Service coordination for children with special health care needs is available for children eligible for Medicaid Enhanced Benefits who meet certain criteria. If the child has limited access to gain services or can’t coordinate or maintain services on their own or through other means, they might be eligible for service coordination services. The service coordinator identifies the need for assistance in gaining and coordinating access to care and services appropriate to the needs of the individual.
The Developmental Disabilities program was responsible for reviewing these applications prior to July 1, 2013, but now those applications are being reviewed by the Medical Care Unit (MCU) in the Division of Medicaid.
Service Coordinator functions are:
- Plan Development Assessment – A person centered planning process that identifies the person's need for assistance in gaining and coordinating access to care and services.
- Plan Development – The process of developing a plan that links a participant to needed medical, psychiatric, social, early intervention, education, and other services. The plan does not govern or manage community developmental disabilities services or any other services.
- Referrals – Links the participant to needed medical, psychiatric, social, early intervention, education, and other services.
- Monitoring – Monitors the plan to assure participant has been linked to needed services identified on the plan. The Service Coordinator will adjust the plan as necessary.
- Crisis Assistance: Provides crisis assistance and may seek involvement of Department’s crisis prevention team.
To be eligible for service coordination, children must have special health care needs requiring medical and multidisciplinary habilitation or rehabilitation services to prevent or minimize a disability
Service coordination eligibility is determined by the MCU staff based on information provided by the service coordination agency or the family. All information necessary to make the eligibility determination must be received by the MCU 20 business days prior to the anticipated start date of any service coordination services. The eligibility determination must be made by MCU staff prior to the initiation of services.
As of 2/1/2014 Idaho Medicaid is adjusting prior authorization requirements for service coordination for children with special healthcare needs. The changes can also be found in the “Agency Professional’ provider handbook available at https://www.idmedicaid.com/Provider%20Guide/Provider%20Handbook.aspx.
The changes to Service Coordination are:
- Prior authorization will no longer be required for plan development (G9012).
- Prior authorization will be required for ongoing service hours (G9002) for new plans.
- Prior authorization will be required for ongoing service hours (G9002) for updated (renewing) plans.
Existing service coordination plans do not require authorization for ongoing services. The scheduling for renewing authorizations remains the same.
You may continue to deliver services on existing plans. When the plan comes up for renewal, you will need to re-assess your client’s needs and update the plan as you have in the past. Once the plan has been updated, you will need to send it in to the Medical Care Unit and request authorization for continued service coordination hours.
You will find new Children Service Coordination Forms on the DHW website. The Children Service Coordination Request Form is no longer required.
To allow processing within the Medicaid system and authorizations for Service Coordination Services please legibly complete and fax the Assessment Form, Plan Form, Healthy Connection Referral Form, Agency Choice and Consent Form and supporting medical documentation to (877) 314-8779. The Plan Development Request Form is no longer required. For more information or questions, please contact (208) 364-1904.
Service coordination is also available through the Idaho Infant Toddler Program. Service coordination through the Infant Toddler Program is available to all qualifying children from birth through 36 months of age.
Please see the Children’s Developmental Disability Services webpage for more information about case management services available to children with developmental delay.
Beginning September 1, 2013, service coordination for children with serious emotional disturbance (SED) will be administered by a managed care contractor, Optum Idaho. Questions regarding eligibility, coverage, and services can be addressed by accessing their website at www.optumidaho.com or calling their member number at (855) 202-0973.