IME Phase II MEDICAID Administrative Pre- Authorization (PA) Procedures IME Provider Webinar Training IME- Rutgers University Behavioral Health Care Utilization Management Unit and New Jersey State Division of Mental Health and Addiction services (DMHAS) 1

IME Phase II Medicaid Administrative Pre- Authorization (PA) Procedures The Administrative PA procedures are designed to enable two PA procedures : 1. IME Issuing of Medicaid Administrative PAs to providers for: A. Medicaid funded consumers in active treatment in IOP or PC LOC as of March 31, 2016 who are expected to be in treatment on and after May 24, AND B. Consumers who enter (are admitted to) Medicaid funded IOP or PC between April 1 and May 23, IME UM staff to send Medicaid Admin PAs created for both consumer groups to Molina to establish a record of provider treatment PAs prior to May 24, 2016 for IOP & PC LOC funded by Medicaid. These procedures will establish a storehouse of PAs in Medicaid/Molina system for Medicaid covered consumers prior to the implementation of the managed UM phase commencing on May 24, 2016 for consumers who are likely to continue in Medicaid funded treatment after May 23,

Responsible Parties: Network Providers and IME Staff Time Frames: Commencing on April 1, 2016 Ending on May 23,

Consumers in Medicaid Funded IOP or PC Tx on March 31 IME creates list of consumers from NJSAMS in active Tx in IOP and PC LOC funded by Medicaid on March 31. Provider will be sent a list of consumers who are listed in NJSAMS as “admitted” in Medicaid funded IOP or PC. Provider corrects entries on list so that final list shows only consumers in active treatment at that provider in Medicaid funded IOP or PC on March 31 who are expected to be in treatment on and after May 24, Provider-corrected list is sent back to IME no later than April 22. Consumers listed by the provider will be issued a Medicaid Administrative PA which will be sent to Molina and then a verification letter sent to the provider by Molina. (True PA) 4

Consumers Admitted to Medicaid Funded IOP or PC Tx Between April 1 and May 23 The Medicaid Enrolled Consumer is: either A. Referred to provider by IME. or B. Presents at provider. 5

Action Steps by Provider: 1. Provider assesses consumer. 2. Provider checks eMEVS to verify patient Medicaid enrollment. 3. Provider submits (faxes or secure -scans) to IME the Administrative PA Request Form for Medicaid funded LOC, indicating the LOC-HCPC code for either IOP or PC and PA Start (admission) date. (Request Form is presented in two (2) parts on next two slides) 6

Part 1 REQUEST for MEDICAID ADMINISTRATIVE PRE-AUTHORIZATION (PA) FOR “MEDICAID ENROLLED” (MEDICAID FUNDED CONSUMERS: This Administrative REQUEST for Pre-Authorization (PA) for Medicaid funded Substance Use Disorder treatment is required of Medicaid providers for all Medicaid covered consumers newly admitted between April 1 and May 23, No clinical information is required for this request to be processed by the IME. Record below applicable Medicaid funded LOC: IOP = HCPC # H0015 HF or PC (partial care) = HCPC # H2036 HF This form is valid for ADMINISTRATIVE Medicaid PA requests only. SEND COMPLETED REQUEST to IME - (See bottom of form for IME contact information Beneficiary’s Last Name: First Name: MI: DOB: Gender: Check one: F □ M □ Transgender □ Medicaid ID # (12 digits) → SS#: - - 7

Part 2 Beneficiary’s St. Address↓ │ City↓ State ↓ ZIP Code↓ Telephone #: Service Provider Name: St. Address↓ City↓ State↓ PROVIDER Medicaid Site ID # ↓ Telephone #: Fax #: Date submitted: - - TREATMENT REQUESTED: Record below the SUD Medicaid funded LOC Requested with Start (admission) date. LOC/HCPC: Start (admission) date: Comments: Send this Administrative PA Request form to UBHC-IME Utilization Management unit either by secure scan at or Fax it to In the case of a concern call UBHC IME UM staff at 8

Providers’ Administrative PA Requests for Medicaid Funded IOP and PC admissions between April 1 and May 23 are NOT subject to Utilization Review (UR) and do not require the submission of clinical information to the IME UM staff. 9

4. After receiving provider’s PA request, IME confirms in eMEVS consumer’s Medicaid enrollment and Medicaid eligibility End date. Once confirmed Medicaid Admin PA is created. 5. For each PA created, IME staff communicates Medicaid PA number with PA Start and End dates to the provider via new NJSAMS “Medicaid Prior Authorization” screen and number of units approved in NJSAMS Notes. (Will continue after May 24, 2016) 6. Should eMEVS show the consumer as NOT eligible when IME checks, IME staff will contact the provider to resolve the discrepancy. 7. IME sends all Administrative PAs completed during each day to Molina, at end of each day. 10

8. Should a consumer’s Medicaid eligibility terminate during the Administrative PA LOS, the provider will re-register the consumer in NJSAMS to determine if the consumer is eligible for any managed NJ State initiative (DUII, SJI, MATI, Block Grant). 9. If the consumer is eligible for NJ State funded treatment the provider will obtain their NJ State funded treatment PA via the current unmanaged procedure via NJSAMS during the Administrative PA period (until May 24). 10. On and after May 24, Continuation of Care requests for treatment previously authorized with an Administrative PA for Medicaid funded treatment (IOP or PC) will be processed as fully managed clinical PAs. 11. Provider does not require an authorization for an initial assessment (90791 or 90792) to obtain the Medicaid funded treatment PA. 12. Provider and IME will record in NJSAMS Notes their transactions with each other and with consumers. This is important. 11

Thank You for Your Participation Should you have any questions please contact the IME UM unit at either: OR Provider Phone #