We greatly appreciate your participation in our program and the care you offer our members. Healthier washington medicaid transformation section 1115. Summary the arizona health care cost containment system ahcccs is requesting an amendment to the 1115 research and demonstration waiver to seek expenditure authority to claim as medical. State identified request form for in lieu of services in. In the final rule 81 fr 27555 27556, we discussed our rationale for ensuring that the use of imd settings inlieu of covered settings for covered care is sufficiently limited so as to not contravene subparagraph b of section 1905a29 of the act. Description of service, including which state plan service this may be offered as a substitute for short term intensive stay in a private imd licensed by omh. Under the demonstration, mcos continue to be responsible for authorization and reimbursement of imd stays for their enrollees that are within the scope of in lieu of services. This effectively restricts arizonas in lieu of authority so that stays in imds in lieu of more. At least two competitive bids cost estimates from qualified providersbuilding. Arizona ahcccs complete care unitedhealthcare community. In addition, imd services must be medically appropriate and costeffective and enrollees cannot be required to accept imd services in lieu. Mental disease imd, and inpatient behavioral health residential treatment facilities. Arizona section 1115 waiver amendment request institution for mental disease imd i.
Arizona section 1115 waiver amendment request medicaid. Imd waiver amendment request draft edit, fill, sign. Arizona health care cost containment system arizona longterm. Prior to this rule change, washington state was able to utilize ffp for services in imd facilities in lieu of providing those services in non imd settings. Ahcccs employees who have been issued a two factor token, click here to log on. Institutions for mental disease imd overview azahcccs. Printable and fillable imd waiver amendment request draft. Please refer to the ahcccs website at for further information regarding.
These in lieu of services must be no more costly than. Descriptionpolicy ahcccs covers medically necessary inpatient hospital services provided by a licensed participating hospital for all eligible members, as specified in a. The timeframe is from the effective date of eligibility to. The division of developmental disabilities medical az des az. New york state medicaid managed care alternative services and settings in lieu of services ils new york state, pursuant to federal regulation 42 cfr 438. In lieu of authority cms allows states that contract with managed care entities to allow the mcos to provide services a different way than is specified under federal law these in lieu of services must be no more costly than the services they take the place of arizona allowed mcos to provide access to imd. Please do not put us on hold during todays meeting. Ppc prior period coverage is the period of time prior to the members enrollment, during which a member is eligible for covered services. An explanation of the rule, including the agencys reasons for initiating the rule. A person who is in an imd at the time of application, unless provided under ar ticle 12 of this chapter. Conveyance by authorities to municipalities or school districts of established projects.
Acute and subacute services provided in an institute for. Exemption from taxation and payments in lieu of taxes. Changes that could not be implemented by existing information systems or service. Document is also available in portable document format pdf state identified inlieu of services ils request form procedure for institutions of mental disease imd webinar with mmcos august 2019 purpose. Medicaid funds to finance imd services, they relied on other options, such as stateonly funding, or providing services in smaller non imd facilities. Document is also available in portable document format pdf costeffective alternative services in lieu of effective july 6, 2016, federal regulations allowed and clarified the use of costeffective alternative services that are approved by the state to be offered by medicaid managed care organizations mmcos. The provision of inpatient psychiatric or substance use disorder treatment in an imd must meet the requirements for in lieu of services or settings at 42 cfr 438. Benefit changes must be able to be easily operationalized by ahcccs and contractors.
Institutions for mental disease exclusion federal law prohibits federal funding for services that members aged 2164 receive in institutions for mental disease since the inception of the medicaid program 1965 legislative intent was for states to be responsible for the institutional care of people with mental illnesses. In the event the ahcccs beneficiary does not want to act as the legal employer and assume all employerbased responsibilities of the employer of the. New york state medicaid managed care alternative services. If you have questions about the information or material in this manual, or about our policies, please call provider services. Nprm clarifies that mc plans have had flexibility under risk contracts to provide alternative services or services in alternative settings in lieu of covered services or settings if. Cash deposits, irrevocable letter of credit, certificate of deposit, or any other type of substitute security agreed to by ahcccs. Macpac study and report on mat utilization controls under state. Edit, fill, sign, download imd waiver amendment request draft online on. In lieu of receiving hcbs services under a traditional service.
State of californiahealth and human services agency. Under this regulation, federal payments for imd ser vices are limited to 15 days per month for individuals ages 2164. Nursing facility services in lieu of hospitalization not to exceed. Please mute your phone and computer microphone to avoid feedback. Codifies regulations permitting managed care plans to cover treatment in an imd for a certain number of days in a month in lieu of other types of services. Ahcccs arizona health care cost containment system, which is composed of the administration, contractors, and other arrangements through which health care services are provided to an eligible person, as defined in a.
This can take the form of one or more of the following. The timeframe is from the effective date of eligibility to the day a member is enrolled with a contractor. To learn how to submit an application for state budget initiative imd ils coverage permitted under 2016 final rule, 42 cfr 438. The way that cms proposed it to us was, any stay in an imd thats. Ahca rfi 0011011, page 1 of state of florida agency for health care administration request for information. Every effort should be made to consider what other services would be utilized in lieu of the elimination or limitation of benefits. System ahcccs to utilize imds with no limits the in lieu of option. Arizona allowed mcos to provide access to imd services. An agreedupon practice for regular communication and providertoprovider consultation, and. You are required to login if you wish to access this ahcccs applications. Cms allows state payment for inpatient psychiatric. Ahcccs contractor operations manual chapter 400 operations 436 page 6 of 17 6 definition revised to align with a. Wyork department office of office of alcoholism and.
Imd facility shall develop a discharge plan and communicate this. Waive the current restriction on individual visits only allowed for intake, crisis intervention, collateral services, and treatment and discharge planning. This is a requirement to access any information that is considered either sensitive or covered under hipaa. This is an alternative setting in lieu of the state plan inpatient psychiatric services available in omh licensed inpatient units of article 28 hospitals. Cms allows state payment for inpatient psychiatric, substance use services april 27, 2016 5. The proposed rules will eliminate the requirement for obtaining prior authorization pa for services such as, but not limited to. Diseases imd states and plans may provide alternative services or services in alternative settings such as an approved institution for mental diseases imd in lieu of covered services or settings if they are medically appropriate.
Providers must follow the requirements for inpatient level of care outlined in the division of medical assistance dma clinical coverage policy ccp 8b, inpatient behavioral health services. Arizona section 1115 waiver amendment request institution. Ahcccs medical policy manual section 310 covered services 310k page 2 of 5 i. Institution for mental disease imd waiver amendment request. The division provides adult developmental homes in lieu of adult foster care. Facilitative support from acute plans and rbhas, enhance relationships with behavioral health providers in their community by establishing. Medicaid and chip managed care final rule cms2390f. This authority was included in the states 1915b waiver, and deemed a cost effective alternative to medicaid state plan services. Statewide inpatient psychiatric program for individuals under the age of eighteen.
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