Is a behavioral health diagnosis required for concurrent review of OLP, PSR and CPST?
OLP and CPST do not require a diagnosis to begin the service, however it is likely that a diagnosis and/or documentation of medical necessity would be determined before the point at which concurrent review is needed. PSR, on the other hand, does require a diagnosis for receipt of the service.
Since medication management is not a service under OLP, CPST or PSR, is the 30 visit count inclusive of the child’s clinic visits or doctor visits?
Doctor and clinic visits do not count towards the 30 visits that are authorized as part of concurrent review for OLP, CPST, or PSR.
For children currently enrolled in transitioning Waiver services, is there a different authorization period? Is it still the case, that children will be authorized for 6 months after go live for any service they are currently receiving?
The 6 month provision is for the MMCP authorizing existing Plans of Care for children in HCBS and begins when HCBS become part of the managed care benefit package, currently targeted for Oct 1, 2019.
Will there be a standard form for the child's Treatment plan? For the assessments to determine medical necessity for each service?
No specific assessment tool needs to be completed for a child to access CFTSS; all that is needed is for the child to meet medical necessity criteria for the service.
Care Managers can refer directly to a CFTSS provider who is designated for OLP, for the non-physician licensed behavioral health practitioner to determine medical necessity for any CFTSS.
In addition, any licensed practitioner treating the child (such as their doctor) can make a recommendation to CFTSS by completing a written recommendation to document medical necessity based on clinical judgement.
Please clarify how long transitioning waiver children are authorized for CFTSS. Are they authorized to receive the cross-walked services for one year from initial CANS?
CFTSS are Medicaid State Plan services. Any child on Medicaid can receive these services as long as they continue to meet medical necessity. Waiver eligibility is not required for access to CFTSS.
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: