Prior authorizations for the following Developmental Disabilities waiver services: adult nursing, therapies, and behavioral support consultation. Prior Per Authorization Prior authorizations for services or programs that are Review Reviews exempt from managed care, including physical health and Alternative Benefit Plan and Alternative Benefit Plan Medically Fragile exemption. Prior authorizations for initial, concurrent and retro Annual Behavioral reviews Per Health reviews Recipient Per Prior authorizations for inpatient psychiatric care Review Level of Care – Initial and annual level of care determinations plus the Annual in-home assessment for Mi Via adults and children Per requiring ICF/IID level of care. Recipient Mi Via Initial and annual level of care determinations for adults and children in the Developmental Disabilities and Medically Fragile home and community-based Level of Care – waiver programs. Annual Per Initial and annual level of care for recipients receiving Recipient All others long-term care services in an ICF/IID facility. Level of care determinations for recipients in the Program of All-Inclusive Care for the Elderly. Review and approval of Individual Service Plans and Annual ISP/SSP and budgets for DDW and MFW recipients. Per Budgets Review and approval of Service and Support Plans and Recipient budgets for Mi Via participants. OPTION TWO (2) Cost Proposal Form Medicaid Third Party Assessor Name of Offeror:
Prior Authorization Reviews Prior authorizations for the following Developmental Disabilities waiver services: adult nursing, therapies, and behavioral support consultation. Prior authorizations for services or programs that are exempt from managed care, including physical health and Alternative Benefit Plan and Alternative Benefit Plan Medically Fragile exemption. Per Review Behavioral Health reviews Prior authorizations for initial, concurrent and retro reviews Annual Per Recipient Prior authorizations for inpatient psychiatric care Per Review Level of Care – Mi Via Initial and annual level of care determinations plus the in-home assessment for Mi Via adults and children requiring ICF/IID level of care. Annual Per Recipient Level of Care – All others Initial and annual level of care determinations for adults and children in the Developmental Disabilities and Medically Fragile home and community-based waiver programs. Initial and annual level of care for recipients receiving long-term care services in an ICF/IID facility. Level of care determinations for recipients in the Program of All-Inclusive Care for the Elderly. Annual Per Recipient ISP/SSP and Budgets Review and approval of Individual Service Plans and budgets for DDW and MFW recipients. Review and approval of Service and Support Plans and budgets for Mi Via participants. Annual Per Recipient OPTION TWO (2) Cost Proposal Form Medicaid Third Party Assessor Name of Offeror:
14-630-8000-0003%20Third%20Party%20Assessor%20-%20Utilization%20Review%20for%20the%20HSD%20RFP.docx