Revision 14-2; Effective September 1, 2014

 

 

11100 Medically Dependent Children Program (MDCP)

Revision 13-1; Effective February 1, 2013

 

The Service Authorization System (SAS) online application is used to create the authorizations for all Long-term Services and Supports (LTSS). The Claims Management System cannot pay a provider if a valid Service Authorization record does not exist in SAS.

 

11200 Create an Initial Service Authorization for MDCP

Revision 13-1; Effective February 1, 2013

 

These areas must be completed to create an Initial Service Authorization for MDCP:

  • Client Details
  • Address
  • Location
  • Other Information
  • Phone
  • Authorizing Agent
  • Enrollment
  • Service Plan
  • Level of Service
  • Diagnosis
  • Medical Necessity
  • Service Authorization

 

11205 Client – Initial Service Authorization

Revision 13-1; Effective February 1, 2013

 

The Client Details record is system generated with information from the Texas Integrated Eligibility Redesign System (TIERS) database or from information entered in the Create New Client record.

The Client Details record is read-only and is updated with new TIERS identifying information on a monthly basis, a few days after cutoff.

 

11210 Address Area – Initial Service Authorization

Revision 13-1; Effective February 1, 2013

 

The address area contains the individual’s addresses. Create separate address records to record an individual’s home or mailing address (if different than home address), a responsible party’s address, and/or an executor’s address.

Changes: When an address changes, add a new Address record. The system will read the latest record as the current address.

To Register a Home or Mailing Address:

Note: If the address Type selected is 1, 2, 3 or Executor, the screen will display an Address4 field in place of the Tel.No. If the address Type selected is 4 or 5, the screen will display Tel.No.

  1. Select the Address area in the Client Functional area.
  2. Select Add and a blank Address Details record will appear.
  3. Select the Type Code from the drop-down menu in the Type field. The system defaults to 05 - MAILING/HOME.
  4. Type the Effective Date of the address in the Begin Date field, which is the first day of the Initial Individual Plan of Care (IPC). Changes: When an address changes, type the Effective Date of the new address in the Begin Date field.
  5. Type the address in the Address field. If using the primary caregiver or executor, use “C/O” for “in care of.”
  6. Type the phone number of the primary caregiver, if it is different from the individual’s, or the executor in the Phone field. Do not type the individual’s phone number here.
  7. Type the city in the City field.
  8. Select the state from the drop-down menu in the State field. The system defaults to TX-TEXAS.
  9. Type the ZIP code in the Zipcode field.
  10. Select the Save button

To Register a Responsible Party's (RP's) Address:

  1. Select the Address area in the Client Functional area.
  2. Select Add and a blank Address Details record will appear.
  3. Select the Type Code 04 – RESPONSIBLE PARTY from the drop-down menu in the Type field. The system defaults to 05 - MAILING/HOME.
  4. Type the Effective Date of the address in the Begin Date field, which is the first day of the Initial IPC. When an address changes, type the Effective Date of the new address in the Begin Date field.
  5. Type the following in the Address lines:
    1. Address1 – Enter the RP’s name, First, Middle, Last. Start this line with “C/O” (for “in care of”) before the first name.
    2. Address2 – Enter the first line of the RP’s address (usually a street number or a P.O. Box).
    3. Address3 – Enter the second line of the RP’s address (if needed, such as for an apartment number).

    Note: Do not enter identifiers, such as “parent,” directions to the home or any other miscellaneous text in any of these fields.

  1. Type the phone number of the RP in the Tel.No. field, including the area code. Do not use parentheses. For example, enter 555-123-4567.
  2. Type the city in the City field.
  3. Select the state from the drop-down menu in the State field. The system defaults to TX-TEXAS.
  4. Type the ZIP code in the Zipcode field.
  5. Select the Save button.

By adding the Address record, the Location record will be created automatically.

 

11215 Location – Initial Service Authorization

Revision 13-1; Effective February 1, 2013

 

The Location Summary record is used to register the county and region in which an individual resides.

The Location record is system generated from the information on the Texas Integrated Eligibility Redesign System (TIERS) or from the Create New Client function. If the county code on TIERS is actually the guardian’s county, or if the Medicaid for the Elderly and People with Disabilities (MEPD) specialist or Social Security Administration (SSA) worker has not updated the county code for an individual, the case manager must register the county where the individual resides on the Service Authorization System (SAS) Online.

Warning: To avoid creating duplicate Location Summary records, the case manager should never add a Location Details record before the Initial Individual file is submitted to the Department of Aging and Disability Services (DADS) database.

If the county identified in the Location Summary record is incorrect (because the county in TIERS is actually the guardian’s county, the individual has moved, the MEPD specialist or SSA worker has not updated the county code, or any other reason), the location information must be corrected. TIERS updates SAS every month on the day after TIERS cutoff. Therefore, the most effective way to correct the county is to correct the county in TIERS. Since most of these corrections must be done by the MEPD specialist, SSA worker or Texas Works staff, timely updates to TIERS may not be possible. The case manager can correct the county information in SAS. However, the corrected record must be Forced or TIERS will rewrite the information at the next TIERS/SAS reconciliation.

To Correct Location Information:

  1. Select the Location area in the Client Functional area.
  2. Select the check box for the latest record listed on the screen.
  3. Select the Modify button.
  4. Move to the End Date field and enter the date before the new county will be registered.
  5. Select the Save button.
  6. Select Add and a blank Location Details record will appear.
  7. Select the appropriate county from the drop-down menu in the County field.
  8. Move to the Begin Date field and enter the date the new county is being registered. Leave the End Date field blank.
  9. Select the Save button.

    In order for TIERS to not overwrite this record, move to the Force field and set the Force Flag. Enter comments explaining why the record is being forced.

 

11220 Other Information

Revision 13-1; Effective February 1, 2013

 

The Other Information area contains additional information about the individual.

  1. Select the Other Information area in the Client Functional area.
  2. Select the individual’s marital status from the drop-down menu in the Marital Status field.
  3. Select the language requiring translation from the drop-down menu in the Translation Needs field, if applicable.
  4. Type directions to the individual’s residence in the Directions field.
  5. Select the Update button.

 

11225 Phone – Initial Service Authorization

Revision 13-1; Effective February 1, 2013

 

The Phone area is used to document an individual's phone number or the phone number of a relative or friend.

To Register Phone Information for an Initial Service Authorization:

  1. Select the Phone area in the Client Functional area.
  2. Select Add and a blank Phone Details record will appear.
  3. The Type field defaults to HO - HOME which is OK if registering a phone number for an individual. Select OT - OTHER if registering a phone number for a relative or friend. There can be multiple records with phone listings, depending on the number of contacts documented in a case.
  4. Move to the Begin Date field and type the date the phone number is valid. This can be the same date as the Begin Date for Enrollment.
  5. Move to the Phone No. field and type the appropriate phone number.
  6. Select the Save button.

To Remove a Telephone Record:

  1. Select the Phone area in the Client Functional area.
  2. Select the check box for the Phone record to be removed.
  3. Select the Remove button.
  4. Select Submit to SAS.
  5. Select Outbox and then the Inbox to ensure the case processed accurately.

 

11230 Authorizing Agent – Initial Service Authorization

Revision 13-1; Effective February 1, 2013

 

Only one Authorizing Agent record is required for MDCP, however more than one can be created.

To Register the Authorizing Agent for an MDCP Individual:

  1. Select the Authorizing Agent area in the Case Worker Functional area.
  2. Select Add and a blank Authorizing Agent Details record will appear.
  3. Move to the Type field and select CM - CASE MANAGER from the drop-down menu.
  4. Move to the Group field and select 18 – MEDICALLY DEPENDENT CHILDREN PROGRAM (MDCP) from the drop-down menu.
  5. Move to the Send to TMHP field and select Y - YES.
  6. Move to the Begin Date field and type the earliest date the MDCP individual is authorized to receive services. Leave the End Date field at the default blank.
  7. Move to the Autho. Agent ID field and type the MDCP case manager’s budgeted job number (BJN).
  8. The Agency field is read-only at 324 - DHS.
  9. Move to the Name field and type the name of the MDCP case manager.
  10. Move to the Phone [Ext] field and type the phone number of the MDCP case manager.
  11. Move the Mail Code field and type the Mail Code of the MDCP case manager.
  12. Select the Save button.

When the Case Manager Changes

When the individual is assigned to another case manager, enter an End Date in the existing Authorizing Agent record and create another record with the new information using these same instructions. To avoid gaps or overlaps in the Authorizing Agent records, the End Date of the existing record should be one day before the Begin Date of the new record.

Currently, although SAS will accept multiple Authorizing Agent records, Texas Medicaid & Healthcare Partnership (TMHP) will only accept two Authorizing Agent records when a SAS file is transmitted to TMHP. Therefore, select NO in the SEND TO TMHP field for all updates.

 

11235 Enrollment – Initial Service Authorization

Revision 13-1; Effective February 1, 2013

 

To Register the Initial Enrollment for an MDCP Individual:

  1. Select the Enrollment area in the Program and Service Functional area.
  2. Select Add and a blank Enrollment Details record will appear.
  3. Move to the Service Group field and select 18 – MEDICALLY DEPENDENT CHILDREN PROGRAM (MDCP) from the drop-down menu.
  4. Move to the Enrolled From field and select the appropriate entry from the drop-down menu. This drop-down menu also contains entries for noting the individual is being enrolled while in a CHILDREN’S FOSTER CARE Level 1 or 2 situations.

    Note: Select 12 - MONEY FOLLOWS THE PERSON for individuals who are enrolling in MDCP under MFP provisions. Do not select “Nursing Facility” for these individuals.

  5. Move to the Living Arrangement field, and select the appropriate Community-Based Living Arrangement from the drop-down menu.
  6. Move to the Begin Date field and type the Effective Date of the IPC period.
  7. Enter the day before the 21st birthday in the End Date field.

    Note: If the child leaves the program earlier than the day before the 21st birthday, change the End Date field to the actual day the child is leaving the program.

  8. Leave the Termination code and Waiver Type at the default.
  9. Select the Save button.

 

11240 Service Plan – Initial Service Authorization

Revision 13-1; Effective February 1, 2013

 

The Initial Service Plan record is used to register an Individual Plan of Care (IPC) for an MDCP individual. The Initial Service Plan record includes the total estimated cost of MDCP services taken from the individual's IPC form.

To Register a Service Plan for an Initial MDCP Individual:

  1. Select the Service Plan area in the Program and Service Functional area.
  2. Select Add and a blank Service Plan Details record will appear.
  3. Leave the Type field at the default selection AN - ANNUAL PLAN.
  4. Move to the Service Group field and select 18 – MEDICALLY DEPENDENT CHILDREN PROGRAM (MDCP) from the drop-down menu.
  5. Move to the Ceiling field and type the Annual MDCP IPC Cost Limit for the assigned Resource Utilization Group (RUG) Value from the Medical Necessity/Level of Care (MN/LOC) Assessment.
  6. Move to the Begin Date field and type the Effective Date of the IPC period.
  7. Move to the End Date field and type the last day of the IPC period.
  8. Move to the Amount Authorized field and enter the Total Estimated Cost of All MDCP Services Authorized for the current IPC period.
  9. Leave the Units Authorized field at the default 0.00.
  10. Select the Save button.

 

11245 Level of Service – Initial Service Authorization

Revision 13-1; Effective February 1, 2013

 

All MDCP individuals must have a Resource Utilization Group (RUG) registered on a Level of Service record. Texas Medicaid & Healthcare Partnership (TMHP) will determine the RUG value based on information on the Medical Necessity/Level of Care (MN/LOC) Assessment. RUG values are calculated and assigned electronically by the automated system when DADS nurses submit the MN/LOC Assessment to TMHP.

To Register the Level of Service RUG for an Initial MDCP Individual:

  1. Select the Level of Service area in the Medical Functional area.
  2. Select Add and a blank Level of Service Details record will appear.
  3. Move to the Type field and select CP - MDCP RUG from the drop-down menu.
  4. Move to the Service Group field and select 18 – MEDICALLY DEPENDENT CHILDREN PROGRAM (MDCP) from the drop-down menu.
  5. Leave Contract field blank.
  6. Move to the Level field and type the RUG Value from the MN/LOC Assessment.
  7. Move to the Begin Date field and type the Effective Date of the IPC period.
  8. Move to the End Date field and type the last day of the IPC period.
  9. Select the Save button.

 

11250 Diagnosis – Initial Service Authorization

Revision 13-1; Effective February 1, 2013

 

The Diagnosis Codes listed on the MN/LOC Assessment are registered on SAS Online.

To Register Diagnosis Code(s) for an Initial MDCP Individual:

  1. Select the Diagnosis area in the Medical Functional area.
  2. Select Add and a blank Diagnosis Details record will appear.
  3. Move to the Service Group field and select 18 – MEDICALLY DEPENDENT CHILDREN PROGRAM from the drop-down menu.
  4. Move to the Begin Date field and type the Effective Date of the IPC period.
  5. Move to the End Date field and type the last day of the IPC period.
  6. Move to the Diagnosis fields and enter the numeric code(s) for the individual's diagnosis, without decimals. Up to five diagnosis codes can be entered.
  7. Move to the Version field and leave at the default 09 - ICD-9-CM CODE.
  8. Select the Save button.

 

11255 Medical Necessity – Initial Service Authorization

Revision 13-1; Effective February 1, 2013

 

The MDCP Medical Necessity determination is registered on SAS Online.

To Register Medical Necessity Information for an Initial MDCP Individual:

  1. Select the Medical Necessity area in the Medical Functional area.
  2. Select Add and a blank Medical Necessity Details record will appear.
  3. Leave the Medical Necessity field at the default selection Y - YES.
  4. Leave the Permanent field at the default selection N - NO.
  5. Move to the Begin Date field and type the Effective Date of the IPC period.
  6. Move to the End Date field and type the last day of the IPC period.
  7. Select the Save button.

    Note: If the End Date of the Medical Necessity (MN) record does not match the IPC period, add a record with a Begin Date that is the day after the current MN End Date and an End Date that matches the IPC End Date. This process covers the gap.

 

11260 Service Authorization – Initial Service Authorization

Revision 14-2; Effective September 1, 2014

To Register a Service Authorization for Each Service Code on the IPC for an Initial MDCP Individual:

  1. Select the Service Authorization area in the Program and Service Functional area.
  2. Select Add and a blank Service Authorization Details record will appear.
  3. Leave the MHMR Case No. field blank.
  4. Move to the Service Group field and select 18 – MEDICALLY DEPENDENT CHILDREN PROGRAM (MDCP) from the drop-down menu.
  5. Move to the Service Code field and select the appropriate Service Code from the drop-down menu.
  6. Leave the Fund and Term Code at the default.
  7. The Agency field is read-only at 324-DHS.
  8. Move to the Unit Type field and select 4 - PER AUTHORIZATION from the drop-down menu for all MDCP services, except for the Consumer Directed Services (CDS) Monthly Administrative Fee, select 2-MONTH.
  9. Move to the Units field and type the following entries for the MDCP services authorized in the IPC period.
    If the Service Code is: Enter the following:

    Respite – In-Home (11)
    Respite – Nursing Facility (11F)
    Respite – Camp (11G)
    Respite – Day Care/Licensed Child Care Facility (11H)
    Respite-Licensed Special Care Facility or Host Families (11J)
    Respite-Hospital (11L)
    Respite-HCSS (RN/LVN) (11M)
    Specialized Respite – HCSS (RN/LVN) (11MS)
    Respite-Pas Delegated (11Q)
    FFSS-HCSS (RN/LVN) (11R)
    Specialized FFSS – HCSS (RN/LVN) (11RS)
    FFSS-PAS HCSS (11U)
    FFSS-PAS Delegated (11V)
    Supported Employment (37)
    Employment Assistance (54)

    Total Estimated Annual Hours

    CDS FFSS PAS HCSS (11UV)
    CDS Respite – Specialized RN (11PSV)
    CDS Respite – RN (11PV)
    CDS Respite – LVN (11NSV)
    CDS Respite – LVN (11NV)
    CDS FFSS Support Services Specialized RN (11TSV)
    CDS FFSS Support Services – RN (11TV)
    CDS FFSS Support Services Specialized LVN (11SSV)
    CDS FFSS Support Services – LVN (11SV)
    CDS MDCP Respite-in-Home (11ZV)
    CDS Supported Employment (37)
    CDS Employment Assistance (54)

    Total Annual Cost

    Adaptive Aids/DME (15)
    Minor Home Modifications (16)

    Total Estimated Annual Cost

    TAS (53)

    Total Amount Authorized

    TAS Requisition Fee (53A)

    1

    CDS Monthly Administrative Fee (63V)

    1
  10. Move to the Begin Date field and type the Effective Date of the IPC period.
  11. Move to the End Date field and type the last day of the IPC period.
  12. Move to the Contract No field and type the correct Provider Contract Number for each service.
  13. The NPI field is read-only.
  14. Select the Save button.

Service Code 60, Unlimited Prescriptions

The Service Authorization record for Service Code 60, Unlimited Prescriptions is system-generated. Enter the day before the individual’s 21st birthday in the End Date field.
Repeat Steps 1-14 to create an individual Service Authorization record for each Service Code authorized.

  1. Select Submit to SAS from the toolbar to submit the information when all the required records have been completed.
  2. Select Outbox and then Inbox to ensure the case processed accurately.

 

11265 Consumer Directed Services (CDS) Calculation of the Individual Plan of Care (IPC)

Revision 13-1; Effective February 1, 2013

 

The SAS Unit equals the dollar amount for services delivered in CDS. The case manager determines SAS Units by multiplying the number of hours of CDS services times the number of weeks remaining in the IPC. This total is then multiplied by the rate to get a dollar amount. A separate Service Authorization record is completed for the Monthly Administrative Fee.

 

11270 Service Authorization for CDS Option – Initial Service Authorization

Revision 13-1; Effective February 1, 2013

 

To Register a Service Authorization for the Consumer Directed Services (CDS) Option for an MDCP Individual:

  1. Select the Service Authorization area in the Program and Service Functional area.
  2. Select Add and a blank Service Authorization Details record will appear.
  3. Leave the MHMR No. blank.
  4. Move to the Service Group field and select 18 – MEDICALLY DEPENDENT CHILDREN PROGRAM (MDCP) from the drop-down menu.
  5. Move to the Service Code field and select the appropriate Service Code from the drop-down menu (11UV; 11PSV; 11PV; 11NSV; 11NV; 11TSV; 11TV; 11SSV; 11SV; and 11ZV).
  6. Leave the Fund field and Term Code field at the defaults.
  7. The Agency field is read-only at 324-DHS.
  8. Move to the Unit Type field and select 2 - MONTH from the drop-down menu.
  9. Move to the Units field and enter the dollar Amount.

    Note: For Code 63V, enter the number of months in the Units field.

  10. Move to the Begin Date field and type the Effective Date of the IPC period.
  11. Move to the End Date field and type the last day of the IPC period.
  12. Move to the Contract No. field and type the Provider Contract Number for each service.
  13. The NPI field is read-only.
  14. Select the Save button.

 

11300 Reauthorize MDCP Services for Another IPC Period

Revision 13-1; Effective February 1, 2013

 

Search the Service Authorization System (SAS) database using the SAS Individual Number. Check the Client Details record to ensure you have the correct individual.

 

11310 Address, Location, Phone and Authorizing Agent – Reassessment

Revision 13-1; Effective February 1, 2013

 

Check the Address, Location, Phone and Authorizing Agent-Reassessment records for accuracy and update, as necessary, using the instructions for changes in Create an Initial Authorization.

 

11320 Enrollment – Reassessment

Revision 13-1; Effective February 1, 2013

 

Check the Enrollment record to be sure the End Date is the day before the individual’s 21st birthday. If it is not, change the End Date to the day before the individual’s 21st birthday.

 

11330 Service Plan – Reassessment

Revision 13-1; Effective February 1, 2013

 

To Register a Service Plan for Another IPC Period:

  1. Select the Service Plan area in the Program and Service Function area.
  2. Check the existing record to ensure that an End Date was previously entered.
  3. If not, select the check box for the existing record for the current IPC period.
  4. Select the Modify button.
  5. Enter the End Date for the current IPC period.
  6. Select the Save button.
  7. Select Add and a blank Service Plan Details record will appear.
  8. Leave the Type field at the default selection AN - ANNUAL PLAN.
  9. Move to the Service Group field and select 18 – MEDICALLY DEPENDENT CHILDREN PROGRAM (MDCP) from the drop-down menu.
  10. Move to the Ceiling field and type the Annual MDCP IPC Cost Limit for the RUG Value from the MN/LOC Assessment.
  11. Move to the Begin Date field and type the Effective Date of the new IPC period.
  12. Move to the End Date field and type the last day of the new IPC period.
  13. Move to the Amount Authorized field and enter the Total Estimated Cost of All MDCP Services Authorized for the new IPC period.
  14. Leave the Units Authorized field blank.
  15. Select the Save button.

 

11340 Service Authorization – Reassessment

Revision 13-1; Effective February 1, 2013

 

Create a Service Authorization record for each Service Code for the new IPC period, using the same instructions used for Initial Authorizations. If the same Service Code is approved for the next year, the Begin Date of the Service Authorization record for the new IPC period is the day after the End Date of the current IPC period. This prevents a gap in service.

Service Code 60, Unlimited Prescriptions

The Service Authorization record for Service Code 60, Unlimited Prescriptions, is system generated. Enter the day before the individual’s 21st birthday in the End Date field. At the annual review, check to see that the correct information was entered during the Initial Authorization.

 

11350 Level of Service – Reassessment

Revision 13-1; Effective February 1, 2013

 

To Register a Level of Service RUG Value for Another IPC Period:

  1. Select Level of Service area in the Medical Functional area.
  2. Check the existing record to ensure that an End Date was previously entered.
  3. If not, select the check box for the existing record for the current IPC period.
  4. Select the Modify button.
  5. Enter the End Date for the current IPC period.
  6. Select the Save button.
  7. Select Add and a blank Level of Service Details record will appear.
  8. Move to the Type field and select CP - MDCP RUG from the drop-down menu.
  9. Move to the Service Group field and select 18 – MEDICALLY DEPENDENT CHILDREN PROGRAM (MDCP) from the drop-down menu.
  10. Leave the Contract field blank.
  11. Move to the Level field and type the RUG value from the MN/LOC Assessment.
  12. Move to the Begin Date field and type the Effective Date of the new IPC period.
  13. Move to the End Date field and type the last day of the new IPC period.
  14. Select the Save button.

 

11360 Diagnosis – Reassessment

Revision 13-1; Effective February 1, 2013

 

To Register Diagnosis Code(s) for Another IPC Period:

  1. Select the Diagnosis area in the Medical Functional area.
  2. Check the existing record to ensure that an End Date was previously entered.
  3. If not, select the check box for the existing record for the current IPC period.
  4. Select the Modify button.
  5. Enter the End Date for the current IPC period.
  6. Select the Save button.
  7. Select Add and a blank Diagnosis Details record will appear.
  8. Move to the Service Group field and select 18 – MEDICALLY DEPENDENT CHILDREN PROGRAM (MDCP).
  9. Move to the Begin Date field and type the Effective Date of the new IPC period.
  10. Move to the End Date field and type the last day of the new IPC period.
  11. Move to the Diagnosis fields and enter the numeric code(s) for the individual's diagnosis with no decimals. Up to five diagnosis codes can be entered.
  12. Leave the Version field at the default 09 - ICD-9-CM CODE.
  13. Select the Save button.

 

11370 Medical Necessity – Reassessment

Revision 13-1; Effective February 1, 2013

 

To Register Medical Necessity Information for Another IPC Period:

  1. Select Medical Necessity area in the Medical Functional area.
  2. Check the existing record to ensure that an End Date was previously entered.
  3. If not, select the check box for the existing record for the current IPC period.
  4. Select the Modify button.
  5. Enter the End Date for the current IPC period.
  6. Select the Save button.
  7. Select Add and a blank Medical Necessity Details record will appear.
  8. Leave the Medical Necessity field at the default selection Y - YES.
  9. Leave the Permanent field at the default selection N - NO.
  10. Move to the Begin Date field and type the Effective Date of the new IPC period.
  11. Move to the End Date field and type the last day of the new IPC period.
  12. Select the Save button.

 

11400 Terminations

Revision 13-1; Effective February 1, 2013

 

The Enrollment and all Service Authorization records must be closed when all services for an existing MDCP individual are terminated in SAS Online. When enrollment is terminated, change the End Date to the Effective Date of the termination, Select Save, and manually terminate active Service Authorization records for each MDCP Service Code.

Individual Service Authorization records can be terminated for specific Service Codes on SAS Online also. See Section 11420, Terminating a Specific Service Code.

 

11410 Terminating All Services

Revision 13-1; Effective February 1, 2013

 

To Terminate All Services for an Existing MDCP Individual:

  1. Open the file and the Client Details record will appear.
  2. Move to the Enrollment area in the Program and Service Functional area.
  3. Select the check box for the appropriate record from the list.
  4. Select the Modify button.
  5. Move to the End Date field and type the Effective Date of the termination.
  6. Move to the Termination Code field and select the appropriate code from the drop-down menu.
  7. Select the Save button.
  8. Move to the Service Authorization area in the Program and Service Functional area.
  9. Select the check box for the appropriate record from the list.
  10. Select the Modify button.
  11. Move to the Term. Code field and select the appropriate code from the drop-down menu.
  12. Move to the End Date field and enter the Effective Date of the termination.
  13. Select the Save button.

Repeat Steps 1-13 to terminate each active Service Authorization record.

  1. Select Submit to SAS from the toolbar to submit the information.
  2. Select Outbox and then Inbox to ensure the case processed accurately.

It is permissible, however, not necessary, to close all other existing records for the individual (Diagnosis, Medical Necessity, Service Plan, Address, Authorizing Agent, Location and Level of Service) unless the individual will transfer to another Service Group. If this happens, the Effective Date of termination is used in the End Date fields.

 

11420 Terminating a Specific Service Code

Revision 13-1; Effective February 1, 2013

 

To Terminate a Specific Service Code for an Existing MDCP Individual who is Still Eligible for the Program:

  1. Open the file and the Client Details record will appear.
  2. Move to the Service Authorization area in the Program and Service Functional area.
  3. Select the check box for the appropriate record from the list.
  4. Select the Modify button.
  5. Move to the Term. Code field and select the appropriate code from the drop-down menu.
  6. Move to the End Date field and enter the last day of the Service Code.
  7. Select the Save button.
  8. Select Submit to SAS from the toolbar to submit the information.
  9. Select Outbox and then Inbox to ensure the case processed accurately.

 

11500 Individual Plan of Care (IPC) Changes

Revision 13-1; Effective February 1, 2013

 

 

11510 Provider Transfers

Revision 13-1; Effective February 1, 2013

 

When an individual transfers from one provider to another, the MDCP case manager must verify the number of units or the cost of services delivered from the time the individual was certified until the change is effective. Then, the case manager must calculate the estimated number of units or the cost of services that will be delivered by the new provider from the effective date of the change to the end of the IPC period.

To Register an IPC When a MCDP Individual Transfers Between Providers:

  1. Select the Service Authorization area in the Program and Service Functional area.
  2. Select the check box for each Service Authorization record for the Service Codes currently authorized.
  3. Select the Modify button.
  4. In each Service Authorization record, move to the Units field and type the number of units or the cost of services delivered by the losing provider. Change the End Date to the last day the losing provider is authorized to deliver services.
  5. Select the Save button.
  6. Select Add and a blank Service Authorization Details record will appear.
  7. Leave the MHMR Case No. field blank.
  8. Move to the Service Group field and select 18 – MEDICALLY DEPENDENT CHILDREN PROGRAM (MDCP) from the drop-down menu.
  9. Move to the Service Code field and select the appropriate Service Code from the drop-down menu.
  10. Leave the Fund and Term Code at the default.
  11. The Agency field is read-only at 324-DHS.
  12. Move to the Unit Type field and select 4 - PER AUTHORIZATION from the drop-down menu for all MDCP services, except for the CDS Monthly Administrative Fee, select 2 - MONTH.
  13. Move to the Units field and type the number of units or the cost of services that will be delivered by the new provider.
  14. Move to the Begin Date field and type the date the new provider is authorized to deliver services.
  15. Move to the End Date field and type the last day of the IPC period.
  16. Move to the Contract No field and type the provider contract number for each service.
  17. The NPI field is read-only.
  18. Select the Save button.
  19. When all appropriate services are changed and saved, select Submit to SAS from the toolbar.
  20. Select Outbox and then Inbox to ensure the case processed accurately.

 

11520 Service Plan – IPC Changes

Revision 13-1; Effective February 1, 2013

 

Adjust the Service Plan record if the provider transfer results in a change to the Amount Authorized field.

 

11530 All Other IPC Changes

Revision 13-1; Effective February 1, 2013

 

To process a change to the IPC, the MDCP case manager must calculate the number of units or cost of services previously authorized or obtain utilized units plus the number of units or cost of services necessary to complete the IPC period. The new projected annual units and cost of services must be registered on SAS when the IPC is changed.

To Register an IPC Change:

  1. Select the Service Authorization area in the Program and Service Functional area.
  2. Select the check box for the Service Authorization record(s) for the Service Code(s) being changed.
  3. Select the Modify button.
  4. Move to the Units field and type the new number of units. Do not make any other changes to the record, unless existing information is incorrect.
  5. Select the Save button.
  6. Select the Service Plan area from the Program and Service Functional area.
  7. Select the check box for the Service Plan you wish to change.
  8. Select the Modify button.
  9. Move to the Amount Authorized field and type the new Total Cost of Services Authorized on the IPC. Do not make any other changes to the record.
  10. Select the Save button.
  11. Select Submit to SAS from the toolbar to submit the information.
  12. Select Outbox and then Inbox to ensure the case processed accurately.