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July 21, 2006
 
MEDICAID INFORMATION RELEASE MA06-27
 
TO:  Service Coordination Agencies for Adults with Mental Illness
 
FROM:   Leslie M. Clement, Administrator
 
SUBJECT:   TRANSITION OF PARTICIPANTS FROM MEDICAID BASIC PLAN TO MEDICAID ENHANCED PLAN FOR SERVICE COORDINATION
 
The purpose of this Information Release is:
-- to describe how participants covered under the Idaho Medicaid Basic Plan become eligible for Service Coordination for Individuals With Severe and Persistent Mental Illness and
-- to describe how providers fulfill their role in helping to ensure that the service coordination services are reimbursable.
 
No Change to Medical Necessity Criteria for Receiving Service Coordination
In order to receive service coordination, a participant covered by the Medicaid Basic Plan must first obtain the required assessment to establish eligibility for service coordination services. Although the assessment of the need for service coordination is covered under the Basic Plan, service coordination is only reimbursable under the Medicaid Enhanced Plan (see Information Release # MA 2006-15). The eligibility criteria for service coordination is presently described at IDAPA 16.03.17.300. New rules publishing August 2, 2006 will describe the same criteria at IDAPA 16.03.10.722-726.
 
New Process and Form Effective July 1, 2006
When the Service Coordinator has determined that an adult participant is eligible for service coordination, the provider must complete IDHW form H0002 and submit it via fax or electronically to the Family Medicaid Unit. The provider should maintain the original H0002 and the assessment in the participant’s medical record. Upon receipt of form H0002, the Family Medicaid Unit will enroll the participant in the Medicaid Enhanced Plan so that the provider’s claims for enhanced services may be reimbursed. The provider must keep the original signed copy of form H0002 in the participant’s medical record.
 
If you have any questions concerning the information contained in this release, please contact Pat Guidry at (208) 364-1813
 
Thank you for your continued participation in the Idaho Medicaid Program.
 
LMC/pg/sw
Directions: Please fill in all blanks, print and sign the form, submit to Family Medicaid by fax at 208-528-5980.  Maintain original in participant’s records. You may choose to submit the form electronically to:  familymedicaid@idhw.state.id.us
 
IDENTIFYING INFORMATION
 
Name of Participant:_______________________ Medicaid ID#:__________________
 
Name of Provider Certifying Medicaid Enhanced Plan: _________________________
 
______________________________________________________________________
Name of Agency and Agency provider#:
 
RATIONALE FOR ENHANCED PLAN SERVICES
 
(Provider: please check the appropriate box as indication of the justification for this participant needing Medicaid Enhanced Plan)
 
Participant needs the following services:
 
o Additional Psychotherapy    o Service Coordination
o Partial Care                          o Developmental Disabilities
o Psychosocial Rehabilitation o Inpatient Psychiatric Hospitalization
 
CERTIFICATION
 
I have assessed ______________________on _____________and certify that this
 
 
(Name of participant)                                                                                 (date)
participant meets the requirements in IDAPA 16.03.10 for receiving the above indicated services in the Medicaid Enhanced Plan.