Who will certify providers of Comprehensive Behavioral Health Assessments?
Magellan will certify providers and will send a complete list annually to the CBC as well as ongoing updates to the provider list.
Do we still need the suitability assessment by a Qualified Evaluator and court hearing for Therapeutic Group Care and SIPP?
Yes, by Statue [F.s.39.407; F.S.394.492(5) or (6)], this is still a requirement.
Will there still be a Multidisciplinary Team and, if so, who will participate on the Team?
MDT staffings will be scheduled and coordinated by the CBC (SPOA) in coordination with SEDNET and will include the child welfare family services counselor for the child, the case manager, and the clinician for the child (or clinical representative of the provider agency). Others may be included as appropriate, such as Guardian Ad Litem, parents, foster parents, attorneys, etc.
Does the CBC have specific expectations of providers in this process?
Yes. Along with expecting that the procedures for requesting services are followed, the CBC would expect the provider to have given clinical input prior to the service request to the CBC. Communication of issues and service information will be critical to both the CBC and Providers.
Where can a provider find documents and information on processes and managed care system?
All related documents may be found by clicking here.
How will this work for our kids who are out of state and for out of state kids who are in Florida (ICPC cases)?
If they are on the eligibility list we receive they will need authorization by your organization.
For services that do not need pre-authorization, will there be concurrent review—will providers know when it needs to be ok’d by concurrent review?
No concurrent review needed for services that do not need to be authorized.
Is the Appendix B still needed for CBHAs?
Fee for service children require authorization so providers can be paid. The Appendix B should be sent to the provider. It does not require all signatures as before (the SPOA will continue to sign off). For children on the eligibility list for the Magellan plan, providers do not need the Appendix B anymore they will be given the form that the CBC has created.
Are we still required to enter data into the SAMH system for CBHAs?
No. The CBC does not have to enter into this system. It is optional. The CBC may use its own tracking system if they choose.
How will providers contact the CBC for authorization of new services that require pre-authorization?
Providers will contact Laura Beyrle (SPOA) at 904-421-5820. Providers are to fill out information related to the type of service being requested for the client prior to calling the SPOA for authorization. The forms for this are also located on the managed care web pages. The SPOA will be responsible for calling Magellan and communicating the results back to the provider.
If a child leaves the child welfare system/Hsn, the provider would not be able to bill for services under this Plan, correct?
Correct. To continue to provide services to a child no longer in the child welfare system/Hsn, a Provider would need a Medicaid provider number in order to bill fee for service for that child. If the child goes into another prepaid plan, the Provider would need a contract with that particular prepaid plan.