(1) Customized goods and services allow for the purchase as a program service of services or goods not typically reimbursed by Medicaid. These customized goods and services are used by the youth to facilitate access to supports designed to improve and maintain the youth in the community.

(2) The plan of care must:

(a) document the youth's need for this service;

(b) document attempts to identify alternative funding and/or resources; and

(c) include all documentation/receipts.

(3) Customized goods and services must be prior authorized and are limited in expenditure to $200 for each annual period beginning with a youth's most recent date of enrollment into the waiver.

(4) Customized goods and services cannot be used to provide any otherwise covered services or goods, monthly rent or mortgage, food, regular utility charges, household appliances, automobile repairs, or items that are for purely diversion/recreational purposes.

(5) Providers must have the fiduciary capacity to procure the goods and services.