Loading...
HomeMy WebLinkAboutMH-202 Service Authorizations1 FRANKLIN/FULTON COUNTY MENTAL HEALTH/INTELLECTUAL & DEVELOPMENTAL DISABILITIES/EARLY INTERVENTION 425 Franklin Farm Lane Chambersburg, PA 17202 (717) 264-5387 MH/IDD/EI PROCEDURE STATEMENT PROCEDURE SUBJECT: Service Authorizations PROCEDURE NUMBER: MH-202 Effective Date: January 1, 2008 Date Revised: September 9, 2020 INTRODUCTION: Regulations and contracts require that all services purchased on behalf of individuals by MH/IDD/EI be authorized by the Base Service Unit (BSU) and approved by the MH/IDD/EI Administrator (or designee). PROCEDURE: The following authorization procedure will apply to all individuals receiving Mental Health (MH) funded services:  At least yearly, the case manager and the individual (with the individual's parent, legal guardian, or significant other, if applicable) will review the Environmental Matrix Adult Scoring Sheet. The completed Matrix will be included in the individual’s file.  Based on the Matrix, as well as the individual’s interests, strengths and needs, the case manager will fill out a formal referral form for the service and submit the form to the service provider. If the individual is currently receiving services from the provider, a new request does not need to be submitted.  The service provider will submit an authorization request to the BSU or Franklin/Fulton MH/IDD/EI as appropriate for the proposed services. This can be submitted on an individual basis or as a listing of all MH/IDD/EI individuals to which services are being provided.  If the authorization is a renewal of a current authorization, it must be submitted at least two (2) weeks in advance of the expiration of the current authorization. 2  The service providers who are submitting requested authorization lists will review the lists before submitting them to ensure that the individuals on the list are actually receiving services and not eligible for any other funding source for the services.  Determination of liability for an individual must be completed prior to an authorization of MH/IDD/EI funded outpatient mental health services. A redetermination of liability must be completed at least once every twelve (12) months, more frequently if the adjusted family income amount increases or decreases by more than 5% on an annualized basis. A written notice of the liability shall be given to the liable person and the results of the liability determination communicated to the county contracted provider of outpatient services.  Upon intake and yearly thereafter (unless a change of circumstances warrants it earlier), a medical assistance (MA) application must be submitted. The individual will have a grace period of sixty (60) days for the MA eligibility to be determined with the option of an additional thirty (30) days under extenuating circumstances and with the approval of MH/IDD/EI staff.  Upon receipt of the authorization requests, a designated staff will complete the authorization procedure.  It is incumbent upon the BSU to provide prompt notice to all providers from which the individual is receiving services (in particular those which are County funded) that the BSU is intending to close the individual. This will allow sufficient time to discuss the potential ramifications of this action and any revisions to current authorizations which exist in CPR-web and any associated data platforms. This will prevent the potential provision of services past the closure date and the need to reopen and reauthorize the individual for this service provision. [This also pertains to MHIDD-301 Termination and Discharge.]  MA denial letters [dated within one (1) year from date of referral/authorization] are secured by the case manager (CM) and scanned into CPR-web when referrals to services are made. The option exists for the CM to request an exception for not needing to secure an MA denial letter under three (3) circumstances: (1) the person is currently incarcerated and their MA eligibility has been suspended. A six (6) month exception is requested; (2) the person’s income has not changed since the previous liability was completed and it exceeds the eligibility threshold; and, (3) the gathering of supporting documentation necessary to complete the MA eligibility application process places an undue stress on the individual. The CM completes and submits the designated form requesting the exception which must be approved by MH/IDD/EI staff.  If the person is not MA/PerformCare eligible and packets/criteria are met for the services, CM is able to make referrals as appropriate. The program will review and request authorization for the service(s) from CM using their authorization request form/process. CM will then fax or securely email the authorization to MH/IDD/EI to the appropriate Program Specialist. Program Specialist will review the request, liability and MA denial 3 letter and, if approved, enter the authorization in CPR-web or request more information from either the CM or program.  A procedure has been established and the respective form created in the event that the CM wants to request county funding for Blended Case Management (BCM) services for an individual who does not have a Serious Mental Illness (SMI) diagnosis (also referred to as Priority Populations exception) but would benefit from a level of case management higher than Administrative Case Management (ACM). This requires approval by the MH/IDD/EI Administrator.