Benefit Plan Streamlining. Spencer Clark, Patsy Coleman, Starleen Scott Robbins, DeDe Severino, Thelma Hayter. 6/17/14 & 6/19/14. DMHDDSAS. Benefit Plan Streamlining. Purpose:
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Spencer Clark, Patsy Coleman,
Starleen Scott Robbins,
DeDe Severino, Thelma Hayter
6/17/14 & 6/19/14
To reduce LME-MCO administrative resources necessary to appropriately pull down DMHDDSAS Federal and State Single Stream funding.
The LME-MCO authorization and claims adjudication process must ensure that consumers who receive State/Federal funded services meet the eligibility criteria of the Service Definition or the Benefit Plan, whichever is strictest. The LME-MCO must maintain documentation to support this determination, and make it available to the Division or its agents upon request.
With procedures in place to support the new policy:
must continue to be determined individually, as they require review of several individual and clinical characteristics beyond the primary diagnosis and age group.
GAP = Generic Assessment Payment
Add to the list of Level of Functioning or Risk Factors:
i. Any individual with chronic mental illness who is currently stable but without continued treatment and supports would likely experience significant decompensation and deterioration of functioning.