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Reminder to Behavioral Treatment Providers Regarding the Transition Schedule

Last November, the Department of Health Services sent a letter to autism treatment providers under the Children's Long-Term Support (CLTS) Waiver Program explaining the schedule for transitioning children from the CLTS Waiver Program to the new ForwardHealth behavioral treatment benefit. Due to the large amount of information that ForwardHealth has sent to this provider group over the last several months, the Department would like to remind providers of the transition schedule.

In order to effectively manage the volume of children transitioning to the new benefit, each child was assigned a transition month between May and October 2016. The assigned transition month determines the date by which the provider should submit a prior authorization (PA) request for that child (see the transition schedule below for the PA request submission deadline for each transition month). For each transition month, providers are required to submit PA requests four months in advance. This allows ForwardHealth and the provider 60 days to finalize the PA request and, once the PA request is approved, allows the waiver agency 60 days to meet with the family to assess whether the child and/or family is eligible to receive other waiver services.

If the child is scheduled to transition in: The PA request needs to be submitted by the end of: So waiver agencies have time for service coordination, assessment and plan updates:
May 2016 January 2016 March/April 2016
June 2016 February 2016 April/May 2016
July 2016 March 2016 May/June 2016
August 2016 April 2016 June/July 2016
September 2016 May 2016 July/August 2016
October 2016 June 2016 August/September 2016

It's important that providers adhere to this schedule to ensure an efficient and manageable transition. If providers have fallen behind on this schedule or have questions regarding the PA process or criteria, they should call Provider Services at (800) 947-9627. Providers should not call waiver agencies with PA-related questions. However, providers should continue to contact waiver agencies with specific questions about the transition schedule.

 
 
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