This Administrative Memorandum (ADM) describes the payment standards and service documentation requirements to support a provider’s claim for reimbursement for Individual Directed Goods and Services. New York State regulations require each Medicaid provider to prepare records to demonstrate its right to receive Medicaid payment for a service. These records must be “contemporaneous” and kept for ten (10) years from the date the services were provided.
Individual Directed Goods and Services are available only for Home and Community Based Services (HCBS) Waiver authorized participants who self-direct their services with a self- direction budget. When an individual chooses to receive IDGS, the individual must choose a Fiscal Intermediary (FI) to bill and administer the service.
This ADM was originally issued on April 10, 2014. It is now revised to include the current term “Life Plan.” This revision also updates the Individual Directed Goods and Services (IDGS) Definitions Chart, separately attached. Additionally, the records retention requirement was changed. These changes appear in bold and are underlined.