other single purpose districts. Pursuant to this intent, and because the Idaho state independent living council is not a state department or agency, the Idaho state independent living council is exempt from the required participation in the services of the purchasing agent or employee liability coverage, as rendered by the department of administration. However, nothing shall prohibit the Idaho state independent living council from entering into contractual arrangements with the department of administration, or any other department of state government or an elected constitutional officer, for these or any other services.

It is legislative intent to require compliance with the state merit system, and to affirm the participation of the Idaho state independent living council in the public employee retirement system, chapter 13, title 59, Idaho Code, and the personnel system, chapter 53, title 67, Idaho Code.

It is also legislative intent that the matters of location of deposit of Idaho state independent living council funds, or the instruments or documents of payment from those funds shall be construed as no more than items of convenience for the conduct of business, and in no way reflect upon the nature or status of the Idaho state independent living council as an entity of government.

This section merely affirms that the Idaho state independent living council created under this chapter is not a state agency and in no way changes the character of it as it existed prior to this chapter. The functions previously performed by the state independent living council created by executive order no. 2002-05, are hereby transferred to the Idaho state independent living council pursuant to this chapter.

§ 56-1202. Idaho state independent living council — Powers.

The council shall:

1. Be independent of any state agency;
2. Adopt bylaws and policies governing its operation;
3. Provide to the council’s employees the employee benefit package offered to state of Idaho employees; and
4. Meet at least quarterly.

§ 56-1203. Directors of Idaho state independent living council.

Directors of the Idaho state independent living council shall be appointed by, and serve at the pleasure of, the governor. The governor shall comply with the provisions of the rehabilitation act of 1973, as amended, in making appointments to the council. The council shall select an executive director to carry out the executive functions of the council.

§ 56-1204. Additional powers and duties.

The council shall carry out those powers and duties set forth in the rehabilitation act of 1973, as amended. The council shall also:

1. Assess the need for services for Idahoans with disabilities and advocate with decision makers;
2. Supervise and evaluate such staff as may be necessary to carry out the functions of the council;
3. Ensure that all regularly scheduled meetings of the council are open to the public and that sufficient advance notice of meetings is provided pursuant to the open meeting law;
4. Prepare reports and make recommendations, as necessary;
5. Perform other activities the council deems necessary to increase the ability of Idahoans with disabilities to live independently;
6. Promulgate rules, as may be necessary, in compliance with chapter 52, title 67, Idaho Code.

§ 56-1205. Allocation of funds by designated state units.

The Idaho state independent living council shall enter into an agreement with the state agency designated by the state plan for independent living for the receipt, allocation and disbursement of funds to support the council’s activities. The funds shall be deposited in the Idaho state independent living council fund created pursuant to section 56-1206, Idaho Code. Such an agreement shall not be subject to the competitive bidding requirements as provided by law, and shall be limited to the amounts appropriated by the legislature or the United States congress.

§ 56-1206. Idaho state independent living council fund.

There is hereby created in the state treasury the Idaho state independent living council fund. Moneys in the fund shall consist of appropriations, grants, federal funds, donations, gifts, or moneys from any other source. Moneys in the fund are hereby perpetually appropriated for purposes provided in this chapter. The state treasurer shall invest idle moneys in the fund and any interest received on those investments shall be returned to the fund.

§ 56-1301. Short title.

This chapter shall be known and may be cited as the “Idaho Long-term Care Partnership Program.”

§ 56-1302. Definitions.

The following words and phrases when used in this chapter have the meanings given to them unless the context clearly indicates otherwise:

1. “Asset disregard” means the total assets an individual owns and may retain under medicaid and still qualify for benefits at the time the individual applies for benefits if the individual is a beneficiary of a long-term care partnership program approved policy.
2. “Department” means the department of health and welfare.
3. “Long-term care partnership program approved policy” means a long-term care insurance policy which is approved by the department of insurance and is provided through state approved long-term care insurers through the Idaho long-term care partnership program.
4. “Medicaid” means the federal medical assistance program established under title XIX of the social security act.

§ 56-1303. Long-term care partnership program.

1. Upon the repeal of restrictions to asset protection contained in the omnibus budget reconciliation act of 1993 (public law 103-66, 107 Stat. 312), there shall be established the Idaho long-term care partnership program, to be administered by the department with the assistance of the department of insurance to do the following:
   1. Provide incentives for individuals to insure against the costs of providing for their long-term care needs;
   2. Provide a mechanism for individuals to qualify for coverage of the cost of their long-term care needs under medicaid without first being required to substantially exhaust their resources;
   3. Provide counseling services to individuals planning for their long-term care needs; and
   4. Alleviate the financial burden on the state’s medical assistance program by encouraging the pursuit of private initiatives.
2. In the case of an individual who has received or is entitled to receive benefits under a long-term care partnership program policy, certain resources of that individual, as described in subsection (3) of this section, shall not be considered by the department as a determination of any of the following:
   1. Eligibility for medicaid;
   2. Amount of any medicaid payment; or
   3. Any subsequent recovery by the state of a payment for medical services.
3. The department shall promulgate necessary rules and amendments to the state plan to allow for asset disregard. To provide asset disregard, for purchasers of a long-term care partnership program policy, the department shall count insurance benefits paid under the policy toward asset disregard to the extent the payments are for covered services under the long-term care partnership program policy.

§ 56-1304. Specific eligibility.

1. An individual who is a beneficiary of a long-term care partnership program policy is eligible for assistance under medicaid using the asset disregard under section 56-1303(3), Idaho Code.
2. If the program is discontinued, an individual who purchased a long-term care partnership policy prior to the date the program is discontinued shall be eligible to receive asset disregard.
3. The department may enter into reciprocal agreements with other states to extend the asset disregard to residents of the state who purchased long-term care policies in another state which has a substantially similar asset disregard program to the program under section 56-1303, Idaho Code.

§ 56-1305. Administration.

The department and the department of insurance are authorized to adopt rules to implement the provisions of this chapter and for its administration.

§ 56-1306. Notice requirement.

1. An insurer issuing or marketing policies that qualify as partnership policies shall explain the benefits associated with a partnership policy by providing an asset disregard notice indicating that at the time of issue the coverage is an approved long-term care partnership policy. This asset disregard notice shall be provided to the policyholder or certificate holder no later than the time of policy or certificate delivery. This asset disregard notice shall also provide disclosure that the partnership status may be lost if the insured moves to a different state or modifies the coverage after issue, or if changes in federal or state laws occur.
2. The notice to the consumer under subsection (1) of this section shall be developed by the director of the department of insurance.

§ 56-1401. Short title — Legislative intent.

1. This chapter shall be known and may be cited as the “Idaho Hospital Assessment Act.”
2. It is the intent of the legislature to encourage the maximization of financial resources eligible and available for medicaid services by establishing a fund within the Idaho department of health and welfare to receive private hospital assessments to use in securing federal matching funds under federally prescribed upper payment limit and disproportionate share hospital programs available through the state medicaid plan.

§ 56-1402. Definitions.

As used in this chapter:

1. “Department” means the department of health and welfare.
2. “Disproportionate share hospital” means a hospital that serves a disproportionate share of medicaid low-income patients as compared to other hospitals as determined by department rule.
3. “Governmental entity” means and includes the state and its political subdivisions.
4. “Hospital” is as defined in section 39-1301(a), Idaho Code.
5. “Political subdivision” means a county, city, municipal corporation or hospital taxing district and, as used in this chapter, shall include state licensed hospitals established by counties pursuant to chapter 36, title 31, Idaho Code, or jointly by cities and counties pursuant to chapter 37, title 31, Idaho Code.
6. “Private hospital” means a hospital that is not owned by a governmental entity.
7. “Upper payment limit” means a limitation established by federal regulations, 42 CFR 447.272 and 42 CFR 447.321, that disallows federal matching funds when state medicaid agencies pay certain classes of hospitals an aggregate amount for inpatient and outpatient hospital services that would exceed the amount that would be paid for the same services furnished by that class of hospitals under medicare payment principles.

§ 56-1403. Hospital assessment fund established.

1. There is hereby created in the office of the state treasurer a dedicated fund to be known as the hospital assessment fund, hereinafter “fund,” to be administered by the department of health and welfare, hereinafter “department.” The state treasurer shall invest idle moneys in the fund and any interest received on those investments shall be returned to the fund.
2. Moneys in the fund shall consist of:
   1. All moneys collected or received by the department from private hospital assessments required by this chapter;
   2. All federal matching funds received by the department as a result of expenditures made by the department that are attributable to moneys deposited in the fund;
   3. Any interest or penalties levied in conjunction with the administration of this chapter; and
   4. Any appropriations, federal funds, donations, gifts or moneys from any other sources.
3. The fund is created for the purpose of receiving moneys in accordance with this section and section 56-1404, Idaho Code. The fund shall not be used to replace any moneys appropriated to the Idaho medical assistance program by the legislature. Moneys in the fund shall be distributed by the department subject to appropriation for the following purposes only:
   1. Payments to private hospitals as required under Idaho’s medical assistance program as set forth in sections 56-209b through 56-209d, Idaho Code;
   2. Reimbursement of moneys collected by the department from private hospitals through error or mistake in performing the activities authorized under Idaho’s medical assistance program;
   3. Payments of administrative expenses incurred by the department or its agent in performing the activities authorized by this chapter;
   4. Payments made to the federal government to repay excess payments made to private hospitals from the fund if the assessment plan is deemed out of compliance and after the state has appealed the findings. Hospitals shall refund the payments in question to the assessment fund. The state in turn shall return funds to both the federal government and hospital providers in the same proportion as the original financing. Individual hospitals shall be reimbursed based on the proportion of the individual hospital’s assessment to the total assessment paid by all private hospitals. If a hospital is unable to refund payments, the state shall develop a payment plan and deduct moneys from future medicaid payments;
   5. Transfers to any other fund in the state treasury, provided such transfers shall not exceed the amount transferred previously from that other fund into the hospital assessment fund; and
   6. Making refunds to hospitals pursuant to section 56-1410, Idaho Code.

§ 56-1404. Assessments.

1. All private hospitals, except those exempted under section 56-1408, Idaho Code, shall make payments to the fund in accordance with this chapter. Subject to section 56-1410, Idaho Code, an annual assessment on both inpatient and outpatient services is determined for each qualifying hospital for each state fiscal year in an amount calculated by multiplying the rate, as set forth in subsections (2)(b) and (3)(b) of this section, by the assessment base, as set forth in subsection (5) of this section.
2. 1. The department shall calculate the private hospital upper payment limit gap for both inpatient and outpatient services. The upper payment limit gap is the difference between the maximum allowable payments eligible for federal match, less medicaid payments not financed using hospital assessment funds. The upper payment limit gap shall be calculated separately for hospital inpatient and outpatient services. Medicaid disproportionate share payments shall be excluded from the calculation. (2)(a) The department shall calculate the private hospital upper payment limit gap for both inpatient and outpatient services. The upper payment limit gap is the difference between the maximum allowable payments eligible for federal match, less medicaid payments not financed using hospital assessment funds. The upper payment limit gap shall be calculated separately for hospital inpatient and outpatient services. Medicaid disproportionate share payments shall be excluded from the calculation.
   2. The department shall calculate the upper payment limit assessment rate for each state fiscal year to be the percentage that, when multiplied by the assessment base as defined in subsection (5) of this section, equals the upper payment limit gap determined in paragraph (a) of this subsection.
3. 1. The department shall calculate the disproportionate share allotment amount to be paid to private in-state hospitals. (3)(a) The department shall calculate the disproportionate share allotment amount to be paid to private in-state hospitals.
   2. The department shall calculate the disproportionate share assessment rate for private in-state hospitals to be the percentage that, when multiplied by the assessment base as defined in subsection (5) of this section, equals the amount of state funding necessary to pay the private in-state hospital disproportionate share allotment determined in paragraph (a) of this subsection.
4. For private in-state hospitals, the assessments calculated pursuant to subsections (2) and (3) of this section shall not be greater than two and one-half percent (2.5%) of the assessment base as defined in subsection (5) of this section.
5. The assessment base shall be the hospital’s net patient revenue for the applicable period. “Net patient revenue” for state fiscal year 2009 shall be determined using the most recent data available from each hospital’s fiscal year 2004 medicare cost report on file with the department on June 30, 2008, without regard to any subsequent adjustments or changes to such data. Net patient revenue for each state fiscal year thereafter shall be determined in the same manner using a rolling yearly schedule for each hospital’s fiscal year medicare cost report on file with the department on June 30 of each subsequent year without regard to any subsequent adjustments or changes to such data.

§ 56-1405. Review of annual assessment amount.

Each state fiscal year, hospitals shall have at least thirty (30) days prior to implementation to review and verify the assessment base, rate, and the estimated assessment amount.

§ 56-1406. Inpatient and outpatient adjustment payments.

All private hospitals, except those exempted under section 56-1408, Idaho Code, shall be eligible for inpatient and outpatient adjustments as follows:

1. For state fiscal year 2009, the inpatient upper payment limit gap for private hospitals shall be divided by medicaid inpatient days for the same hospitals from calendar year 2007 to establish an average per diem adjustment rate. Each private hospital shall receive an annual payment that is equal to the average per diem adjustment rate multiplied by the hospital’s calendar year 2007 medicaid inpatient days. For purposes of this section, “hospital medicaid inpatient days” are days of inpatient hospitalization paid for by the Idaho medical assistance program for the applicable calendar year. Each state fiscal year thereafter shall be determined in the same manner using a rolling yearly schedule to determine the hospital inpatient adjustment payment. In the event that either the inpatient upper payment limit gap for private hospitals or the available hospital assessment funding is lower than anticipated, the department shall apply an across-the-board factor such that the inpatient payment adjustments are maximized, financed entirely from hospital assessment funding, and do not exceed the Idaho inpatient upper payment limit for private hospitals. Payments shall be made no later than thirty (30) days after the receipt of the last deposit of the hospital assessment required in section 56-1404, Idaho Code.
2. For state fiscal year 2009, the outpatient upper payment limit gap for private hospitals shall be divided by medicaid outpatient hospital reimbursement for the same hospitals from calendar year 2007 to establish an average percentage adjustment rate. Each hospital, except those exempt under section 56-1408, Idaho Code, shall receive an annual payment that is equal to the average percentage adjustment rate multiplied by the hospital’s calendar year 2007 hospital medicaid outpatient reimbursement. For purposes of this section, “hospital outpatient reimbursement” is reimbursement for hospital outpatient services paid for by the Idaho medical assistance program for the applicable calendar year. Each state fiscal year thereafter shall be determined in the same manner using a rolling yearly schedule to determine the outpatient hospital adjustment payment. In the event that either the outpatient upper payment limit gap for private hospitals or the available hospital assessment funding is lower than anticipated, the department shall apply an across-the-board factor, such that outpatient adjustment payments are maximized, financed entirely from hospital assessment funding, and do not exceed the Idaho outpatient upper payment limit for private hospitals. Payments shall be made no later than thirty (30) days after the receipt of the last deposit of the hospital assessments required in section 56-1404, Idaho Code.

§ 56-1407. Timing of payments and assessments.

1. The department shall establish an annual assessment schedule for all payments created under this chapter.
2. If a hospital fails to pay the full amount of an installment when due, including any extensions granted, there shall be added to the assessment imposed by section 56-1404, Idaho Code, unless waived by the department for reasonable cause, a penalty equal to the lesser of:
   1. An amount equal to five percent (5%) of the assessment installment amount not paid on or before the due date, plus five percent (5%) of the portion thereof remaining unpaid on the last day of each month thereafter; or
   2. An amount equal to one hundred percent (100%) of the assessment installment amount not paid on or before the due date.
3. For purposes of subsection (2) of this section, payments shall be credited first to unpaid installment amounts rather than to penalty or interest amounts, beginning with the most delinquent installment.

§ 56-1408. Exemptions.

1. State hospital south in Blackfoot, Idaho, and state hospital north in Orofino, Idaho, and the department of veterans affairs medical center in Boise, Idaho, are exempt from the assessment required by section 56-1404, Idaho Code.
2. A private hospital that does not provide emergency services through an emergency department and is not categorized as “rehabilitation” or “psychiatric” as provided in section II.C. of the “application for hospital licenses and annual report — 2007” by the bureau of facility standards of the department of health and welfare, is exempt from the assessment required by section 56-1404, Idaho Code.

§ 56-1409. Multihospital locations, hospital closure and new hospitals.

1. If a hospital conducts, operates or maintains more than one (1) hospital licensed by the department, the hospital shall pay the assessment for each hospital separately.
2. A hospital, subject to assessments under this chapter, that ceases to conduct hospital operations or maintain its state license or did not conduct hospital operations throughout a calendar or fiscal year, shall have its required assessment adjusted by multiplying the assessment computed under section 56-1404, Idaho Code, by a fraction, the numerator of which is the number of days in the year during which the hospital conducts hospital business, operates a hospital and maintains licensure, and the denominator of which is three hundred sixty-five (365). The hospital shall pay the required assessment computed under section 56-1404, Idaho Code, on the date and in pro rata installments as required by the department for that portion of the state fiscal year during which the hospital operated and maintained state licensure, to the extent not previously paid.
3. A hospital, subject to assessments under this chapter, that has not been previously licensed as a hospital by the department and that commences hospital operations during a fiscal year, shall pay the required assessment computed under section 56-1404, Idaho Code, and shall be eligible for payment adjustments under section 56-1406, Idaho Code, only after two (2) complete state fiscal years have elapsed and two (2) full fiscal year medicare cost reports are filed with the center for medicare and medicaid services (CMS) after the commencement of operations and on the date as required by the department beginning on the first day of the next state fiscal year.

§ 56-1410. Applicability.

1. The assessment required by section 56-1404, Idaho Code, shall not take effect or shall cease to be imposed, and any moneys remaining in the fund shall be refunded to hospitals in proportion to the amounts paid by such hospitals if:
   1. The fund created in section 56-1403, Idaho Code, is used to replace moneys appropriated to the Idaho medical assistance program by the legislature; or
   2. The payments to hospitals required under section 56-1403(3), Idaho Code, are changed or are not eligible for federal matching funds under the Idaho medical assistance program.
2. The assessment required by section 56-1404, Idaho Code, shall not take effect or shall cease to be required if the assessment is not approved or is determined to be impermissible under title XIX of the social security act. Moneys in the fund derived from assessments required prior thereto shall be distributed in accordance with section 56-1403(3), Idaho Code, to the extent federal matching funds are not reduced due to the impermissibility of the assessments, and any remaining moneys shall be refunded to hospitals in proportion to the amounts paid by such hospitals.

§ 56-1501. Short title.

This chapter shall be known and may be cited as the “Idaho Skilled Nursing Facility Assessment Act.”

§ 56-1502. Legislative intent.

It is the intent of the legislature to encourage the maximization of financial resources eligible and available for medicaid services by establishing a fund within the Idaho department of health and welfare to receive nursing facility assessments to use in securing federal matching funds under federally prescribed programs available through the state medicaid plan.

§ 56-1503. Definitions.

As used in this chapter:

1. “CMS” means the centers for medicare and medicaid.
2. “Department” means the department of health and welfare.
3. “Fiscal year” means the time period from July 1 to June 30.
4. “Fund” means the nursing facility assessment fund established pursuant to section 56-1504, Idaho Code.
5. “Net patient service revenue” means gross revenue from services provided to nursing facility patients, less reductions from gross revenue resulting from an inability to collect payment of charges. Patient service revenue excludes nonpatient care revenue such as beauty and barber, vending income, interest and contributions, revenue from sale of meals and all outpatient revenue. Reductions from gross revenue includes: bad debts; contractual adjustments; uncompensated care; administrative, courtesy and policy discounts and adjustments; and other such revenue deductions.
6. “Nursing facility” means a nursing facility as defined in section 39-1301, Idaho Code, and licensed pursuant to chapter 13, title 39, Idaho Code.
7. “Resident day” means a calendar day of care provided to a nursing facility resident, including the day of admission and excluding the day of discharge, provided that one (1) resident day shall be deemed to exist when admission and discharge occur on the same day.
8. “Medicare part A resident days” means those resident days funded by the medicare program or by a medicare advantage or special needs plan.
9. “Upper payment limit” means the limitation established by federal regulations, 42 CFR 447.272, that disallows federal matching funds when state medicaid agencies pay certain classes of nursing facilities an aggregate amount for services that exceed the amount that is paid for the same services furnished by that class of nursing facilities under medicare payment principles.
10. “Value-based purchasing payments” means supplemental payments effective in state fiscal year 2021 made to providers for reaching department-selected quality indicators.

§ 56-1504. Nursing facility assessment fund.

1. There is hereby created in the office of the state treasurer a dedicated fund to be known as the nursing facility assessment fund, hereinafter the “fund,” to be administered by the department. The state treasurer shall invest idle moneys in the fund and any interest received on those investments shall be returned to the fund.
2. Moneys in the fund shall consist of:
   1. All moneys collected or received by the department from nursing facility assessments required pursuant to this chapter;
   2. All federal matching funds received by the department as a result of expenditures made by the department that are attributable to moneys deposited in the fund;
   3. Any interest or penalties levied in conjunction with the administration of this chapter; and
   4. Any appropriations, federal funds, donations, gifts or moneys from any other sources.
3. The fund is created for the purpose of receiving moneys in accordance with this section and section 56-1511, Idaho Code. Collected assessment funds shall be used to secure federal matching funds available through the state medicaid plan, which funds shall be used to make medicaid payments for nursing facility services that equal or exceed the amount of nursing facility medicaid rates, in the aggregate, as calculated in accordance with the approved state medicaid plan in effect on June 30, 2009. The fund shall be used exclusively for the following purposes:
   1. To pay administrative expenses incurred by the department or its agent in performing the activities authorized pursuant to this chapter, provided that such expenses shall not exceed a total of one percent (1%) of the aggregate assessment funds collected for the prior fiscal year.
   2. To reimburse the medicaid share of the assessment in accordance with IDAPA 16.03.10.264.
   3. To provide financial incentives for nursing facilities to improve quality to be implemented as value-based purchasing payments in state fiscal year 2021 based on performance data from the prior state fiscal year, in accordance with section 56-1511, Idaho Code.
   4. To increase nursing facility payments to fund covered services to medicaid beneficiaries within medicare upper payment limits, as negotiated with the department.
   5. To repay the federal government any excess payments made to nursing facilities if the state plan, once approved by CMS, is subsequently disapproved for any reason, and after the state has appealed the findings. Nursing facilities shall refund the excess payments in question to the assessment fund. The state, in turn, shall return funds to both the federal government and nursing facility providers in the same proportion as the original financing. Individual nursing facilities shall be reimbursed based on the proportion of the individual nursing facility’s assessment to the total assessment paid by nursing facilities. If a nursing facility is unable to refund payments, the state shall develop a payment plan and deduct moneys from future medicaid payments. The state will refund the federal government for the federal share of these overpayments.
   6. To make refunds to nursing facilities pursuant to section 56-1507, Idaho Code.

§ 56-1505. Nursing facility assessments.

1. Nursing facilities shall pay the nursing facility assessment to the fund in accordance with the provisions of this chapter, with the exception of state and county-owned facilities, which are not required to contribute.
2. The aggregated amount of assessments for all nursing facilities, during a fiscal year, shall be an amount not exceeding the maximum percentage allowed under federal law of the total aggregate net patient service revenue of assessed facilities from each provider’s prior fiscal year. The department shall determine the assessment rate prospectively for the applicable fiscal year on a per-resident-day basis, exclusive of medicare part A resident days. The per-resident-day assessment rate shall be uniform. The department shall notify nursing facilities of the assessment rate applicable to the fiscal year by August 30 of that fiscal year.
3. The department shall collect, and each nursing facility shall pay, the nursing facility assessment on an annual basis subject to the terms of this subsection. The nursing facility assessment shall be due annually, with the initial payment due within sixty (60) days after the state plan has been approved by CMS. Subsequent annual payments are due no later than thirty (30) days after receipt of the department invoice.
4. Nursing facilities may increase their charges to other payers to incorporate the assessment but shall not create a separate line-item charge on the bill reflecting the assessment.
5. 1. For state fiscal years 2020 and 2021, the department shall adjust assessments and payments for privately owned nursing facilities as follows. The department shall: (5)(a) For state fiscal years 2020 and 2021, the department shall adjust assessments and payments for privately owned nursing facilities as follows. The department shall:
      1. Increase nursing facility assessments by an amount adequate to reduce state general fund needs by one million seven hundred eighty-six thousand dollars ($1,786,000) in state fiscal year 2020 and five million dollars ($5,000,000) in state fiscal year 2021; and
      2. Support provider rate adjustments that will offset the medicaid share of the assessment increase.
   2. The department shall work with nursing facility providers to collect the increased assessments on a schedule to support state budget needs and provider rate adjustments.
   3. Provider rate adjustments for state fiscal years 2020 and 2021 shall not be considered or carried forward for payments established under section 56-116, Idaho Code.

§ 56-1506. Approval of state plan.

The department shall seek necessary federal approval in the form of the state plan amendments in order to implement the provisions of this chapter.

§ 56-1507. Multifacility locations.

If an entity conducts, operates or maintains more than one (1) nursing facility licensed by the department, the entity shall pay the nursing facility assessment for each nursing facility separately.

§ 56-1508. Termination of assessment.

1. The nursing facility assessment shall terminate and the department shall discontinue the imposition, assessment and collection of the nursing facility assessment if the plan amendment incorporating the payment in section 56-1504(3)(a) through (c), Idaho Code, is not approved by CMS. The payment calculations in section 56-1504(3)(b) and (c), Idaho Code, may be modified if necessary to obtain CMS approval of the plan amendment.
2. Upon termination of the assessment, all collected assessment revenues, less any amounts expended by the department, shall be returned on a pro rata basis to nursing facilities that paid the nursing facility assessment.

§ 56-1509. Penalties for failure to pay assessment.

1. If a nursing facility fails to pay the full amount of a nursing facility assessment when due, there shall be added to the assessment, unless waived by the department for reasonable cause, a penalty equal to five percent (5%) of the amount of the assessment that was not paid when due. Any subsequent payments shall be credited first to unpaid assessment amounts rather than to penalty or interest amounts, beginning with the most delinquent installment.
2. In addition to the penalty identified in subsection (1) of this section, the department may seek any of the following remedies for failure of any nursing facility to pay its assessment when due:
   1. Withhold any medical assistance reimbursement payments until such time as the assessment amount is paid in full;
   2. Suspend or revoke the nursing facility license; or
   3. Develop a plan that requires the nursing facility to pay any delinquent assessment in installments.

§ 56-1510. Rulemaking authority.

The department shall adopt rules to implement the provisions of this chapter.

§ 56-1511. Annual nursing facility adjustment payments.

1. All nursing facilities, with the exception of the state and county-owned facilities not included in subsection (2) of this section, shall be eligible for annual nursing facility adjustments.
2. The Idaho state veterans nursing homes shall be eligible to participate in the program and shall be eligible for annual nursing facility adjustments.
3. For the purpose of this section, “nursing facility days” are days of nursing facility services paid for by the Idaho medical assistance program for the applicable state fiscal year.
   1. For state fiscal year 2010, medicaid days for each provider’s cost report ending in calendar year 2008 shall be utilized to determine the nursing facility adjustment payment.
   2. For state fiscal year 2011, medicaid days for each provider’s cost report ending in calendar year 2009 shall be utilized to determine the nursing facility adjustment payment.
4. Adjustment payments shall be paid on an annual basis to reimburse covered medicaid expenditures in the aggregate within the upper payment limit.
5. Each annual payment shall be made no later than thirty (30) days after the receipt of the last annual deposit of the nursing facility assessments required in section 56-1504, Idaho Code.
6. The department shall implement quality performance reporting beginning in state fiscal year 2019.
   1. During state fiscal years 2019 and 2020, quality performance data will be provided to nursing facilities to illustrate how their performance would impact their value-based purchasing payment.
   2. For state fiscal year 2021 and beyond, payments from the fund described in section 56-1504, Idaho Code, shall be based on quality indicators.

§ 56-1601. Short title — Legislative intent.

1. This chapter shall be known and may be cited as the “Idaho Intermediate Care Facility Assessment Act.”
2. It is the intent of the legislature to encourage the maximization of financial resources eligible and available for medicaid services by establishing a fund within the Idaho department of health and welfare to receive ICF assessments to be used in securing federal matching funds under federally prescribed programs available through the state medicaid plan.

§ 56-1602. Definitions.

As used in this chapter:

1. “CMS” means the centers for medicare and medicaid services.
2. “Department” means the Idaho department of health and welfare.
3. “Fiscal year” means the time period from July 1 to June 30.
4. “Fund” means the ICF assessment fund established pursuant to section 56-1603, Idaho Code.
5. “ICF” means an intermediate care facility for people with intellectual disabilities as defined in section 39-1301, Idaho Code, and licensed pursuant to chapter 13, title 39, Idaho Code.
6. “Net patient service revenue” means gross revenues from services provided to ICF patients, less reductions from gross revenue resulting from an inability to collect payment of charges. Patient service revenue excludes nonpatient care revenues such as beauty and barber, vending income, interest and contributions, revenues from sale of meals and all outpatient revenues. Reductions from gross revenue includes: bad debts; contractual adjustments; uncompensated care; administrative, courtesy and policy discounts and adjustments; and other such revenue deductions.
7. “Resident day” means a calendar day of care provided to an ICF resident, including the day of admission and excluding the day of discharge, provided that one (1) resident day shall be deemed to exist when admission and discharge occur on the same day.
8. “Upper payment limit” means the limitation established in 42 CFR section 447.272, that disallows federal matching funds when state medicaid agencies pay certain classes of facilities an aggregate amount for services that exceed the amount that is paid for the same services furnished by that class of facilities under medicare payment principles.

§ 56-1603. Intermediate care facility assessment fund.

1. There is hereby created in the office of the state treasurer a dedicated fund to be known as the ICF assessment fund to be administered by the department. The state treasurer shall invest idle moneys in the fund, and any interest received on those investments shall be returned to the fund.
2. Moneys in the fund shall consist of:
   1. All moneys collected or received by the department from ICF assessments required pursuant to this chapter;
   2. All federal matching funds received by the department as a result of expenditures made by the department that are attributable to moneys deposited in the fund;
   3. Any interest or penalties levied in conjunction with the administration of this chapter; and
   4. Any appropriation or federal funds.
3. The fund is created for the purpose of receiving moneys in accordance with the provisions of this section and section 56-1604, Idaho Code. The fund shall not be used to replace any moneys appropriated to the Idaho medical assistance program by the legislature. Moneys in the fund, which are deemed to be perpetually appropriated, shall be used exclusively for the following purposes:
   1. To pay administrative expenses incurred by the department or its agent in performing the activities authorized pursuant to this chapter, provided that such expenses shall not exceed a total of one percent (1%) of the aggregate assessment funds collected for the prior fiscal year.
   2. To reimburse the medicaid share of the assessment as a pass-through.
   3. To secure federal matching funds available through the state medicaid plan, which funds shall be used to make medicaid payments for ICF services that equal or exceed the amount of ICF medicaid rates, in the aggregate, as calculated in accordance with the approved state medicaid plan in effect on July 1, 2011.
   4. To increase ICF payments to fund covered services to medicaid beneficiaries within medicare upper payment limits.
   5. To make refunds to ICFs pursuant to section 56-1607, Idaho Code. If an ICF is unable to refund payments, the state shall develop a payment plan and deduct moneys from future medicaid payments. The state will refund the federal government for the federal share of these overpayments.
   6. To make transfers to any other fund in the state treasury, provided such transfers shall not exceed the amount transferred previously from that other fund into the ICF assessment fund.

§ 56-1604. Intermediate care facility assessments.

1. The ICF shall pay the ICF assessment to the fund in accordance with the provisions of this chapter.
2. The aggregated amount of assessments for all ICFs during a fiscal year shall be an amount not exceeding the maximum percentage allowed under federal law of the total aggregate net patient service revenue of assessed ICFs from each provider’s prior fiscal year. The department shall determine the assessment rate prospectively for the applicable fiscal year on a per-resident-day basis. The per-resident-day assessment rate shall be uniform for all ICFs.
3. The department shall collect, and each ICF shall pay, the ICF assessment on an annual basis subject to the terms of this subsection. The ICF assessment shall be due no later than thirty (30) days after the receipt of the department invoice.

§ 56-1605. Approval of state plan.

The department shall seek necessary federal approval in the form of the state plan amendments in order to implement the provisions of this chapter.

§ 56-1606. Multifacility locations.

If an entity conducts, operates or maintains more than one (1) ICF licensed by the department, the entity shall pay the assessment for each ICF separately.

§ 56-1607. Termination of ICF assessments.

1. The ICF assessment shall terminate and the department shall discontinue the imposition, assessment and collection of the ICF assessment if the plan amendment incorporating the payment in section 56-1604, Idaho Code, is not approved by CMS. In the event that CMS subsequently determines that the operation of this assessment program fails to abide by federal statute, regulation and/or CMS policy, the state shall return funds back to the providers on a pro rata basis of the assessments collected. The payment calculations in sections 56-1604 and 56-1609, Idaho Code, may be modified if necessary to obtain CMS approval of the plan amendment.
2. Upon termination of the assessment, all collected assessment revenues, less any amounts expended by the department, shall be returned on a pro rata basis to ICFs that paid the ICF assessment.

§ 56-1608. Penalties for failure to pay intermediate care facility assessment.

1. If an ICF fails to pay the full amount of an ICF assessment when due, there shall be added to the assessment, unless waived by the department for reasonable cause, a penalty equal to five percent (5%) of the amount of the assessment that was not paid when due. Any subsequent payments shall be credited first to unpaid assessment amounts rather than to penalty or interest amounts, beginning with the most delinquent installment.
2. In addition to the penalty identified in subsection (1) of this section, the department may seek any of the following remedies for failure of any ICF to pay its assessment when due:
   1. Withhold any medical assistance reimbursement payments until such time as the assessment amount is paid in full;
   2. Suspend or revoke the ICF license; or
   3. Develop a plan that requires the ICF to pay any delinquent assessment in installments.

§ 56-1609. Annual intermediate care facility adjustment payments.

1. All ICFs shall be eligible for annual ICF adjustments.
2. For the purpose of this section, “medicaid days” are days of ICF services paid for by the Idaho medical assistance program for the applicable state fiscal year.
   1. For state fiscal year 2011, medicaid days for each provider’s cost report ending in calendar year 2009 shall be utilized to determine the ICF adjustment payment.
   2. For state fiscal year 2012, medicaid days for each provider’s cost report ending in calendar year 2010 shall be utilized to determine the ICF adjustment payment.
   3. Adjustment payments for a new provider, not new ownership, without a full year cost report shall be determined using medicaid patient day information from the full calendar quarter of business prior to the rate adjustment quarter.
3. Adjustment payments shall be paid on an annual basis to reimburse covered medicaid expenditures in the aggregate within the upper payment limit.
4. If a provider does not pay its annual assessment within thirty (30) days after receipt of the department invoice, no further rate adjustment payments shall be made to the provider until receipt of all assessments in arrears. If a provider pays its annual assessment more than sixty (60) days after receiving the department invoice, the subsequent adjustment payment shall be reduced twenty percent (20%).

§ 56-1610. Rulemaking authority.

The department shall adopt rules to implement the provisions of this chapter.