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 (requires medical and multidisciplinary habilitation or rehabilitation including physical, mental or emotional limitations as a result of birth defects, illness, or injury).
Service coordination eligibility is determined initially and annually 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 initial and ongoing plan development and services.
To allow processing within the Medicaid system and prior authorization for Service Coordination Services please legibly complete the Plan Development Request form and fax it to (877) 314-8779. Supporting documentation is required for service coordination so please review the current Plan Developement Request form which identifies the necessary information for review.
For more information or questions, please contact (208) 364-1954.
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. Children with SED who were already receiving service coordination service will automatically have their prior authorizations extended until October 30, 2013.