MaineCare General E-Message - June 20, 2016

Attention Referral Sources of Child Intensive Temporary Residential Treatment (ITRTs)

Effective July 1 2016, APS Healthcare, in coordination with the Office of Child and Family Services and the Office of MaineCare Services, will implement process updates for members who are being referred for ITRT under the MaineCare Benefits Manual, Ch. II - Section 97: Private Non-Medical Institution Services. Referrals for ITRT will no longer be faxed to APS Healthcare. Instead, providers will submit ITRT referrals electronically through the CareConnection Portal.

Below are the steps for submitting an ITRT referral:

1. Providers referring youth for ITRT will select “Contact for Service Notification” from the dropdown menu in the Authorization Type field on the Administrative Page in the CareConnection Portal.

2. Select “Children Services” from the dropdown menu in the Review Type field and “ITRT Referral” from the dropdown menu in the Category of Service field.

Administrative Page:

3. Select the code “100-219 - Section 97 ITRT Eligibility Determination” from the dropdown menu in the Service Field.

Services Requested Page:

4. Providers will use ITRT Submission Guidelines under the Section 97 – ITRT section of the Provider Manual and Forms webpage to enter information into CareConnection for clinical review.  The ITRT referral submission will be reviewed to determine medical necessity for residential treatment.

The following questions about the past 60 days must be answered in the Additional Info Section of the CareConnection Portal to determine eligibility for ITRT services:

• What is the potential for hospitalization or significant deterioration of functioning that would require a higher level of care without ITRT?
• What is the significant aggression that has occurred across multiple environments?
• Explain aggression that has caused serious injury including frequency, intensity, and duration of the aggression.
• Explain homicidal ideation including intent, plan, and means that has occurred.
• Explain suicidal ideation including intent, plan, and means that has occurred in the past two months.
• List and describe symptoms of mental illness, individuals with intellectual disabilities, or pervasive developmental disorders that have resulted in the inability to care for self to a developmentally appropriate level, even with home and community supports.
• Submission must include what lower levels of care have been attempted and if they have not been attempted why ITRT is being explored without attempt at a lower level of care. 

5. Attach supporting documentation to the CareConnection request, using “Document Upload.”  Please see the “Document Upload Webinar Recording” on the Provider Home Page  for instructions. 

Specific clinical documents within the past 60 days will be reviewed to support the member’s referral for ITRT. The documents include: MD Letter of Medical Necessity, inpatient and crisis assessments, incident reports from police, fire, animal control, and most recent psychological evaluation.  DO NOT submit additional documentation that is outside the 60-day look back period.

For questions, please call APS Healthcare at: 1-866-521-0027, option 1