UnitedHealthcare Plan of the River Valley, Inc. Iowa Medicaid Level of Care Guidelines. Supported Employment Individual Employment Habilitation
|
|
- Avis Barnett
- 7 years ago
- Views:
Transcription
1 UnitedHealthcare Plan of the River Valley, Inc. Iowa Medicaid Level of Care Guidelines Effective Date: March, 2016 Revision Date: Supported Employment Individual Employment Habilitation Home and Community Based Services (HCBS) SEIE supports may be furnished to any member who requires and chooses them through a person-centered planning process. They are not limited to persons with intellectual or developmental disabilities. SEIE support services are the ongoing supports to members who, because of their disabilities, need intensive ongoing support to obtain and maintain employment. Supports are provided to members employed in a competitive or customized job, or to members who are self-employed. Members shall be integrated into the general workforce and compensated at or above the minimum wage, but not less than the customary wage and level of benefits paid by the employer for the same or similar work performed by individuals without disabilities. The outcome of this service is sustained paid employment at or above the minimum wage in an integrated setting in the general workforce, in a job that meets personal and career goals. INSTRUCTIONS FOR USE This Level of Care Guideline provides assistance in interpreting behavioral health benefits managed by UnitedHealthcare Plan of the River Valley, Inc., and is used to make coverage determinations in accordance with the terms of the member s benefits. All reviewers must first identify enrollee eligibility, any federal or state regulatory requirements and the member s benefits prior to use of this guideline. UnitedHealthcare Plan of the River Valley, Inc. reserves the right, in its sole discretion, to modify its Level of Care Guidelines and other clinical guidelines as necessary. While this Level of Care Guideline does reflect UnitedHealthcare Plan of the River Valley, Inc. s understanding of generally accepted standards of clinical practice, it does not constitute medical advice. Admission Criteria 1. (See Common Criteria for All Levels of Care) AND 2. The member is enrolled in the Home and Community Based State Plan Habilitation Program. AND 3. Home-Based Habilitation is medically necessary. i
2 AND 3. The member has chosen to participate in activities to support the process of acquiring and maintaining employment. AND 5. The member is not in imminent or current risk of harm to self, others, and/or property. AND 6. The why now factors that precipitated admission (e.g., changes in the member s signs and symptoms, psychosocial and environmental factors, or level of functioning) indicates that the member needs intensive ongoing support to obtain and maintain employment. AND 7. At minimum the following Supported Employment Habilitation services and activities should be available to the member: 7.1. Providing time-limited employment and on-the-job training in one or more integrated employment settings as an integral part of the individual's vocational rehabilitation growth Providing support to members in order to gain skills to enable transition to integrated, competitive employment Training activities provided in regular business, industry, and community settings Promoting integration into the workplace and interaction between members and people without disabilities in those workplaces Providing on the job supports, (e.g., initial and ongoing employment planning and advancement, employment assessment, job placement, job development, negotiation with prospective employers, job analysis, training, coaching, instruction and transportation) Providing services not specifically related to job skill training that enable the member to be successful integrating into the job setting Intensive Supported Employment: 7.8. Assisting the member to locate a job or develop a job on behalf of the member via the use of individualized placement and support services that include rapid job search Supporting the member to establish or maintain self-employment, including home-based self-employment Providing ongoing vocational/job-related discovery or assessment Providing activities needed to sustain paid work by participants, including supervision and training. Supported Employment Habilitation Page 2 of 10
3 7.12. Providing reminders of effective workplace practices and reinforcement of skills already gained. Continued Service Criteria 1. (See Common Criteria for All Levels of Care) Discharge Criteria 2. (See Common Criteria for All Levels of Care) Clinical Best Practices 1. Evaluation & Person-Centered Planning 1.1. (See Common Clinical Best Practices for All Levels of Care) 1.2. The responsible service provider in conjunction with the treatment team completes an initial evaluation of the member s home-based needs upon admission The responsible service provider in conjunction with the treatment team and, whenever possible, the member develops a person-centered service plan that includes a description of the following: The member s recovery and resiliency goals; Strengths; Problems; Specific and measurable goals for each problem; Interventions that will support the member in meeting the goals The comprehensive person-centered service planning process: Includes people chosen by the member Provides necessary information and support to the member to ensure that the member directs the process to the maximum extent possible Is timely and occurs at times and locations of convenience to the member Reflects cultural considerations and uses plain language Includes strategies for solving a disagreement Offers choices to the member regarding services and supports the member receives and from whom Includes a method to request updates Records the alternative home and community based settings that were considered by the individual. Supported Employment Habilitation Page 3 of 10
4 The services plan must reflect the services and supports that are important for the member to meet the needs identified through the assessment of functional need, as well as what is important to the individual with regard to preferences for the delivery of such services and supports. The plan: Reflects the member s strengths and preferences Reflects clinical and support needs Includes observable and measureable goals and desired outcomes: Identify interventions and supports needed to meet those goals with incremental action steps, as appropriate Identify the staff people, businesses, or organizations responsible for carrying out the interventions or supports Identifies for a member receiving home-based habilitation: The member s living environment at the time of enrollment, The number of hours per day of on-site staff supervision needed by the member, and The number of other members who will live with the member in the living unit Reflects providers of services and supports, including unpaid supports provided voluntarily in lieu of waiver or state plan HCBS, including: Name of the provider Service authorized Units of service authorized Includes risk factors and measures in place to minimize risk Includes individualized backup plans and strategies when needed Identify any health and safety issues that apply to the member based on information gathered before the team meeting, including a risk assessment Identifies an emergency backup support and crisis response system to address problems or issues arising when support services are interrupted or delayed or the member s needs change Providers of applicable services shall provide for emergency backup staff. Supported Employment Habilitation Page 4 of 10
5 Includes individuals important in supporting the member Includes the names of the individuals responsible for monitoring the plan Is written in plain language and understandable to the member Documents who is responsible for monitoring the plan Documents the informed consent of the member for any restrictions on the member s rights, including maintenance of personal funds and self-administration of medications, the need for the restriction, and either a plan to restore those rights or written documentation that a plan is not necessary or appropriate Includes the signatures of all individuals and providers responsible Is distributed to the member and others involved in the plan Includes purchase and control of self-directed services Excludes unnecessary or inappropriate services and supports 1.5. The provider completes a comprehensive employment assessment in order to establish a vocational profile and individual employment support plan to include: Evaluating for job readiness by understanding the member s strengths, capabilities, needs, skills and experiences. For example: Employment/education history and preferences; Ability to attend a job and learn job duties; Ability to perform age appropriate daily functions (e.g. dressing, feeding self); Ability to relate to the expectations of a work environment; Mental health history; Existing natural supports; Social skills and ability to relate to co-workers; Existing barriers; Benefits received and impact of employment; Ability to follow stepwise directions and response to supervision; Ability to self-restrain as redirected; Ability to maintain and/or attend to basic hygienic needs independently or as instructed by supportive party; Supported Employment Habilitation Page 5 of 10
6 Ability to manage medical expectations, (e.g. medication compliance, diet, exercise); Ability to manage age appropriate finances, (e.g. paying bills, tracking financial resources, budgeting); Ability to navigate in the community The service plan may be informed by the findings of the initial clinical evaluation The service plan summarizes the member s goals, and describes what Employment Support services will be provided to accomplish those goals Employment service planning is directed by the member and conducted to reflect the member s preferences including consideration of all of the following elements: The member should determine his/her own readiness to participate in employment support activities; Employment support services should be integrated with the member s mental health treatment. Employment support providers should join and meet regularly with the treatment team to ensure that all services are seamless and coordinated; Obtaining and maintaining competitive employment is the end goal and the focus is on jobs that are in integrated settings; Searching for a job should begin as rapidly as possible; The plan should support a job that fits the member in terms of strengths, preferences, experiences and unique challenges Follow-along supports (i.e., natural supports, team members, co-workers, family members) should continue to provide support to the member once employment is obtained The service plan shall be updated or revised at least quarterly, or as necessary to document changes in the member's service needs. 2. Discharge Planning 2.1. (See Common Clinical Best Practices for All Levels of Care) 2.2. Prevocational services are designed to be provided for a limited time in order to prepare a member for employment. If a member has been receiving prevocational services for more than one year and is not ready for regular employment, the interdisciplinary team should re-evaluate the necessity of prevocational services and explore other service options to meet the member s vocational needs, if necessary. 3. Supported Employment Habilitation Service Delivery Supported Employment Habilitation Page 6 of 10
7 3.1. SEIE supports may also include support to establish or maintain selfemployment, including home-based self-employment. Supported employment services are individualized and may include any combination of the following services: Vocational or job-related discovery or assessment, Person-centered employment planning, Job placement, Job development, Negotiation with prospective employers, Job analysis, Job carving, Training and systematic instruction, Job coaching, Benefits support, training, and planning, Transportation, Asset development and career advancement services, and Other workplace support services including services not specifically related to job skill training that enable the waiver member to be successful in integrating into the job setting SEIE supports may include services and supports that assist the member in achieving self-employment through the operation of a business; however, not be used associated with starting up or operating a business. Assistance for self-employment may include: Aid to the member in identifying potential business opportunities; Assistance in the development of a business plan, including potential sources of business financing and other assistance needed to develop and launch a business; Identification of the supports that are necessary in order for the member to operate the business; and Ongoing assistance, counseling, and guidance once the business has been launched. 4. Supported Employment Habilitation Limitations and Exclusions 4.1. SEIE supports do not include payment for supervision, training, support, and adaptations typically available to other workers without disabilities filling similar positions in the business. Supported Employment Habilitation Page 7 of 10
8 4.2. SEIE supports do not include volunteer work. Such volunteer learning and training activities that prepare a person for entry into the paid workforce are addressed through prevocational services SEIE support is not intended for people working in mobile work crews of small groups of people with disabilities in the community. That type of work support is addressed in the core service definition for Supported Employment Small Group (Enclave) employment support SEIE support does not include facility based, or other similar types of vocational services furnished in specialized facilities that are not a part of the general workplace Transportation between the member s place of residence and the employment site is a component part of SEIE support services and the cost of this transportation is included in the rate paid to providers of SEIE support services SEIE supports may be provided by a co-worker or other job site personnel provided that the services that are furnished are not part of the normal duties of the co-worker, supervisor or other personnel and these individuals meet the pertinent qualifications for the providers of service Personal care and assistance may be a component of SEIE supports, but may not comprise the entirety of the service Members receiving SEIE support services may also receive educational, prevocational or day habilitation services and career planning services. A member s person-centered services and supports plan may include two or more types of non-residential habilitation services. However, different types of non-residential habilitation services may not be billed during the same period of time. 5. State plan HCBS habilitation services do not include any of the following: 5.1. Respite services 5.2. Room and board 5.3. Family support services 5.4. Inpatient hospital services 5.5. Services that are solely educational in nature 5.6. Services that are not in the member s comprehensive person-centered service plan 5.7. Services provided before the approval of a member s plan by the Iowa Medicaid Enterprise or the Iowa Plan for Behavioral Health contractor 5.8. Services to persons under 65 years of age who reside in institutions for mental diseases Supported Employment Habilitation Page 8 of 10
9 5.9. Services directed at a parent or family member to meet the protective, supportive, or preventive needs of a child. Services that are otherwise covered by the Iowa Medicaid program or that are an integral and inseparable part of another Medicaid-reimbursable service, including but not limited to: Institutional services, such as in a nursing facility or ICF/ID Services under a behavioral health managed care program, such as Assertive Community Treatment (ACT) Non-emergency medical transportation (NEMT) services cannot be used for transportation to state plan HCBS habilitation services as that service is not included in the state plan approved for the transportation service. 6. Duplication 6.1. Members may be enrolled for state plan HCBS habilitation services while also enrolled in an HCBS waiver program under the following conditions: References The member must meet all eligibility requirements for both programs Services may not be duplicated between the two programs. When a needed service is available under both programs, it should be accessed through habilitation services rather than the waiver Only one case manager is permitted per member. When case management is to be provided as an HCBS service, such as with the elderly waiver, the habilitation case manager must oversee both programs. When the member receives HCBS waiver service coordination from a service worker, the HCBS habilitation services and HCBS waiver services must be monitored and managed by a case manager CFR Person-Centered Service Plan. Retrieved from 2. Commission on Accreditation of Rehabilitation Facilities. (2015). Behavioral health standards manual. Tucson, AZ: CARF International. 3. Iowa Administrative Code Home and Community Based Habilitation Services. 4. Iowa Administrative Code (225C) Standards for services. 5. Iowa Department of Human Services. (June, 2014). Habilitation Services Manual. Supported Employment Habilitation Page 9 of 10
10 6. Substance Abuse and Mental Health Services Administration (2009). Evidence-Based Practices Knowledge Informing Transformation. Supported Employment. History Revision Date Name Revision Notes 2/2016 L. Urban Version 1-Final i To be payable by Medicaid as a habilitation service, a service must: Be reasonable and necessary. Be based on the member s needs as identified in the member s comprehensive service plan. Be delivered in the least restrictive environment appropriate to the needs of the member. Be provided at the most appropriate level for the member. Include the applicable and necessary instruction, supervision, assistance, and support required by the member to achieve the member s life goals. Be consistent with professionally accepted guidelines and standards of practice for the service being provided. Supported Employment Habilitation Page 10 of 10
CMCS Informational Bulletin
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard, Mail Stop S2-26-12 Baltimore, Maryland 21244-1850 Center for Medicaid, CHIP and Survey & Certification
More informationSEMP Redesign Amendments to 14 NYCRR Subparts 635-10, 635-12 & 635-99. Proposed Regulations Effective: July 1, 2015 Comments Due: Monday, June 8, 2015
Comments submitted by New York State Rehabilitation Association (NYSRA) and New York Association of Community and Residential Agencies (NYSACRA) on OPWDD Supported Employment (SEMP) Proposed Regulations
More informationOptum By United Behavioral Health. 2015 Florida Medicaid Managed Medical Assistance (MMA) Level of Care Guidelines
Optum By United Behavioral Health 2015 Florida Medicaid Managed Medical Assistance (MMA) Level of Care Guidelines (PSR) services combine daily medication use, independent living and social skills training,
More informationOptum By United Behavioral Health. 2015 Florida Medicaid Managed Medical Assistance (MMA) Level of Care Guidelines
Optum By United Behavioral Health 2015 Florida Medicaid Managed Medical Assistance (MMA) Level of Care Guidelines (TBOS) Therapeutic behavioral on-site services are intended to prevent members under the
More informationPart 4: Intellectual/Developmental Disabilities Services Waivers
Part 4: Intellectual/Developmental Disabilities Services Waivers Section 4.1: Medicaid Waiver Overview Sections 4.1 4.7 Section 4.2: State Definition of a Developmental Disability Section 4.3: Cost Neutrality
More informationOptum By United Behavioral Health. 2015 KanCare Medicaid Level of Care Guidelines
Optum By United Behavioral Health 2015 KanCare Medicaid Level of Care Guidelines (PRTF) A sub-acute facility-based program which delivers 24-hour/7-day assessment and diagnostic services, and active behavioral
More informationMCTAC / CTAC Medicaid Managed Care (MMC) Readiness Assessment Tool Addendum for Child-Serving Organizations
I. Present Managed Care Involvement Percentage of current reimbursement for services coming from managed care Less than 10% 26 to 50% More than 75% 10 to 25% 51% to 75% I do not know/not applicable Insurance
More informationOptum By United Behavioral Health. 2015 Mississippi Coordinated Access Network (CAN) Medicaid Level of Care Guidelines
Optum By United Behavioral Health 2015 Mississippi Coordinated Access Network (CAN) Medicaid Level of Care Guidelines Assertive Community Treatment is a multi-disciplinary, selfcontained clinical team
More informationProfessional Treatment Services in Facility-Based Crisis Program Children and Adolescents
Professional Treatment Services in Facility-Based Crisis Program Children and Adolescents Medicaid and North Carolina Health Choice (NCHC) Billable Service WORKING DRAFT Revision Date: September 11, 2014
More informationOptum By United Behavioral Health. 2015 New Jersey Managed Long-Term Services and Support (MLTSS) Medicaid Level of Care Guidelines
Optum By United Behavioral Health 2015 New Jersey Managed Long-Term Services and Support (MLTSS) Medicaid Level of Care Guidelines (AMHR) AMHR provides services in/by a licensed community residence. Services
More informationINTENSIVE IN HOME SERVICES FOR THE INTELLECTUALLY AND/OR DEVELOPMENTALLY DISABLED (I/DD) YOUTH
CSOC Service Guidelines Clinical Criteria INTENSIVE IN HOME SERVICES FOR THE INTELLECTUALLY AND/OR DEVELOPMENTALLY DISABLED (I/DD) YOUTH Definition Intensive In-Home Services means an array of rehabilitation
More informationIowa Medicaid Integrated Health Home Provider Agreement General Terms
Iowa Medicaid Integrated Health Home Provider Agreement General Terms This Agreement is between the state of Iowa, Department of Human Services, (the Department ) and the Provider (the Provider ). The
More informationother caregivers. A beneficiary may receive one diagnostic assessment per year without any additional authorization.
4.b.(8) Diagnostic, Screening, Treatment, Preventive and Rehabilitative Services (continued) Attachment 3.1-A.1 Page 7c.2 (a) Psychotherapy Services: For the complete description of the service providers,
More informationNEW YORK STATE MEDICAID PROGRAM OFFICE OF PERSONS WITH DEVELOPMENTAL DISABILITIES HOME AND COMMUNITY BASED SERVICES WAIVER MANUAL
NEW YORK STATE MEDICAID PROGRAM OFFICE OF PERSONS WITH DEVELOPMENTAL DISABILITIES HOME AND COMMUNITY BASED SERVICES WAIVER MANUAL POLICY GUIDELINES Table of Contents SECTION I - DESCRIPTION OF THE OPWDD
More informationAssertive Community Treatment (ACT)
Assertive Community Treatment (ACT) Definition The Assertive Community Treatment (ACT) Team provides high intensity services, and is available to provide treatment, rehabilitation, and support activities
More information4. Program Regulations
Table of Contents iv 437.401: Introduction... 4-1 437.402: Definitions... 4-1 437.403: Eligible Members... 4-2 437.404: Provider Eligibility... 4-3 437.405: Out-of-State Hospice Services... 4-3 437.406:
More informationSECTION 2 TARGETED CASE MANAGEMENT FOR THE CHRONICALLY MENTALLY ILL. Table of Contents
SECTION 2 TARGETED CASE MANAGEMENT FOR THE CHRONICALLY MENTALLY ILL Table of Contents 1 GENERAL POLICY... 2 1-1 Authority... 2 1-2 Definitions... 2 1-3 Target Group... 2 1-4 Qualified Targeted Case Management
More informationOptum By United Behavioral Health. 2015 Florida Medicaid Managed Medical Assistance (MMA) Level of Care Guidelines
Optum By United Behavioral Health 2015 Florida Medicaid Managed Medical Assistance (MMA) Level of Care Guidelines Statewide Inpatient Psychiatric Program Services (SIPP) Statewide Inpatient Psychiatric
More informationFlorida Medicaid. Mental Health Targeted Case Management Handbook. Agency for Health Care Administration
Florida Medicaid Mental Health Targeted Case Management Handbook Agency for Health Care Administration JEB BUSH, GOVERNOR ALAN LEVINE, SECRETARY June 7, 2006 Dear Medicaid Provider: Enclosed please find
More informationMedicaid and Employment
Medicaid and Employment Opportunities for Systems Change and Successful Employment Outcomes for People with Disabilities Nancy Kirchner Colleen Gauruder Disabled and Elderly Health Programs Group 1915
More informationGlossary of Terms/Acronyms Used By Habilitation/Vocational Rehabilitation Funded Programs
Glossary of Terms/Acronyms Used By Habilitation/Vocational Rehabilitation Funded Programs Accessible: Refers to the client s ability to reach and utilize the services in the community if they are non ambulatory,
More information2016 MEDICAL REHABILITATION PROGRAM DESCRIPTIONS
2016 MEDICAL REHABILITATION PROGRAM DESCRIPTIONS Contents Comprehensive Integrated Inpatient Rehabilitation Program... 2 Outpatient Medical Rehabilitation Program... 2 Home and Community Services... 3
More informationOptum By United Behavioral Health. 2015 Florida Medicaid Managed Medical Assistance (MMA) Level of Care Guidelines
Optum By United Behavioral Health 2015 Florida Medicaid Managed Medical Assistance (MMA) Level of Care Guidelines Therapeutic group care services are community-based, psychiatric residential treatment
More informationPOST SCHOOL EMPLOYMENT OPPORTUNITIES
POST SCHOOL OPPORTUNITIES VIII- 1 POST-SCHOOL OPPORTUNITIES COMPETITIVE APPRENTICESHIP PROGRAMS SUPPORTED DAY TRAINING / HABILITATION EXTENDED INDIVIDUAL PLACEMENT JOB SHARING MOBILE WORK CREW ENCLAVE
More informationwww.norc.org info@norc.org June 17, 2014
Research Summary www.norc.org info@norc.org June 17, 2014 ACA SECTION 2401, COMMUNITY FIRST CHOICE OPTION (Section 1915(k) of the Social Security Act); OREGON STATE PLAN AMENDMENT SUMMARY OVERVIEW Oregon
More informationILLINOIS DEPARTMENT OF CENTRAL MANAGEMENT SERVICES CLASS SPECIFICATION SERIES REHABILITATION COUNSELOR SERIES
ILLINOIS DEPARTMENT OF CENTRAL MANAGEMENT SERVICES CLASS SPECIFICATION SERIES REHABILITATION COUNSELOR SERIES CLASS TITLE POSITION CODE REHABILITATION COUNSELOR TRAINEE 38159 REHABILITATION COUNSELOR 38145
More informationTargeted Case Management Services
Targeted Case Management Services 2013 Acronyms and Abbreviations AHCA Agency for Health Care Administration MMA Magellan Medicaid Administration CBC Community Based Care CBH Community Behavioral Health
More informationSubacute Inpatient MH - Adult
Subacute Inpatient MH - Adult Definition Subacute Inpatient hospital psychiatric services are medically necessary short-term psychiatric services provided to a client with a primary psychiatric diagnosis
More informationDEFINING SUPPORT SERVICES AND SERVICE UNITS. Moving To Individualized Services and Rates
SECTION I: DEFINING SUPPORT SERVICES AND SERVICE UNITS This section covers: The similarities and differences between comprehensive and support services Services that a support services customer can purchase
More informationComplete Program Listing
Complete Program Listing Mental Health (MH) Services Division Adult Mental Health Outpatient Clinics - Provide outpatient mental health services to individuals 18 years and older who live with severe and
More informationTN No: 09-024 Supersedes Approval Date:01-27-10 Effective Date: 10/01/09 TN No: 08-011
Page 15a.2 (iii) Community Support - (adults) (CS) North Carolina is revising the State Plan to facilitate phase out of the Community Support - Adults service, which will end effective July 1, 2010. Beginning
More informationFlorida Medicaid. Nursing Facility Services Coverage Policy
Florida Medicaid Agency for Health Care Administration May 2016 Table of Contents Florida Medicaid 1.0 Introduction... 1 1.1 Description... 1 1.2 Legal Authority... 1 1.3 Definitions... 1 2.0 Eligible
More informationTABLE OF CONTENTS. Scope of Benefits
TABLE OF CONTENTS Introduction and Guidelines for Benefits Interpretation... 2 National Coverage Determinations (NCDs)... 2 Local Coverage Determinations (LCDs)... 3 Medicare Coverage Database... 3 Home
More informationOptum By United Behavioral Health. 2015 Mississippi Coordinated Access Network (CAN) Medicaid Level of Care Guidelines
Optum By United Behavioral Health 2015 Mississippi Coordinated Access Network (CAN) Medicaid Level of Care Guidelines is a behavioral intervention program, provided in the context of a therapeutic milieu,
More informationAddressing Medical Necessity for Medicaid Funded Mental and Behavioral Health Services for Persons with Dual Diagnoses
Addressing Medical Necessity for Medicaid Funded Mental and Behavioral Health Services for Persons with Dual Diagnoses Contract Number 732HC08B Prepared by Human Systems and Outcomes, Inc. Edited by Celeste
More informationAdvocating for Services: How a Parent Can Access a Special Education Program, Special Education Teacher Support Services and/or Related Services
Advocating for Services: How a Parent Can Access a Special Education Program, Special Education Teacher Support Services and/or Related Services Applied Behavioral Counseling Applied ABC Presented by Joan
More informationRULES AND REGULATIONS DEPARTMENT OF HEALTH DIVISION OF DEVELOPMENTAL DISABILITIES CHAPTER 1
RULES AND REGULATIONS DEPARTMENT OF HEALTH DIVISION OF DEVELOPMENTAL DISABILITIES CHAPTER 1 Rules For Individually-selected Service Coordination Section 1. Authority. The Department of Health, through
More informationFlorida Data as of July 2003. Mental Health and Substance Abuse Services in Medicaid and SCHIP in Florida
Mental Health and Substance Abuse Services in Medicaid and SCHIP in Florida As of July 2003 2,441,266 people were covered under Florida's Medicaid and SCHIP programs. There were 2,113,820 enrolled in the
More informationSCARC, Inc. 11 US Route 206, Suite 100 Augusta, NJ 07822 973-383-7442
Section: D.6 Page 1 of 5 The purpose of this policy is to define Supported Employment, describe SCARC s Supported Employment, and establish standards and procedures for job development and support for
More informationService Authorization Home and Community Based Services for Persons with Developmental Disabilities Waiver (HCBS DD)
Service Definition Thresholds Consideration and Questions Red Flags/Exclusions Behavioral Services Behavioral services identified in the Service Plan including individual and/or group counseling, behavioral
More informationWest Virginia Department of Health and Human Resources Bureau for Behavioral Health Services
West Virginia Department of Health and Human Resources Bureau for Behavioral Health Services Support and Alternative Services Reporting Policy Effective July 1, 2005 (Revised ) For the Comprehensive Behavioral
More informationUnderstanding Changes to Medicaid Behavioral Health Care in New York. Consumer/Recipient Education Forum
Understanding Changes to Medicaid Behavioral Health Care in New York Consumer/Recipient Education Forum MARCH July 2015 2015 Presentation Overview What are the Goals for the Medicaid Changes? What is Medicaid
More informationRHODE ISLAND DEPARTMENT OF HUMAN SERVICES OFFICE OF REHABILITATION SERVICES Section 115.10 POLICY AND PROCEDURES MANUAL Rev.
I. LEGAL AUTHORITY: EMPLOYMENT Rehabilitation Act of 1973, as amended in Title IV of the Workforce Investment Act of 1998; Sections 7(11), 12(C), 100(a)(2),102(b)(3)(A) of the Act; 29 U.S.C. 705(11), 720(a)(2),
More information2016 AGING SERVICES PROGRAM DESCRIPTIONS
2016 AGING SERVICES PROGRAM DESCRIPTIONS Contents Adult Day Services... 2 Assisted Living... 2 Person-Centered Long-Term Care Community... 3 Home and Community Services... 3 Case Management... 4 Independent
More informationPsychiatric Rehabilitation Clinical Coverage Policy No: 8D-1 Treatment Facilities Revised Date: August 1, 2012. Table of Contents
Table of Contents 1.0 Description of the Procedure, Product, or Service... 1 2.0 Eligible Recipients... 1 2.1 Provisions... 1 2.2 EPSDT Special Provision: Exception to Policy Limitations for Recipients
More informationRequest for Information (RFI): Electronic Health Record (EHR) systems For New York State Designated Home and Community Based Services (HCBS) Providers
Request for Information (RFI): Electronic Health Record (EHR) systems For New York State Designated Home and Community Based Services (HCBS) Providers Behavioral Health Information Technology (BHIT) Grant
More informationUNIVERSITY PHYSICIANS OF BROOKLYN, INC. POLICY AND PROCEDURE. No: Supersedes Date: Distribution: Issued by:
UNIVERSITY PHYSICIANS OF BROOKLYN, INC. POLICY AND PROCEDURE Subject: ALCOHOL & SUBSTANCE ABUSE INFORMATION Page 1 of 10 No: Prepared by: Shoshana Milstein Original Issue Date: NEW Reviewed by: HIPAA Policy
More informationReport on the Repurposing of the Woodside Juvenile Rehabilitation Center
Report to The Vermont Legislature Report on the Repurposing of the Woodside Juvenile Rehabilitation Center In Accordance with Act 146 Sec. C 10: Woodside Juvenile Rehabilitation Center Submitted to: Submitted
More informationIAC 9/30/15 Human Services[441] Ch 24, p.1
IAC 9/30/15 Human Services[441] Ch 24, p.1 CHAPTER 24 ACCREDITATION OF PROVIDERS OF SERVICES TO PERSONS WITH MENTAL ILLNESS, INTELLECTUAL DISABILITIES, OR DEVELOPMENTAL DISABILITIES PREAMBLE The mental
More information907 KAR 9:005. Level I and II psychiatric residential treatment facility service and coverage policies.
907 KAR 9:005. Level I and II psychiatric residential treatment facility service and coverage policies. RELATES TO: KRS 205.520, 216B.450, 216B.455, 216B.459 STATUTORY AUTHORITY: KRS 194A.030(2), 194A.050(1),
More informationTreatment Facilities Amended Date: October 1, 2015. Table of Contents
Table of Contents 1.0 Description of the Procedure, Product, or Service... 1 1.1 Definitions... 1 2.0 Eligibility Requirements... 1 2.1 Provisions... 1 2.1.1 General... 1 2.1.2 Specific... 1 2.2 Special
More informationResearch Summary. ACA SECTION 2401, COMMUNITY FIRST CHOICE OPTION (Section 1915(k) of the Social Security Act); MARYLAND STATE PLAN AMENDMENT SUMMARY
Research Summary www.norc.org info@norc.org October 24, 2014 ACA SECTION 2401, COMMUNITY FIRST CHOICE OPTION (Section 1915(k) of the Social Security Act); MARYLAND STATE PLAN AMENDMENT SUMMARY OVERVIEW
More informationNew Choices Waiver Attachment B Special Provisions Financial Management Services
INTRODUCTION The Home and Community-Based Services (HCBS) New Choices Waiver Program (NCW) is a Medicaid sponsored program administered through the Utah Department of Health, Division of Medicaid and Health
More informationIAC 10/15/14 Human Services[441] Ch 24, p.1
IAC 10/15/14 Human Services[441] Ch 24, p.1 CHAPTER 24 ACCREDITATION OF PROVIDERS OF SERVICES TO PERSONS WITH MENTAL ILLNESS, INTELLECTUAL DISABILITIES, OR DEVELOPMENTAL DISABILITIES PREAMBLE The mental
More informationTRANSITIONAL RESIDENTIAL TREATMENT PROGRAM Session Law 2007-323 House Bill 1473, Section 10.49(i)
REPORT TO THE THE JOINT LEGISLATIVE OVERSIGHT COMMITTEE ON MENTAL HEALTH, DEVELOPMENTAL DISABILITIES AND SUBSTANCE ABUSE SERVICES TRANSITIONAL RESIDENTIAL TREATMENT PROGRAM Session Law 2007-323 House Bill
More informationNew Mexico Home- and Community-Based Services Waiver Provider Rate Study
New Mexico Home- and Community-Based Services Waiver Provider Rate Study December 1, 2005 Prepared for the New Mexico Human Services Department New Mexico Home- and Community-Based Services Waiver Provider
More informationDepartment of Mental Health and Addiction Services 17a-453a-1 2
17a-453a-1 2 DEPARTMENT OF MENTAL HEALTH AND ADDICTION SERVICES General Assistance Behavioral Health Program The Regulations of Connecticut State Agencies are amended by adding sections 17a-453a-1 to 17a-453a-19,
More informationCHAPTER 535 HEALTH HOMES. Background... 2. Policy... 2. 535.1 Member Eligibility and Enrollment... 2. 535.2 Health Home Required Functions...
TABLE OF CONTENTS SECTION PAGE NUMBER Background... 2 Policy... 2 535.1 Member Eligibility and Enrollment... 2 535.2 Health Home Required Functions... 3 535.3 Health Home Coordination Role... 4 535.4 Health
More informationIowa s Employment First Initiative: Statement of Findings
Iowa s Employment First Initiative: Statement of Findings October 2011 Contributors: Goal 1 Work Group Members SueAnn Morrow Tammara Amsbaugh LeAnn Moskowitz Casey Westhoff Maria Walker Others: Sherry
More informationAssertive Community Treatment (ACT) Providing Health Home Care Management Interim Instruction: February 19, 2014
Assertive Community Treatment (ACT) Providing Health Home Care Management Interim Instruction: February 19, 2014 Introduction The Office of Mental Health (OMH) licensed and regulated Assertive Community
More informationPsychosocial Rehabilitation Program Services
Psychosocial Rehabilitation Program Services 2013 Overview Objectives Definitions What it is not What it is Who can provide What to focus on Populations of Service Documentation Requirements 2 Objectives
More informationService Coordination Core Training Module Component 1
Service Coordination Core Training Module Component 1 It is important to remember that the purpose of this training program is to provide general information about case management services for eligible
More informationGW HEATH Resource Center Non-Degree Postsecondary Options For Individuals with Disabilities By Mario Payne
GW HEATH Resource Center Non-Degree Postsecondary Options For Individuals with Disabilities By Mario Payne HEATH Resource Center staff members field an increasing number of requests for information on
More informationBehavioral Health Forum 2014 Description of 4 Mental Health Service areas
Behavioral Health Forum 2014 Description of 4 Mental Health Service areas Terri Timberlake, Ph.D. Director, Adult Mental Health Department of Behavioral Health and Developmental Disabilities Core Eligibility
More informationTechnical Specifications: Job Preparation, Development and Placement Services
Vocational Rehabilitation Technical Specifications: Job Preparation, Development and Placement Services Effective July 1, 2014 to June 30, 2016 (Revised: 10/2015) Job Preparation, Development and Placement
More informationAssertive Community Treatment (ACT) Providing Health Home Care Management Interim Instruction: December 6, 2013
Assertive Community Treatment (ACT) Providing Health Home Care Management Interim Instruction: December 6, 2013 Introduction The OMH licensed and regulated Assertive Community Treatment Program (ACT) will
More informationAuthorized Signature Issue Date: 6/30/2014
Developmental Disabilities Services Policy Transmittal Patricia Baxter Number: APD-PT-14-023 Authorized Signature Issue Date: 6/30/2014 Topic: Developmental Disabilities Transmitting (check the box that
More informationHow To Get A Health Care Benefit In Texas
RULE 354.1448 Purpose (a) This chapter governs provisions related to the Community First Choice (CFC) benefit. (b) CFC establishes a new state plan option to provide certain home and community based supports.
More informationSources of funding 2012 ANNUAL CONFERENCE. Eligibility to receive services. Structure of County Boards of DD. Primary Service Programs
OHIO ASSOCIATION OF AREA AGENCIES ON AGING 2012 ANNUAL CONFERENCE Dan Ohler, Executive Director County Boards of Developmental Disabilities Created by statute in 1967; SB 169. DD services previously merged
More informationTitle 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE
10.09.79.00 Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Subtitle 09 MEDICAL CARE PROGRAMS Chapter 79 Psychiatric Residential Treatment Facility (PRTF) Demonstration Waiver Authority: Health-General
More informationTitle 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE
Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Subtitle 21 MENTAL HYGIENE REGULATIONS Chapter 26 Community Mental Health Programs Residential Crisis Services Authority: Health-General Article, 10-901
More informationMEDICAL POLICY No. 91607-R1 MENTAL HEALTH RESIDENTIAL TREATMENT: CHILD AND ADOLESCENT
Summary of Changes MEDICAL POLICY MENTAL HEALTH RESIDENTIAL TREATMENT: CHILD ADOLESCENT Effective Date: June 4, 2015 Review Dates: 5/14, 5/15 Date Of Origin: May 14, 2014 Status: Current Clarifications:
More informationJ. PATRICK HACKNEY ALABAMA DISABILITIES ADVOCACY PROGRAM
J. PATRICK HACKNEY ALABAMA DISABILITIES ADVOCACY PROGRAM WHAT IS MEDICAID? Medicaid is a joint state/federal program that provides medical assistance for certain individuals and families with low income
More informationADDENDUM to. Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid
ADDENDUM to Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid Proposal to the Center for Medicare and Medicaid Innovation State Demonstration to Integrate Care
More informationManaged Care Technical Assistance Center Kick-Off Forum FAQs Updated 1.23.2015
1. Billing When will providers receive billing codes? A draft manual will be sent out shortly. All Plans and providers will use the same coding construct, which will crosswalk procedure code and modifier
More informationEmployment Specialist Job Description
Employment Specialist Job Description Overall Function: Helps clients find and keep competitive employment that is consistent with their vocational goals. Responsibilities: Engages clients and establishes
More informationPsychiatric Rehabilitation Services
DEFINITION Psychiatric or Psychosocial Rehabilitation Services provide skill building, peer support, and other supports and services to help adults with serious and persistent mental illness reduce symptoms,
More informationMEDICAID SERVICES MANUAL TRANSMITTAL LETTER CUSTODIANS OF MEDICAID SERVICES MANUAL TAMMY MOFFITT, CHIEF OF PROGRAM INTEGRITY
MEDICAID SERVICES MANUAL TRANSMITTAL LETTER October 19, 2015 TO: FROM: SUBJECT: CUSTODIANS OF MEDICAID SERVICES MANUAL TAMMY MOFFITT, CHIEF OF PROGRAM INTEGRITY MEDICAID SERVICES MANUAL CHANGES CHAPTER
More informationLevel One Waiver Handbook
Level One Waiver Handbook A Guide To: What s are Covered, and for How Much? Who is Eligible? Revised February 2014 The Mission of the Ohio Department of Developmental Disabilities is continuous improvement
More informationMEDICAL POLICY No. 91608-R1 MENTAL HEALTH RESIDENTIAL TREATMENT: ADULT
MENTAL HEALTH RESIDENTIAL TREATMENT: ADULT Effective Date: June 4, 2015 Review Dates: 5/14, 5/15 Date Of Origin: May 12, 2014 Status: Current Summary of Changes Clarifications: Pg 4, Description, updated
More informationHome Care s Perspective
Home Care s Perspective About IAHHC Medicaid Managed Long Term Care (MMLTC) Goals and Outcomes Existing Barriers Current Problems What Works Today Excluded Populations Carved-Out Services Outcome Measurements
More information4.401 Substance Use Partial Hospitalization Program (Adults and Adolescents)
4.40 STRUCTURED DAY TREATMENT SERVICES 4.401 Substance Use Partial Hospitalization Program (Adults and Adolescents) Description of Services: Substance use partial hospitalization is a nonresidential treatment
More informationFY 2012 PROGRAM MANUAL
ILLINOIS DEPARTMENT OF HUMAN SERVICES DIVISION OF DEVELOPMENTAL DISABILITIES FY 2012 PROGRAM MANUAL Additional information regarding the developmental disabilities service system may be accessed via the
More informationPartial Hospitalization - MH - Adult (Managed Medicaid only Service)
Partial Hospitalization - MH - Adult (Managed Medicaid only Service) Definition Partial hospitalization is a nonresidential treatment program that is hospital-based. The program provides diagnostic and
More informationDiagnostic, Screening, Treatment, Preventive and Rehabilitative Services
Page 7c.1 4.b(8) Diagnostic, Screening, Treatment, Preventive and Rehabilitative Services Services provided under this section are provided by licensed practitioners (within their scope of practice as
More informationOverview of CARES Training
Chapter Three CARES Page III.1. Overview of CARES Training Training Goal: The overall goal for this training is to increase a participant s knowledge of the CARES Program so: 1) they will be able to determine
More informationAssertive Community Treatment/Case Management Services/ Health Home Care Management 2012-13 NYC 2013 Upstate/Downstate
Assertive Community Treatment/Case Services/ Health Home Care 2012-13 NYC 2013 Upstate/Downstate Please be advised that, due to delays with the conversion of Adult Targeted Case (TCM) to Health Home Care
More informationATTACHMENT D BLENDED CASE MANAGEMENT GUIDELINES
ATTACHMENT D BLENDED CASE MANAGEMENT GUIDELINES These guidelines establish the standards for the provision of mental health Blended Case Management (BCM) under provisions of the approved Medicaid State
More informationPsychiatric Day Rehabilitation MH - Adult
Psychiatric Day Rehabilitation MH - Adult Definition Day Rehabilitation services are designed to provide individualized treatment and recovery, inclusive of psychiatric rehabilitation and support for clients
More informationHIPAA NOTICE OF PRIVACY PRACTICES
HIPAA NOTICE OF PRIVACY PRACTICES Human Resources Department 16000 N. Civic Center Plaza Surprise, AZ 85374 Ph: 623-222-3532 // Fax: 623-222-3501 TTY: 623-222-1002 Purpose of This Notice This Notice describes
More informationWHEREAS, children caught in the middle of high parental conflict are more likely to be harmed; and
THE ELEVENTH JUDICIAL CIRCUIT MIAMI-DADE COUNTY, FLORIDA CASE NO. 06-1 (Court Administration) ADMINISTRATIVE ORDER NO. 06-03 IN RE: PARENTING COORDINATION IN FAMILY LAW CASES WHEREAS, children caught in
More informationEarly and Periodic Screening, Diagnosis, and Treatment (EPSDT) Current Approved State Plan Language
Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Current Approved State Plan Language Limitations on Attachment 3.1-A Page 9 Type of Service Covered for Medi-Cal eligibles under 21 years
More informationMedicaid Billing Case Management Individual & Group Rehabilitation Family Support Provider Behavioral Health Aide
Medicaid Billing Case Management Individual & Group Rehabilitation Family Support Provider Behavioral Health Aide Behavioral Health Aide (19) This service is limited to children with serious emotional
More informationUnderstanding Changes to Medicaid Behavioral Health Care in New York
Understanding Changes to Medicaid Behavioral Health Care in New York Community Based Provider Education September 2015 Presentation Overview What are the Goals for the Medicaid Changes? What is Changing?
More informationRepairing or replacing devices Assistive Technology. Ongoing maintenance fees Designing, fitting, customizing devices
Evaluation of AT needs Repairing or replacing devices Assistive Technology Purchasing, leasing, acquisition of AT Ongoing maintenance fees Designing, fitting, customizing devices Training or technical
More informationOffice of Health Transformation Enhance Community Developmental Disabilities Services
Office of Health Transformation Enhance Community Developmental Disabilities Services Governor Kasich s Budget: Provides more choices for Ohioans with developmental disabilities. Invests $316 million over
More informationBehavioral Health Services. Provider Manual
Behavioral Health Provider Manual Provider Behavioral Health 1 May 1, 2014 TABLE OF CONTENTS Chapter I. General Program Policies Chapter II. Member Eligibility Chapter IV. Billing Iowa Medicaid Appendix
More informationThe Louisiana Behavioral Health Partnership
The Louisiana Behavioral Health Partnership Transforming the lives of our youth Supporting adults in need Keeping families together Kathy Kliebert Deputy Secretary What is the Louisiana Behavioral Health
More information2. Ensures compliance with all state, federal, and CHAP social service regulatory requirements.
Job Title/Position: Reports To: Social Services Supervisor Clinical Director JOB DESCRIPTION SUMMARY: The Social Services Supervisor is responsible for managing all aspects of the provision of hospice
More informationHow To Care For A Member Of A Psychiatric Rehab Facility
2015 Level of Care Guidelines SH & ESH Supported Housing and Enhanced Supported Housing Psychiatric Rehabilitation services are defined by the Bureau of TennCare per the Contractor Risk Agreement (CRA).
More information