Appendix 4 - Matrix State State State Rule: SPA/ Systems Legislative Proposed Change : Policy Savings Savings Savings Implementation Required; Waiver Changes Approval Tribal Member Provider Public Notice Short-term Strategy Section SFY SFY SFY Date Type Required Needed Required 2013 2014 2015 State State State Rule: SPA/ Systems Legislative Prior Implement concurrent Proposed Change : Policy Savings Savings Savings Implementation Required; Waiver Changes Approval Tribal Member Provider Public Notice Authorization review for psychiatric Section Date Short-term Strategy Section SFY SFY SFY $0.02M $0.05M $0.05M 3/1/13 No No No No No No Yes No Type Required Needed Required 46, PH services for individuals 2013 2014 2015 under 21 in all settings No Elective surgeries PA criteria Section $0.07M $0.3M $0.3M 3/1/13 would No Yes No Yes Yes Yes No 90, PS have to be listed on the portal. No High cost imaging & Radiology PA criteria Excluding Emergent Use Section $0.23M $0.94M $0.94M 3/1/13 would No Yes No Yes Yes Yes No 101, MI have to be listed on the portal No Elective Inductions Section Prior to 39 weeks 90, PS; PA criteria Section $0.08M $0.32M $0.32M 3/1/13 would Yes No Yes Yes Yes No 14, have to be APRN listed on the portal
Appendix 4 - Matrix Proposed Change : Short-term Strategy Policy Section State Savings SFY 2013 State Savings SFY 2014 State Savings SFY 2015 Implementation Date Rule: Required; Type SPA/ Waiver Required Systems Changes Needed Legislative Approval Required Tribal Member Provider Public Notice Prior Authorization Implement concurrent review for psychiatric services for individuals under 21 in all settings Section 46, PH $0.02M $0.05M $0.05M 3/1/13 No No No No No No Yes No Elective surgeries Section 90, PS $0.07M $0.3M $0.3M 3/1/13 No PA criteria would have to be listed on the portal. No Yes No Yes Yes Yes No High cost imaging & Radiology Excluding Emergent Use Section 101, MI $0.23M $0.94M $0.94M 3/1/13 No PA criteria would have to be listed on the portal No Yes No Yes Yes Yes No Elective Inductions Prior to 39 weeks Section 90, PS; Section 14, APRN $0.08M $0.32M $0.32M 3/1/13 No PA criteria would have to be listed on the portal Yes No Yes Yes Yes No Proposed Change : Short-term Strategy Policy Section State Savings SFY 2013 State Savings SFY 2014 State Savings SFY 2015 Implementation Date Rule: Required; Type SPA/ Waiver Required Systems Changes Needed Legislative Approval Required Tribal Member Provider Public Notice