The ASO Process and Socially Necessary Services
Introduction
The Bureau for Children and Families of the West Virginia Department of Health and Human Resources, in partnership with APS Healthcare, an Administrative Services Organization (ASO), is initiating a new process for the authorization of services in child welfare cases. The name Socially Necessary has been chosen to designate the class of services governed by this new process.
What are Socially Necessary Services? Socially Necessary services are interventions necessary to improve relationships and social functioning, with the goal of preserving the individual's tenure in the community or the integrity of the family or social system.
Ultimately, socially necessary services are those necessary to achieve the child welfare goals of safety, permanency and well being. The designation socially necessary is used to distinguish these services from other services that have been determined to be medically necessary and can be obtained through Medicaid. To locate a medicaid provider in your area you can visit the provider website at: http://www.wvmmis.com/provDir/Controller?actionName=providerDirectGetAction
How are Socially Necessary Services Authorized? Authorization to deliver socially necessary services is obtained from the ASO. Authorization is dependent on the provider meeting the qualifications to deliver the service/services, the submittal of all required information to the ASO and the prior approval by the ASO for the delivery of the service/services. The ASO will offer provider training and technical assistance to those who desire to participate.
What is the ASO? ASO stands for Administrative Services Organization. The Department has contracted with APS Health Care to serve as the ASO for socially necessary services. The purpose of the ASO is to provide administrative services necessary to enforce the Department's policies.
What is the ASO Process? The ASO process is a systematic approach to the delivery of a selected group of child welfare services known as socially necessary services. The process includes:
- Standardized service definitions including units of service;
- Establishment of standards for documentation;
- Establishment of provider qualifications (credentials);
- Authorization and reauthorization of the identified services;
- Utilization review process: and
- Development of an appeal process.
What are the Goals of the ASO process? The goals of the ASO process are to insure that families and children served by the Department receive the most appropriate services in the most cost effective manner. The effective management of resources in order to insure the availability of services when needed is as much a part of child welfare as case planning.
What are the Keys to the Success of the ASO Process? The keys to the success of the ASO process are:
- The consistent application of the current policy rules for assessment, case planning and case review by Department staff: and,
- The consistent application of the current policy rules governing the ASO process for socially necessary services by providers.
Enrollment to Become a Provider: Any individual or agency which meets the qualifications for a service or services may enroll to become a provider for that service. The service descriptions and the provider qualifications associated with those services are contained in the Utilization Management (UM) Guidelines for Socially Necessary Services.
Enrollment is an open ended process. By that it is meant that a provider who chooses not to enroll initially with the ASO can choose to do so at a later date. It also means that a provider is not limited to the services for which they originally registered. For example: a provider can decide at any time to expand their service delivery into additional counties or can decide to provide services other than the ones for which they initially enrolled to deliver.
Any changes in geographic coverage or the provision of additional services will require the submittal of additional information to the ASO and the Department. The Department and the ASO will jointly decide upon approval of expanded service delivery.
The Enrollment Process: The enrollment forms and instructions, the matrix of services and the catalogue of services including provider qualifications can be located on this web page.
Training: Once a provider has completed and submitted the enrollment forms, they will need to contact APS Health Care to receive training on how to use the authorization process. The web site for APS Health Care is www.apshealthcare.com.
Questions: All questions shuld be sent to dhhrbcfasosup@wv.gov .
