There are some steps to determine 1915(i) eligibility before you can get these services. Please see below and talk to your Tailored Care Manager (TCM) if you have questions.
You or provider identifies a need for 1915(i) services:
- Your Tailored Care Manager completes 1915(i) assessment
- North Carolina Department of Health and Human Services (NCDHHS) approves independent assessment
- Your TCM helps you find a 1915(i) service provider(s)
- You, your TCM and the provider(s) creates care plan
- Your TCM submits a prior authorization request(s) to Trillium
- Trillium’s Utilization Department (UM) approves the request(s)
- The identified 1915(i) provider(s) start providing the approved service(s)
Depending on the 1915(i) services approved, the 1915(i) provider may:
- Give temporary relief to the primary caregiver
- Offer services during the day, overnight, weekend and emergency care when needed
- Provide 1915(i) services in person
- Document the services billed to and reimbursed by Medicaid
- Continue to monitor member’s progress
