Individualized Service Agreements (ISA) State of Alaska Division of Behavioral Health Policy and Planning

Individualized Service Agreement What is it - A provider Agreement with the State of Alaska for the purpose of providing individual, specialized services for severely emotionally disturbed (SED) children.

Individualized Service Agreements (ISA) – Funding Process Client Eligibility A resident of the state Under 22 years of age Been assessed by a MH professional and meets criteria for SED Is at imminent risk of being removed from the home Been assessed to meet residential level of care Has been approved by DHSS for services

Individualized Service Agreements Examples of Acceptable Uses Non-Medicaid services such as: For Non-MC recipients – all MC covered services Services that allow recipient to maintain at least restrictive level of care Services that would normally be covered by Medicaid for non-resourced recipients Room and board for non-custody kids in level 2-4 BRS facilities, continued need reviewed every 90 days. Vocational rehabilitation Rent including utilities not to exceed 90 days Start up costs for individual living settings Specialized treatments – private practitioners physician clinic services (Must Contract thru Community Behavioral Health center CBHC). Transportation Parenting classes

Individualized Service Agreements Examples of Acceptable Uses (cont.) Care coordination for non Medicaid recipients or case management? Case management for recipient 90 days (60 days payable) prior to discharge from inpatient facilities. (Last 30 days should be billable to Medicaid) Respite Expert consultations e.g. sexual acting out, Limited home modifications necessary to maintain child in home Life management skills After school programs Family home assessment Social activities Mentoring Tuition Other services determined to be clinically appropriate.

Individualized Service Agreements Non-Acceptable Uses: Individualizes services dollars will not pay for or augment: foster care rates substance abuse treatments Capital Funding/substantial home renovations

Individualized Service Agreements (ISA) Other billing mechanisms must be utilized Medicaid Private Insurance 5% Set Aside Funds for CBHCs with SED Grants* * SED Grants do not need to be “spent down” prior to receiving ISA funds

Individualized Service Agreements (ISA) – Funding Process Service provider must be a CBHC Medicaid provider. CBHC may contract with other agencies for identified services.

Individualized Service Agreements (ISA) – Funding Process Providers complete the Referral & Billing Form which includes requested services, # of unit(s) and costs of services (for initial referral and every 90 days)

This information contained in this message may be privileged and confidential, protected from disclosure, and /or intended only for the use of the individual or entity named above. If the reader of this message is not the intended recipient, or an employee, or an agent responsible for delivering this message to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please notify the sender immediately. If you have received this message as a fax, please destroy the fax. Form Rev. 11-29-06

Individualized Service Agreements (ISA) – Funding Process Referral & Billing Form faxed to DBH UR staff along with initial Treatment Plan or quarterly Treatment Plan Review

Individualized Service Agreements (ISA) – Funding Process Billing – submitted by provider every 30 days to DBH For initial funding requests, provider submits Treatment Plan to DBH UR staff For continued funding requests, provider submits quarterly Treatment Plan Review to DBH UR staff

Individualized Service Agreements (ISA) –Website to download Agreement http://www.hss.state.ak.us/publicnotice/grants.htm

Individualized Service Agreements (ISA) – Utilization Review Staff Southeast Region and Matsu Valley - Reta Sullivan (907) 269-8869/ Reta_Sullivan@health.state.ak.us  Northern Region- Judy Helgeson (907) 269-3697 Judith_Helgeson@health.state.ak.us Anchorage- Maureen McGlone (907) 269-3793 Maureen_McGlone@health.state.ak.us Southcentral Region (excluding Matsu)- Anne Gibson (907) 269-8867/ Anne_Gibson@health.state.ak.us