Provider Advisory Group Recommendations through July 6, 2005
Recommendations for language changes and additions have been integrated into the guideline documents and are highlighted in bold print.
Additional Recommendations:
1. Additional guidelines need to be developed for substance abuse, dual disorders and for adults.
2. The ASO should review and manage all inpatient facilities, including Riverview Hospital, under the same acute inpatient clinical care guidelines.
3. Care determinations regarding the number of service days authorized for intensive service levels should be based on the individual needs of clients and not on arbitrary pre-determined numbers dictated within the care guidelines.
4. DCF should clarify the program model and practice standards for Extended Day Treatment.
5. Extended time billing codes should be included for some outpatient level care service types such a group therapy (e.g., providers should be able to bill higher rates for groups that run longer than one hour).
6. In cases of denial of services, it should be the responsibility of the ASO to offer a clinical rationale for the denial and an alternative recommendation for treatment.
7. The ASO should allow for multiple levels of care to be authorized concurrently to allow for treatment continuity and flexibility in service planning. There should be a minimal administrative burden on the provider to obtain and maintain these authorizations.
8. Extended Day Treatment: Can therapeutic recreation be billed under Medicaid? If not, it is recommended references to therapeutic recreation be removed from the definition/description of this service type.
9. Care managers will insure a viable discharge plan is in place for all intensive service level of care discharges.
10. Family members assist the ASO in providing training to providers to assist providers in understanding the family’s perspective in discharge planning.
11. PRTF level of care needs to be reviewed to determine if 24 hour nursing should be made available in these programs.