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ELIGIBILITY DETERMINATION
Initial Service Authorization
The
elapsed time from receipt of completed
application to
service authorization, if approved,
should not exceed 10
working days (two days
for
hospitalization). Services necessary
to address
immediate needs for
stabilization and support will
be initiated as soon
as possible. The elapsed time
from service
authorization to service initiation will
not exceed ten
working days, unless further delay
is required for
evaluation and approved by the
consumer. Likewise, reauthorizations will be
processed within ten
working days of request except
for hospitalization, which will be processed in two
working
days. Applications for Material
Support
Services will be processed in 30 days.
If the consumer is to be placed on one or
more
waiting lists for
services, s/he will be notified
about the expected
time on the waiting list, and
will be contacted on
a monthly basis to check on
current status, and to be advised of any
adjustment
to
the expected time on the list(s).
Description
Of The Service Re-Authorization Utilization Management
Process:
Each ICP for an individual receiving services
under the Lee County
management plan will
specify the time
frames for utilization review
and re-authorization
of the ICP or individual
services within the
plan. In no case will the time
frame for reviewing
certain services extend
beyond
the following thresholds:
Inpatient Hospital
... 1
week
ICF/MR
1 year
RCF, RCF/MR, RCF/PMI
6 months
Supported Employment
.. 6 months
HCBS
Waiver
.... 6 months
Sheltered Workshop /
Work Activity
. 6 months
Case
Management
.. 1 year
Day Treatment
(County Funded)
. 30 days
Supported
Housing
.. 1 year
Supported Community
Living
.. 6 months
Material Support
Services
... 2 months
The CPC
Administrator is responsible for all
utilization review and service re-authorization.
For individuals with an assigned case manager,
the case manager may perform the utilization
review and service re-authorization function for
level one and three services, and may assist the
CPC Administrator with other level services.
Pre-screenings for voluntary admission to the
Mental Health Institutes will be conducted by the
offices of S. Kantamneni, M..D. or Counseling
Associates.
MATRIX OF SERVICE ELIGIBILITY AND
UTILIZATION MANAGEMENT CRITERIA FOR SERVICES PAID BY LEE COUNTY:
SERVICE
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THRESHOLD
|
FINANCIAL
|
SPECIAL
|
UTILIZATION
|
|
TYPE
|
ELIGIBILITY
|
ELIGIBILITY
|
CRITERIA
|
REVIEW
|
|
|
STANDARD
|
STANDARD
|
|
PROCESS
|
ICF/MR
|
Mental
|
|
Medicaid
|
Annual
|
|
|
Retardation
|
Medicaid
|
ICF/MR
|
Case
|
|
|
Or
|
Eligible
|
As
|
Management
|
|
|
Developmental
|
|
Applied
|
|
|
|
Disability
|
|
By The
|
ITP
|
|
|
|
|
Iowa
|
Review
|
|
|
|
|
Foundation
|
With
|
|
|
|
|
Approval
|
CPC
|
|
|
|
|
By CPC
|
Approval
|
|
Outpatient
|
Mental
|
Indigent
|
DSM IV
|
|
|
Clinic
|
Illness
|
Or
|
Diagnosis
|
|
|
Services
|
Or
|
Uninsured
|
And Can
|
Internal
|
|
|
Chronic
|
With
|
Benefit
|
Review
|
|
|
Mental
|
Sliding
|
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|
|
Illness
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Fee:
|
From
|
|
|
|
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Not
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Outpatient
|
|
|
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Medicaid
|
Services
|
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|
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MHAP
|
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RCF
|
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Unable
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SERVICES & INFORMATION