Hello 1115 Waiver Providers,

 

As the 1115 services are being rolled out, there are a lot of questions and confusion regarding service authorizations. A training by DBH will be held on February 29, 2020 to assist agencies in what constitutes a complete Service Authorization based on the recipients’ current maladaptive behaviors and/or mental state and functional status. Times and locations will be forth coming.

As a reminder, any back billing for 1115 services submitted must include a reciprocating service authorization.

 

In the interim, please follow these tips and requirements:

Helpful Hints

Agency Responsibilities

• It is the agency’s responsibility to determine the recipient’s Medicaid eligibility.
• It is the agency’s responsibility to track the specific number of units, for a particular service type, a recipient has used with their organization during the SFY.   

Documentation

• A detailed description of recipients’ current maladaptive behaviors and functional status must be documented in the services authorization.
• A detailed summary of why the recipient cannot maintain their sobriety or mental health without the services that are being requested must be documented in the service authorization.
• Additional supporting documentation may be requested by the department

Service Authorization Limits

• Service authorizations cannot cross from one state fiscal year to another.
• Service authorizations cannot be extended. A new Service Authorization is needed for any additional units being requested beyond what has been already approved per regulations 7 AAC 138.40(c).
• ONE service type request per service authorization form.
• Any services provided by the agency that has exceeded the SFY limits without a service authorization will be denied payment.
• Any SA request made after the SFY service limits have been exhausted during any one treatment episode, will be denied.
• A Service Authorization is only needed when the SFY limits for specific service type have been exhausted for the recipient served.

Deadlines

Service Authorizations (SA) must be submitted in a timely manner. What does this mean?

• A “timely manner” means that the request is made before the SFY limits or additional approved units have been completely exhausted.
  • Example of a timely SA: the client/patient has been in Level 3.5 treatment for 26 days (units) and the SFY limit for that service type is 30 days (units). The agency requesting additional units must submit and SA before the expiration of the 30 days (units). 
• Any SA request made after the current approved SA units have been exhausted during any one treatment episode, will be denied.
  • Scenario: 30 day SFY limit has been used and another 30 days was approved through an SA for the same treatment episode. The recipient is still in the same service, same episode of care but no additional units were requested at day 60. Any units not again requested through a SA will be denied.
  • Hypothetical Example: On October 1^st SallyJo was admitted for residential treatment. SallyJo has almost completed her first month in residential treatment (first 30 days of SFY limit) so a new SA was submitted for another 30 days on October 28^th. The additional 30 days has been approved for SallyJo’s continued stay in residential treatment (treatment episode). SallyJo is still in the same service (residential treatment) same episode of care (has not been discharged or readmitted) but no SA was submitted as of November 28^th.  All services as of December 1^st will be denied.

Definitions

• State Fiscal Year (SFY): The Alaska State Fiscal Year runs from July 1 - June 30 each year.
• Service Authorizations (SA): 1115 Substance Use Disorder Waiver Provider Service Authorization Request form

 

Thank you,

 

Lynn M. Eldridge, MEd

Mental Health Clinician III

State of Alaska/Division of Behavioral Health

3601 C Street, Suite 878

Anchorage, Alaska 99503

Phone (907) 269-3410

Fax (907) 269-3623

Email: lynn.eldridge@alaska.gov

 

Dear Provider,

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