24.5 After-the-Fact Purchases and Revisions to a Service Authorization

Before contacting the vendor to order, request, or schedule the delivery of goods or the provision of services, it is the requester's responsibility to ensure a service authorization was generated and sent to the service provider.

In accordance with the General Appropriations Act (GAA), a state agency must not obligate funds in an amount greater than the amount listed on the service authorization. If it is determined that a staff member obligated funds without following policy, the comptroller is required to deduct the amount of the over-obligation from the salary or other compensation due to the responsible employee with the deducted amount being applied to payment of the obligation.

24.5.1 After-the-Fact Purchases

When a delay of services may endanger a consumer’s well-being, the counselor may authorize hospital or medical services prior to the completion of a service authorization. A CRS program manager must approve an exception before the staff member obligates the budget. Approval must be documented in a case note before the service authorization is generated in RHW.

Management exceptions to after the fact purchases are not permitted.

24.5.2 Backdated Ancillary Service Authorization

A backdated ancillary service authorization is issued after the service has been provided and additional services are needed to directly support the existing service authorization.

When this happens, you can:

  • document the change to the service authorization in the "Comments" section of the original SA, provided a change in services is not significant; or
  • replace the existing SA with a new one (for example, when the specification or the provider changed).

Backdated ancillary service authorizations do not require management approval, but must be justified in a case note before generating the SA in ReHabWorks.

The case note must include the SA number of the original related SA.

The comments section of the backdated ancillary service authorization must include the SA number of the original SA.

For more information about revising a SA, see ReHabWorks Users Guide, Chapter 17 Case Purchase Order, 17.10 PO Change.

24.5.3 Backdated Replacement Service Authorization

The specifications in a service authorization (SA) may change after the delivery of services. If services are delivered by the same vendor and there is a revision to services, such as a change in Maximum Affordable Payment Schedule codes, and manager or medical director approval was required on the initial SA, manager or medical director approval is required on the backdated replacement service authorization.

Approval by the manager or medical director must be documented in the paper case file before the replacement service authorization is issued. If no approvals were required for the original service authorization or the new service authorization, then no additional approvals are required.

Staff must document the need for the backdated replacement service authorization in a case note before generating the replacement SA. The comments section of the backdated replacement service authorization must reference the original SA number.

24.5.4 No Show Payments

A "no-show" occurs when a CRS consumer:

  • misses an appointment for a CRS sponsored service being provided by a psychiatrist, social worker, licensed professional counselor, or psychologist; and
  • does not properly cancel the appointment.

The CRS program accepts for consideration only the no-show billings received from a psychiatrist, social worker, licensed professional counselor, or psychologist. No-show occurrences for other disciplines, specialties, and contractors are not subject to or eligible for no-show payments from the CRS program as described in the above policy. The CRP must notify the counselor within one working day of the consumer’s failure to appear. For more information, see CRS Standards for Providers Manual.

Process the No-Show Payment

If a no-show occurs and if the provider chooses to bill the CRS program for the no-show, the acceptable fee is limited to 50 percent of the payment allowed by the Maximum Affordable Payment Schedule for the codes authorized on the service authorization.

No-show payments are processed in the same manner as any other provider payment. For more information see ReHabWorks Users Guide, Chapter 16 Case Service Record.