Will Medicaid Managed Care Plans (MMCP) need to approve Treatment Plans for Children and Family Treatment and Support Services?
MMCPs do need to approve scope, frequency and duration, but the goal is not to have plans ‘over manage’. MMCPs are approving services based on their review of the documentation submitted by the provider to substantiate medical necessity. This may include the treatment plan.
Will Waiver HCBS Providers who bill Managed Care for cross-walked CFTSS be required to submit Plans of Care to MMCP's?
Plans of Care for Waiver children will need to be submitted to MMCPs beginning 30 days before HCBS become part of the managed care benefit package, currently targeted for July 1, 2019. Plans of Care include a list of all services the child is receiving, including CFTSS.
Plans of Care are separate than the required Treatment Plans for CFTSS. Treatment Plans for CFTSS are not required to be submitted to MMCPs, however, the information necessary to demonstrate medical necessity criteria may need to be submitted to the MMCP for concurrent authorization.
Please refer to MMCP specific authorization requirements at: