Service Continuity Plan
Introduction
The implementation of Socially Necessary services is a profound change in the service delivery process. In order to facilitate the transition from the current delivery system to this new model the following information was developed for use by staff. Because this change is so far reaching this information should be considered a first step. As the implementation process continues there will be additional informational releases.
The key to this change in service delivery is the consistent application of
the policy rules.
The authorization for and the use of Socially Necessary Services is based on
existing policy rules. It is essential that staff study
the Utilization Management Guidelines and apply the rules governing their use. This includes the application
of the appropriate policy rules and the documentation necessary to support
the use of these services.
A. Continuation of and Payment for Services During the Transition to Socially Necessary Services
1. Continuation of Existing Services
Existing services are defined as those services initiated prior to July 1, 2004 which is the start date for Socially Necessary Services. These services will be allowed to be continued for a period up to three months after the initiation date without being converted to the prior authorization process. This means that all existing services would be discontinued by September 30,2004 or converted to the prior authorization process.
By establishing this transition period, services will be provided on an uninterrupted basis until a case review naturally occurs. The case review cycle is 90 days. By establishing a transition period there will be a window of time during which staff can decide whether or not to terminate services or initiate the preauthorization process.
This transition period also allow staff to locate an alternate provider in those instance where services will continue but the current provider has decided not to enroll in the Socially necessary Services initiative.
2. Payment for Existing Services
Grant Providers transitioning to a Socially Necessary Services Provider
Family Preservation & Visitation Grants end June 30, 2004. The Office of Finance and Administration will work with each of these providers to transition to the new process. Beginning July 1, 2004 providers will begin using the new ASO invoice form. These existing services will be paid on a fee for service basis based on the ASO payment rate. The invoices for these services will be sent to the field for approval and forwarded to the Bureau’s Office of Finance and Administration for payment. (350 Capitol Street, Room 730.)
Other Providers - this includes fee for service providers
The reimbursement rates for existing services, those services begun before July 1,2004 and continuing during the transition period, will be changed to the Socially Necessary payment rate effective July 1,2004. The invoices for these services will be sent to the field for approval and forwarded to the Bureau’s Office of Finance and Administration for payment. (350 Capitol Street, Room 730).
3. Wraparound Services
Any service designated as a Wraparound Service will be discontinued effective July1,2004. Prior to that date staff must discuss these services with the provider(s) and determine whether or not the service can end or should be continued. In those instances in which it is determined that the services should continue the caseworker and provider need to determine if the services are covered in the Utilization Management Guidelines.
If the services are covered then they will be subject to the new authorization procedures. If the services are not covered then they must be discontinued.
4. Services Initiated on or After July 1,2004
All Socially Necessary Services initiated on or after July 1,2004 will require a prior authorization before payment can be made. A new invoice has been developed and is available here. It is mandatory that Providers use the new invoice. Providers will be instructed to send the invoice directly to the Bureau’s Office of Finance and Administration for payment.
B. Preparing for the Transition
In order to assure continuity of service provision when Socially Necessary Services are implemented, it is recommended that Regional Directors and Community Services Managers cause the following to occur:
Community Services Managers and Supervisors should encourage workers to access the web site for Socially Necessary Service and review the Utilization Management Guidelines regulating access to and use of these services. Supervisors may chose to print a copy of the Guidelines and review them with their staff during unit meetings.
Workers should be encouraged to prepare for the transition by reviewing cases in which services are already being provided in order to determine what must be done to transition these case to the new process. For example: it may be necessary to implement or continue the Multidisciplinary Treatment Team, complete the Child, Youth and Family Case Plan or Safety Plan or make some other documentation in FACTS.
A chart containing information on those services that require approval by the Multidisciplinary Treatment Team or approval by a supervisor will be prepared and distribute during the staff training held in June. The chart will also include information about the documentation that is required for each service. Workers can use the chart to initially review their cases and then can refer to the UM Guidelines for a complete description of the services requirements.
C. Technical Assistance
It is inevitable that there will be questions about Socially Necessary Services. A list describing the questions that should be referred to the ASO, FACTS or other offices within the Bureau will be prepared and distributed to staff during June,2004.
In general the FACTS Help Desk will address questions related to the FACTS application; the Program Specialists for Child protective Services, Youth Services, Foster Care and Adoption will address policy and practice questions for those programs; staff at the ASO will address questions from providers about securing an authorization and will provide clarification of the Utilization Management Guidelines; and, bcfpay@wvdhhr.org will address questions pertaining to the submission of invoices, payment rates, denial of payments, etc. will address questions pertaining to the submission of invoices, payment rates, denial of payments, etc.
D. FACTS Payment Migration Plan
This Plan contains information about the effects on the payment process resulting from the implementation of Socially Necessary services. Particular attention should be given to the changes in the demand payment processes.
