PA Lookup
If you have questions about prior authorizations, please call:
Member and Recipient Service Line: 1-877-685-2415
Provider Support Service Line: 1-855-250-1539
Community Networking
Community Networking services provide individualized day activities that support the member’s definition of a meaningful day in an integrated community setting, with persons who are not disabled. If the member requires paid supports to participate / engage once connected with the activity, Community Networking can be used to refer and link the member. Services are designed to promote maximum participation in community life while developing natural supports within integrated settings. Community Networking services enable the member to increase or maintain their capacity for independence and develop social roles valued by non-disabled members of the community. As the member gains skills and increase community connections, service hours may fade.
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Unit Value
One unit = 15 minutes
Limits
- • Payment for attendance at classes and conferences cannot exceed $1,000/ per member plan year. The amount of community networking services is subject to the “Limits on Sets of Services.”
- • This service is provided separate and apart from the member’s primary private residence, other residential living arrangement, and/or the home of a service provider. These services do not take place in licensed facilities and are intended to offer the member the opportunity to develop meaningful community relationships with non-disabled individuals.
- • Service does not cover the cost of hotels, meals, materials or transportation while attending conferences.
- • Service does not cover activities that would normally be a component of a member’s home/residential life or services.
- • Service does not pay day care fees or fees for other childcare related activities.
- • The waiver member may not volunteer for the Community Networking service provider.
- • Volunteering may not be done at locations that would not typically have volunteers (that is, hair salon or florist) or in positions that would be paid positions if performed by an individual that was not on the waiver.
- • This service may not duplicate or be furnished/claimed at the same time of day as Day Supports, Community Living and Support, Residential Supports, Respite, Supported Employment or one of the State Plan Medicaid services that works directly with the member.• For a member who is eligible for educational services under the Individuals With Disability Educational Act, Community Networking does not cover transportation to/from school settings. (Transportation to/from member’s home or any community location where the member may be receiving services before/after school is covered for this service.)
- • This service does not pay for overnight programs of any kind.
- • Classes that offer one-to-one instruction are not covered.
- • Classes that are in a nonintegrated community setting are not covered.
- • Exclusions, limitations & exceptions detailed in the Eligibility Requirements, Terms of Service, Limits on Sets of Services, General Limitations on Coverage, Relative as Provider, Individual and Family Directed Services, and Claims sections of this Benefit Plan apply.
- • See the CCP for all applicable exclusions, limitations & exceptions.
Additional Service Specifics
Requesting the core service automatically includes the use of the telehealth (GT) code when approved. A separate request is not needed, and the GT service code should not be requested separate from the non-telehealth service code.
How to Submit
Please submit your request to Trillium Health Resources (iTransact for TP Medicaid members and Provider Direct for MCD Direct members)
Resources
Community Networking
Community Networking services provide individualized day activities that support the member’s definition of a meaningful day in an integrated community setting, with persons who are not disabled. If the member requires paid supports to participate / engage once connected with the activity, Community Networking can be used to refer and link the member. Services are designed to promote maximum participation in community life while developing natural supports within integrated settings. Community Networking services enable the member to increase or maintain their capacity for independence and develop social roles valued by non-disabled members of the community. As the member gains skills and increase community connections, service hours may fade.
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Unit Value
One unit = 15 minutes
Limits
- • Payment for attendance at classes and conferences cannot exceed $1,000/ per member plan year. The amount of community networking services is subject to the “Limits on Sets of Services.”
- • This service is provided separate and apart from the member’s primary private residence, other residential living arrangement, and/or the home of a service provider. These services do not take place in licensed facilities and are intended to offer the member the opportunity to develop meaningful community relationships with non-disabled individuals.
- • Service does not cover the cost of hotels, meals, materials or transportation while attending conferences.
- • Service does not cover activities that would normally be a component of a member’s home/residential life or services.
- • Service does not pay day care fees or fees for other childcare related activities.
- • The waiver member may not volunteer for the Community Networking service provider.
- • Volunteering may not be done at locations that would not typically have volunteers (that is, hair salon or florist) or in positions that would be paid positions if performed by an individual that was not on the waiver.
- • This service may not duplicate or be furnished/claimed at the same time of day as Day Supports, Community Living and Support, Residential Supports, Respite, Supported Employment or one of the State Plan Medicaid services that works directly with the member.• For a member who is eligible for educational services under the Individuals With Disability Educational Act, Community Networking does not cover transportation to/from school settings. (Transportation to/from member’s home or any community location where the member may be receiving services before/after school is covered for this service.)
- • This service does not pay for overnight programs of any kind.
- • Classes that offer one-to-one instruction are not covered.
- • Classes that are in a nonintegrated community setting are not covered.
- • Exclusions, limitations & exceptions detailed in the Eligibility Requirements, Terms of Service, Limits on Sets of Services, General Limitations on Coverage, Relative as Provider, Individual and Family Directed Services, and Claims sections of this Benefit Plan apply.
- • See the CCP for all applicable exclusions, limitations & exceptions.
Additional Service Specifics
Requesting the core service automatically includes the use of the telehealth (GT) code when approved. A separate request is not needed, and the GT service code should not be requested separate from the non-telehealth service code.
How to Submit
Please submit your request to Trillium Health Resources (iTransact for TP Medicaid members and Provider Direct for MCD Direct members)
Resources
Community Networking
Community Networking services provide individualized day activities that support the member’s definition of a meaningful day in an integrated community setting, with persons who are not disabled. If the member requires paid supports to participate / engage once connected with the activity, Community Networking can be used to refer and link the member. Services are designed to promote maximum participation in community life while developing natural supports within integrated settings. Community Networking services enable the member to increase or maintain their capacity for independence and develop social roles valued by non-disabled members of the community. As the member gains skills and increase community connections, service hours may fade.
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Unit Value
One unit = 15 minutes
Limits
- • Payment for attendance at classes and conferences cannot exceed $1,000/ per member plan year. The amount of community networking services is subject to the “Limits on Sets of Services.”
- • This service is provided separate and apart from the member’s primary private residence, other residential living arrangement, and/or the home of a service provider. These services do not take place in licensed facilities and are intended to offer the member the opportunity to develop meaningful community relationships with non-disabled individuals.
- • Service does not cover the cost of hotels, meals, materials or transportation while attending conferences.
- • Service does not cover activities that would normally be a component of a member’s home/residential life or services.
- • Service does not pay day care fees or fees for other childcare related activities.
- • The waiver member may not volunteer for the Community Networking service provider.
- • Volunteering may not be done at locations that would not typically have volunteers (that is, hair salon or florist) or in positions that would be paid positions if performed by an individual that was not on the waiver.
- • This service may not duplicate or be furnished/claimed at the same time of day as Day Supports, Community Living and Support, Residential Supports, Respite, Supported Employment or one of the State Plan Medicaid services that works directly with the member.• For a member who is eligible for educational services under the Individuals With Disability Educational Act, Community Networking does not cover transportation to/from school settings. (Transportation to/from member’s home or any community location where the member may be receiving services before/after school is covered for this service.)
- • This service does not pay for overnight programs of any kind.
- • Classes that offer one-to-one instruction are not covered.
- • Classes that are in a nonintegrated community setting are not covered.
- • Exclusions, limitations & exceptions detailed in the Eligibility Requirements, Terms of Service, Limits on Sets of Services, General Limitations on Coverage, Relative as Provider, Individual and Family Directed Services, and Claims sections of this Benefit Plan apply.
- • See the CCP for all applicable exclusions, limitations & exceptions.
Additional Service Specifics
Requesting the core service automatically includes the use of the telehealth (GT) code when approved. A separate request is not needed, and the GT service code should not be requested separate from the non-telehealth service code.
How to Submit
Please submit your request to Trillium Health Resources (iTransact for TP Medicaid members and Provider Direct for MCD Direct members)
Resources
Community Networking
Community Networking services provide individualized day activities that support the member’s definition of a meaningful day in an integrated community setting, with persons who are not disabled. If the member requires paid supports to participate / engage once connected with the activity, Community Networking can be used to refer and link the member. Services are designed to promote maximum participation in community life while developing natural supports within integrated settings. Community Networking services enable the member to increase or maintain their capacity for independence and develop social roles valued by non-disabled members of the community. As the member gains skills and increase community connections, service hours may fade.
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Unit Value
One unit = 15 minutes
Limits
- • Payment for attendance at classes and conferences cannot exceed $1,000/ per member plan year. The amount of community networking services is subject to the “Limits on Sets of Services.”
- • This service is provided separate and apart from the member’s primary private residence, other residential living arrangement, and/or the home of a service provider. These services do not take place in licensed facilities and are intended to offer the member the opportunity to develop meaningful community relationships with non-disabled individuals.
- • Service does not cover the cost of hotels, meals, materials or transportation while attending conferences.
- • Service does not cover activities that would normally be a component of a member’s home/residential life or services.
- • Service does not pay day care fees or fees for other childcare related activities.
- • The waiver member may not volunteer for the Community Networking service provider.
- • Volunteering may not be done at locations that would not typically have volunteers (that is, hair salon or florist) or in positions that would be paid positions if performed by an individual that was not on the waiver.
- • This service may not duplicate or be furnished/claimed at the same time of day as Day Supports, Community Living and Support, Residential Supports, Respite, Supported Employment or one of the State Plan Medicaid services that works directly with the member.• For a member who is eligible for educational services under the Individuals With Disability Educational Act, Community Networking does not cover transportation to/from school settings. (Transportation to/from member’s home or any community location where the member may be receiving services before/after school is covered for this service.)
- • This service does not pay for overnight programs of any kind.
- • Classes that offer one-to-one instruction are not covered.
- • Classes that are in a nonintegrated community setting are not covered.
- • Exclusions, limitations & exceptions detailed in the Eligibility Requirements, Terms of Service, Limits on Sets of Services, General Limitations on Coverage, Relative as Provider, Individual and Family Directed Services, and Claims sections of this Benefit Plan apply.
- • See the CCP for all applicable exclusions, limitations & exceptions.
Additional Service Specifics
Requesting the core service automatically includes the use of the telehealth (GT) code when approved. A separate request is not needed, and the GT service code should not be requested separate from the non-telehealth service code.
How to Submit
Please submit your request to Trillium Health Resources (iTransact for TP Medicaid members and Provider Direct for MCD Direct members)
Resources
Community Support Team (CST)
Provides direct support to adults with a dx of MH, SU, or comorbid disorder and who have complex and extensive tx needs. This is an intensive community-based rehab team service that provides direct tx and restorative interventions as well as case management. This service consists of community-based MH and SU services, and structured rehabilitative interventions intended to increase and restore a individuals ability to live successfully in the community. The team approach involves assistance in re-est. the individuals community roles related to the following life domains: emotional, behavioral, social, safety, housing, medical and health, educational, vocational, and legal.
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Reauthorization Guidelines
- 1. TAR: prior authorization required
- 2. Face-to-Face Functional Assessment: Required, used to determine the scope and anticipated outcome of the service. Must be administered during the initial 60-calendar days of tx and up to every 90-calendar days thereafter.
- 3. Complete PCP: recently reviewed detailing the individual’s progress with the service to include all required signatures and the 3-page crisis plan.
- 4. Medicaid Application: Required w/in the 30 days of authorization. Evidence of individual applying for Medicaid or update on application status.
Unit Value
One unit = 15 minutes
Length of Stay
- 1. Up to a 60-day auth period per request.
- 2. No more than 3 months in a rolling year will be authorized.
Exclusions
- 1. CST must not be provided in conjunction with ACT; during the same auth period as any other service that contains duplicative service components (to include TMS or PSS); to individuals residing in Institutions for Mental Disease (IMD), and; Family individuals or LRPs of the individual may not provide this service.
- 2. To help w/ transition, CST services may be provided for a max of 8 units for the first and last 30-day period for individuals who transitioning to or from: ACTT, SAIOP or SACOT.
Level of Care
ASAM Level 1 (if applicable). While the LOCUS/ CALOCUS are specifically no longer required, providers are still expected to use a standardized assessment tool when evaluating an individual for treatment services.
Place of Service
At least 75 percent of CST services must be delivered face-to-face by the team with the beneficiary. At least 75 percent of staff time must be spent working outside of the agency’s facility with or on behalf of the member. CST shall provide “first responder” crisis response 24-hours a day, 7 days a week, 365 days a year, to the member.
How to Submit
Please submit your request to Trillium Health Resources (iTransact for TP Medicaid members and Provider Direct for MCD Direct members)
Resources
Community Support Team (CST)
Provides direct support to adults with a MH, SU, or co-morbid disorder and who have complex and extensive treatment needs. Consists of community-based MH and SU services, and structured rehab interventions intended to increase and restore a member’s ability to live successfully in the community. The team approach involves structured, face-to-face therapeutic interventions that assist in reestablishing the members community roles related to life domains.
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Unit Value
One unit = 15 minutes
Length of Stay
It is expected that service intensity titrates down as the member demonstrates improvement.
Exclusions
- 1. When helping a member transition to and from a service, CST services may be provided for a max of eight units for the first and last 30-day period for members transitioning to: ACTT, SAIOP, SACOT.
- 2. May not be provided in conjunction with ACTT or during the same episode period as any other State Plan service that contains duplicative service components. This includes PSS, as CCP 8G states that PSS must not be provided during the same auth period as CST, as a member who needs CST and peer support will be offered by peer support by the CST providers.
Age Group Details
Adults (age 18 and older)
Level of Care
ASAM Level 1 (if applicable). While the LOCUS/ CALOCUS are specifically no longer required, providers are still expected to use a standardized assessment tool when evaluating an individual for treatment services.
Place of Service
At least 75 percent of CST services must be delivered face-to-face by the team with the beneficiary. At least 75 percent of staff time must be spent working outside of the agency’s facility with
How to Submit
N/A - No authorization is required
Resources
Community Support Team (CST)
Provides direct support to adults with a dx of MH, SU, or comorbid disorder and who have complex and extensive tx needs. This is an intensive community-based rehab team service that provides direct tx and restorative interventions as well as case management. This service consists of community-based MH and SU services, and structured rehabilitative interventions intended to increase and restore a individuals ability to live successfully in the community. The team approach involves assistance in re-est. the individuals community roles related to the following life domains: emotional, behavioral, social, safety, housing, medical and health, educational, vocational, and legal.
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Reauthorization Guidelines
- 1. TAR: prior authorization required
- 2. Face-to-Face Functional Assessment: Required, used to determine the scope and anticipated outcome of the service. Must be administered during the initial 60-calendar days of tx and up to every 90-calendar days thereafter.
- 3. Complete PCP: recently reviewed detailing the individual’s progress with the service to include all required signatures and the 3-page crisis plan.
- 4. Medicaid Application: Required w/in the 30 days of authorization. Evidence of individual applying for Medicaid or update on application status.
Unit Value
One unit = 15 minutes
Length of Stay
- 1. Up to a 60-day auth period per request.
- 2. No more than 3 months in a rolling year will be authorized.
Exclusions
- 1. CST must not be provided in conjunction with ACT; during the same auth period as any other service that contains duplicative service components (to include TMS or PSS); to individuals residing in Institutions for Mental Disease (IMD), and; Family individuals or LRPs of the individual may not provide this service.
- 2. To help w/ transition, CST services may be provided for a max of 8 units for the first and last 30-day period for individuals who transitioning to or from: ACTT, SAIOP or SACOT.
Level of Care
ASAM Level 1 (if applicable). While the LOCUS/ CALOCUS are specifically no longer required, providers are still expected to use a standardized assessment tool when evaluating an individual for treatment services.
Place of Service
At least 75 percent of CST services must be delivered face-to-face by the team with the beneficiary. At least 75 percent of staff time must be spent working outside of the agency’s facility with or on behalf of the member. CST shall provide “first responder” crisis response 24-hours a day, 7 days a week, 365 days a year, to the member.
How to Submit
Please submit your request to Trillium Health Resources (iTransact for TP Medicaid members and Provider Direct for MCD Direct members)
Resources
Community Support Team (CST)
Provides direct support to adults with a MH, SU, or co-morbid disorder and who have complex and extensive treatment needs. Consists of community-based MH and SU services, and structured rehab interventions intended to increase and restore a member’s ability to live successfully in the community. The team approach involves structured, face-to-face therapeutic interventions that assist in reestablishing the members community roles related to life domains.
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Unit Value
One unit = 15 minutes
Length of Stay
It is expected that service intensity titrates down as the member demonstrates improvement.
Exclusions
- 1. When helping a member transition to and from a service, CST services may be provided for a max of eight units for the first and last 30-day period for members transitioning to: ACTT, SAIOP, SACOT.
- 2. May not be provided in conjunction with ACTT or during the same episode period as any other State Plan service that contains duplicative service components. This includes PSS, as CCP 8G states that PSS must not be provided during the same auth period as CST, as a member who needs CST and peer support will be offered by peer support by the CST providers.
Age Group Details
Adults (age 18 and older)
Level of Care
ASAM Level 1 (if applicable). While the LOCUS/ CALOCUS are specifically no longer required, providers are still expected to use a standardized assessment tool when evaluating an individual for treatment services.
Place of Service
At least 75 percent of CST services must be delivered face-to-face by the team with the beneficiary. At least 75 percent of staff time must be spent working outside of the agency’s facility with
How to Submit
N/A - No authorization is required
Resources
Community Support Team (CST)
Provides direct support to adults with a dx of MH, SU, or comorbid disorder and who have complex and extensive tx needs. This is an intensive community-based rehab team service that provides direct tx and restorative interventions as well as case management. This service consists of community-based MH and SU services, and structured rehabilitative interventions intended to increase and restore a individuals ability to live successfully in the community. The team approach involves assistance in re-est. the individuals community roles related to the following life domains: emotional, behavioral, social, safety, housing, medical and health, educational, vocational, and legal.
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Reauthorization Guidelines
- 1. TAR: prior authorization required
- 2. Face-to-Face Functional Assessment: Required, used to determine the scope and anticipated outcome of the service. Must be administered during the initial 60-calendar days of tx and up to every 90-calendar days thereafter.
- 3. Complete PCP: recently reviewed detailing the individual’s progress with the service to include all required signatures and the 3-page crisis plan.
- 4. Medicaid Application: Required w/in the 30 days of authorization. Evidence of individual applying for Medicaid or update on application status.
Unit Value
One unit = 15 minutes
Length of Stay
- 1. Up to a 60-day auth period per request.
- 2. No more than 3 months in a rolling year will be authorized.
Exclusions
- 1. CST must not be provided in conjunction with ACT; during the same auth period as any other service that contains duplicative service components (to include TMS or PSS); to individuals residing in Institutions for Mental Disease (IMD), and; Family individuals or LRPs of the individual may not provide this service.
- 2. To help w/ transition, CST services may be provided for a max of 8 units for the first and last 30-day period for individuals who transitioning to or from: ACTT, SAIOP or SACOT.
Level of Care
ASAM Level 1 (if applicable). While the LOCUS/ CALOCUS are specifically no longer required, providers are still expected to use a standardized assessment tool when evaluating an individual for treatment services.
Place of Service
At least 75 percent of CST services must be delivered face-to-face by the team with the beneficiary. At least 75 percent of staff time must be spent working outside of the agency’s facility with or on behalf of the member. CST shall provide “first responder” crisis response 24-hours a day, 7 days a week, 365 days a year, to the member.
How to Submit
Please submit your request to Trillium Health Resources (iTransact for TP Medicaid members and Provider Direct for MCD Direct members)
Resources
Community Support Team (CST)
Provides direct support to adults with a MH, SU, or co-morbid disorder and who have complex and extensive treatment needs. Consists of community-based MH and SU services, and structured rehab interventions intended to increase and restore a member’s ability to live successfully in the community. The team approach involves structured, face-to-face therapeutic interventions that assist in reestablishing the members community roles related to life domains.
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Unit Value
One unit = 15 minutes
Length of Stay
It is expected that service intensity titrates down as the member demonstrates improvement.
Exclusions
- 1. When helping a member transition to and from a service, CST services may be provided for a max of eight units for the first and last 30-day period for members transitioning to: ACTT, SAIOP, SACOT.
- 2. May not be provided in conjunction with ACTT or during the same episode period as any other State Plan service that contains duplicative service components. This includes PSS, as CCP 8G states that PSS must not be provided during the same auth period as CST, as a member who needs CST and peer support will be offered by peer support by the CST providers.
Age Group Details
Adults (age 18 and older)
Level of Care
ASAM Level 1 (if applicable). While the LOCUS/ CALOCUS are specifically no longer required, providers are still expected to use a standardized assessment tool when evaluating an individual for treatment services.
Place of Service
At least 75 percent of CST services must be delivered face-to-face by the team with the beneficiary. At least 75 percent of staff time must be spent working outside of the agency’s facility with
How to Submit
N/A - No authorization is required
Resources
Community Support Team (CST)
Provides direct support to adults with a dx of MH, SU, or comorbid disorder and who have complex and extensive tx needs. This is an intensive community-based rehab team service that provides direct tx and restorative interventions as well as case management. This service consists of community-based MH and SU services, and structured rehabilitative interventions intended to increase and restore a individuals ability to live successfully in the community. The team approach involves assistance in re-est. the individuals community roles related to the following life domains: emotional, behavioral, social, safety, housing, medical and health, educational, vocational, and legal.
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Reauthorization Guidelines
- 1. TAR: prior authorization required
- 2. Face-to-Face Functional Assessment: Required, used to determine the scope and anticipated outcome of the service. Must be administered during the initial 60-calendar days of tx and up to every 90-calendar days thereafter.
- 3. Complete PCP: recently reviewed detailing the individual’s progress with the service to include all required signatures and the 3-page crisis plan.
- 4. Medicaid Application: Required w/in the 30 days of authorization. Evidence of individual applying for Medicaid or update on application status.
Unit Value
One unit = 15 minutes
Length of Stay
- 1. Up to a 60-day auth period per request.
- 2. No more than 3 months in a rolling year will be authorized.
Exclusions
- 1. CST must not be provided in conjunction with ACT; during the same auth period as any other service that contains duplicative service components (to include TMS or PSS); to individuals residing in Institutions for Mental Disease (IMD), and; Family individuals or LRPs of the individual may not provide this service.
- 2. To help w/ transition, CST services may be provided for a max of 8 units for the first and last 30-day period for individuals who transitioning to or from: ACTT, SAIOP or SACOT.
Level of Care
ASAM Level 1 (if applicable). While the LOCUS/ CALOCUS are specifically no longer required, providers are still expected to use a standardized assessment tool when evaluating an individual for treatment services.
Place of Service
At least 75 percent of CST services must be delivered face-to-face by the team with the beneficiary. At least 75 percent of staff time must be spent working outside of the agency’s facility with or on behalf of the member. CST shall provide “first responder” crisis response 24-hours a day, 7 days a week, 365 days a year, to the member.
How to Submit
Please submit your request to Trillium Health Resources (iTransact for TP Medicaid members and Provider Direct for MCD Direct members)
Resources
Community Support Team (CST)
Provides direct support to adults with a MH, SU, or co-morbid disorder and who have complex and extensive treatment needs. Consists of community-based MH and SU services, and structured rehab interventions intended to increase and restore a member’s ability to live successfully in the community. The team approach involves structured, face-to-face therapeutic interventions that assist in reestablishing the members community roles related to life domains.
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Unit Value
One unit = 15 minutes
Length of Stay
It is expected that service intensity titrates down as the member demonstrates improvement.
Exclusions
- 1. When helping a member transition to and from a service, CST services may be provided for a max of eight units for the first and last 30-day period for members transitioning to: ACTT, SAIOP, SACOT.
- 2. May not be provided in conjunction with ACTT or during the same episode period as any other State Plan service that contains duplicative service components. This includes PSS, as CCP 8G states that PSS must not be provided during the same auth period as CST, as a member who needs CST and peer support will be offered by peer support by the CST providers.
Age Group Details
Adults (age 18 and older)
Level of Care
ASAM Level 1 (if applicable). While the LOCUS/ CALOCUS are specifically no longer required, providers are still expected to use a standardized assessment tool when evaluating an individual for treatment services.
Place of Service
At least 75 percent of CST services must be delivered face-to-face by the team with the beneficiary. At least 75 percent of staff time must be spent working outside of the agency’s facility with
How to Submit
N/A - No authorization is required
Resources
Community Support Team (CST)
Provides direct support to adults with a dx of MH, SU, or comorbid disorder and who have complex and extensive tx needs. This is an intensive community-based rehab team service that provides direct tx and restorative interventions as well as case management. This service consists of community-based MH and SU services, and structured rehabilitative interventions intended to increase and restore a individuals ability to live successfully in the community. The team approach involves assistance in re-est. the individuals community roles related to the following life domains: emotional, behavioral, social, safety, housing, medical and health, educational, vocational, and legal.
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Reauthorization Guidelines
- 1. TAR: prior authorization required
- 2. Face-to-Face Functional Assessment: Required, used to determine the scope and anticipated outcome of the service. Must be administered during the initial 60-calendar days of tx and up to every 90-calendar days thereafter.
- 3. Complete PCP: recently reviewed detailing the individual’s progress with the service to include all required signatures and the 3-page crisis plan.
- 4. Medicaid Application: Required w/in the 30 days of authorization. Evidence of individual applying for Medicaid or update on application status.
Unit Value
One unit = 15 minutes
Length of Stay
- 1. Up to a 60-day auth period per request.
- 2. No more than 3 months in a rolling year will be authorized.
Exclusions
- 1. CST must not be provided in conjunction with ACT; during the same auth period as any other service that contains duplicative service components (to include TMS or PSS); to individuals residing in Institutions for Mental Disease (IMD), and; Family individuals or LRPs of the individual may not provide this service.
- 2. To help w/ transition, CST services may be provided for a max of 8 units for the first and last 30-day period for individuals who transitioning to or from: ACTT, SAIOP or SACOT.
Level of Care
ASAM Level 1 (if applicable). While the LOCUS/ CALOCUS are specifically no longer required, providers are still expected to use a standardized assessment tool when evaluating an individual for treatment services.
Place of Service
At least 75 percent of CST services must be delivered face-to-face by the team with the beneficiary. At least 75 percent of staff time must be spent working outside of the agency’s facility with or on behalf of the member. CST shall provide “first responder” crisis response 24-hours a day, 7 days a week, 365 days a year, to the member.
How to Submit
Please submit your request to Trillium Health Resources (iTransact for TP Medicaid members and Provider Direct for MCD Direct members)
Resources
Community Support Team (CST)
Provides direct support to adults with a MH, SU, or co-morbid disorder and who have complex and extensive treatment needs. Consists of community-based MH and SU services, and structured rehab interventions intended to increase and restore a member’s ability to live successfully in the community. The team approach involves structured, face-to-face therapeutic interventions that assist in reestablishing the members community roles related to life domains.
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Unit Value
One unit = 15 minutes
Length of Stay
It is expected that service intensity titrates down as the member demonstrates improvement.
Exclusions
- 1. When helping a member transition to and from a service, CST services may be provided for a max of eight units for the first and last 30-day period for members transitioning to: ACTT, SAIOP, SACOT.
- 2. May not be provided in conjunction with ACTT or during the same episode period as any other State Plan service that contains duplicative service components. This includes PSS, as CCP 8G states that PSS must not be provided during the same auth period as CST, as a member who needs CST and peer support will be offered by peer support by the CST providers.
Age Group Details
Adults (age 18 and older)
Level of Care
ASAM Level 1 (if applicable). While the LOCUS/ CALOCUS are specifically no longer required, providers are still expected to use a standardized assessment tool when evaluating an individual for treatment services.
Place of Service
At least 75 percent of CST services must be delivered face-to-face by the team with the beneficiary. At least 75 percent of staff time must be spent working outside of the agency’s facility with
How to Submit
N/A - No authorization is required
Resources
Community Networking
Community Networking services provide individualized day activities that support the member’s definition of a meaningful day in an integrated community setting, with persons who are not disabled. If the member requires paid supports to participate / engage once connected with the activity, Community Networking can be used to refer and link the member. Services are designed to promote maximum participation in community life while developing natural supports within integrated settings. Community Networking services enable the member to increase or maintain their capacity for independence and develop social roles valued by non-disabled members of the community. As the member gains skills and increase community connections, service hours may fade.
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Unit Value
One unit = 15 minutes
Limits
- • Payment for attendance at classes and conferences cannot exceed $1,000/ per member plan year. The amount of community networking services is subject to the “Limits on Sets of Services.”
- • This service is provided separate and apart from the member’s primary private residence, other residential living arrangement, and/or the home of a service provider. These services do not take place in licensed facilities and are intended to offer the member the opportunity to develop meaningful community relationships with non-disabled individuals.
- • Service does not cover the cost of hotels, meals, materials or transportation while attending conferences.
- • Service does not cover activities that would normally be a component of a member’s home/residential life or services.
- • Service does not pay day care fees or fees for other childcare related activities.
- • The waiver member may not volunteer for the Community Networking service provider.
- • Volunteering may not be done at locations that would not typically have volunteers (that is, hair salon or florist) or in positions that would be paid positions if performed by an individual that was not on the waiver.
- • This service may not duplicate or be furnished/claimed at the same time of day as Day Supports, Community Living and Support, Residential Supports, Respite, Supported Employment or one of the State Plan Medicaid services that works directly with the member.• For a member who is eligible for educational services under the Individuals With Disability Educational Act, Community Networking does not cover transportation to/from school settings. (Transportation to/from member’s home or any community location where the member may be receiving services before/after school is covered for this service.)
- • This service does not pay for overnight programs of any kind.
- • Classes that offer one-to-one instruction are not covered.
- • Classes that are in a nonintegrated community setting are not covered.
- • Exclusions, limitations & exceptions detailed in the Eligibility Requirements, Terms of Service, Limits on Sets of Services, General Limitations on Coverage, Relative as Provider, Individual and Family Directed Services, and Claims sections of this Benefit Plan apply.
- • See the CCP for all applicable exclusions, limitations & exceptions.
Additional Service Specifics
Requesting the core service automatically includes the use of the telehealth (GT) code when approved. A separate request is not needed, and the GT service code should not be requested separate from the non-telehealth service code.
How to Submit
Please submit your request to Trillium Health Resources (iTransact for TP Medicaid members and Provider Direct for MCD Direct members)
Resources
Community Networking
Community Networking services provide individualized day activities that support the member’s definition of a meaningful day in an integrated community setting, with persons who are not disabled. If the member requires paid supports to participate / engage once connected with the activity, Community Networking can be used to refer and link the member. Services are designed to promote maximum participation in community life while developing natural supports within integrated settings. Community Networking services enable the member to increase or maintain their capacity for independence and develop social roles valued by non-disabled members of the community. As the member gains skills and increase community connections, service hours may fade.
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Unit Value
One unit = 15 minutes
Limits
- • Payment for attendance at classes and conferences cannot exceed $1,000/ per member plan year. The amount of community networking services is subject to the “Limits on Sets of Services.”
- • This service is provided separate and apart from the member’s primary private residence, other residential living arrangement, and/or the home of a service provider. These services do not take place in licensed facilities and are intended to offer the member the opportunity to develop meaningful community relationships with non-disabled individuals.
- • Service does not cover the cost of hotels, meals, materials or transportation while attending conferences.
- • Service does not cover activities that would normally be a component of a member’s home/residential life or services.
- • Service does not pay day care fees or fees for other childcare related activities.
- • The waiver member may not volunteer for the Community Networking service provider.
- • Volunteering may not be done at locations that would not typically have volunteers (that is, hair salon or florist) or in positions that would be paid positions if performed by an individual that was not on the waiver.
- • This service may not duplicate or be furnished/claimed at the same time of day as Day Supports, Community Living and Support, Residential Supports, Respite, Supported Employment or one of the State Plan Medicaid services that works directly with the member.• For a member who is eligible for educational services under the Individuals With Disability Educational Act, Community Networking does not cover transportation to/from school settings. (Transportation to/from member’s home or any community location where the member may be receiving services before/after school is covered for this service.)
- • This service does not pay for overnight programs of any kind.
- • Classes that offer one-to-one instruction are not covered.
- • Classes that are in a nonintegrated community setting are not covered.
- • Exclusions, limitations & exceptions detailed in the Eligibility Requirements, Terms of Service, Limits on Sets of Services, General Limitations on Coverage, Relative as Provider, Individual and Family Directed Services, and Claims sections of this Benefit Plan apply.
- • See the CCP for all applicable exclusions, limitations & exceptions.
Additional Service Specifics
Requesting the core service automatically includes the use of the telehealth (GT) code when approved. A separate request is not needed, and the GT service code should not be requested separate from the non-telehealth service code.
How to Submit
Please submit your request to Trillium Health Resources (iTransact for TP Medicaid members and Provider Direct for MCD Direct members)
Resources
Residential Supports
Residential Supports provides individualized services and supports to enable a member to live successfully in a Group Home or Alternative Family Living (AFL) setting of their choice and be an active participant in his/her community. The intended outcome of the service is to increase or maintain the member’s life skills, provide the supervision needed, maximize his/her self-sufficiency, increase self- determination, and ensure the person’s opportunity to have full membership in his/her community. Residential Supports includes learning new skills, practice and improvement of existing skills, and retaining skills to assist the person to complete an activity to his/her level of independence. Residential Supports includes supervision and assistance in activities of daily living when the member is dependent on others to ensure health and safety.
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Limits
- 1. Residential Supports may be provided in an AFL situation. The site must be the primary residence of the AFL provider (includes couples and single persons) who receive reimbursement for the cost of care. Primary AFL Staff who provide Residential Supports should not provide other waiver services to the member.
- 2. Individuals are provided opportunities to seek employment and work in competitive integrated settings, engage in community life and control personal resources.
- 3. Individuals select the setting from among available options, including non-disability specific settings and an option for a private unit in a residential setting (with consideration being given to financial resources)
Exclusions
- • The amount of Residential Supports is subject to the Limits on Sets of Services.
- • A member who receives Residential Supports may not receive Home Modifications, Community Living and Supports, Respite (unless the individual resides in an AFL), Supported Living, or State Plan Personal Care Services.
- • Assistive Technology Equipment & Supplies may be accessed when the item belongs to the individual and can transition to other settings with the individual.• This service is not available at the same time of day as Community Networking, Day Supports, Community Living and Supports, Supported Living, Supported Employment or one of the State Plan Medicaid Services that works directly with the person such as Private Duty Nursing.
- • Payments for Residential Supports do not include payments for room and board, the cost of facility maintenance and upkeep.
- • In specific situations, to ensure member health and safety Trillium may approve the AFL to serve as short term back up staff for day services (Day Supports, Community Networking or Supported Employment). This approval must be documented in the Individuals record at both Trillium and the provider agency.
- • Transportation to and from the residence and points of travel in the community is included to the degree that they are not reimbursed by another funding source.
- • NC Innovations respite may also be used to provide temporary relief to individuals who reside in Licensed and Unlicensed AFLs, but it may not be billed on the same day as Residential Supports. Respite may also be provided for participation in non-integrated camps or for participation in non-integrated Support Groups
- • Back-up staff must be employees of the agency.
- • The setting is integrated in and supports full access of a member to the greater community.
- • Settings optimize, but do not regiment, individual initiative, autonomy and independence in making life choices.
- • Settings facilitate individual choice regarding services and supports, and who provides these.
- • In Provider Owned or Controlled Residential Settings: a) Provide, at a minimum, the same responsibilities and protections from eviction that tenants have under the landlord tenant law for the state, county, city or other designated entity; b) Provide privacy in sleeping or living unit; c) Provide freedom and support to control individual schedules and activities, and to have access to food at any time; d) Allow visitors of the member’s choosing at any time; e) Are physically accessible.
- • Refer to North Carolina DHHS’s HCBS Transition Plan for additional information https://www.ncdhhs.gov/about/department-initiatives/home-and-community-based-services-final-rule/hcbs-resources.
- • Exclusions, limitations & exceptions detailed in the Eligibility Requirements, Terms of Service, Limits on Sets of Services, General Limitations on Coverage, Relative as Provider, Individual and Family Directed Services, and Claims sections of this Benefit Plan apply.
- • See the CCP for all applicable exclusions, limitations & exceptions.
Additional Service Specifics
Residential Supports levels are determined by the IBT and other evidence of support need. The SIS Level is only one piece of evidence that may be considered.
Level 1: SIS Level A Level 2: SIS Level B Level 3: SIS Level C and D Level 4: SIS Level E, F, and G
Other Information
Requesting the core service automatically includes the use of the telehealth (GT) code when approved. A separate request is not needed, and the GT service code should not be requested separate from the non-telehealth service code.
How to Submit
Please submit your request to Trillium Health Resources (iTransact for TP Medicaid members and Provider Direct for MCD Direct members)
Resources
Residential Supports
Residential Supports provides individualized services and supports to enable a member to live successfully in a Group Home or Alternative Family Living (AFL) setting of their choice and be an active participant in his/her community. The intended outcome of the service is to increase or maintain the member’s life skills, provide the supervision needed, maximize his/her self-sufficiency, increase self- determination, and ensure the person’s opportunity to have full membership in his/her community. Residential Supports includes learning new skills, practice and improvement of existing skills, and retaining skills to assist the person to complete an activity to his/her level of independence. Residential Supports includes supervision and assistance in activities of daily living when the member is dependent on others to ensure health and safety.
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Limits
- 1. Residential Supports may be provided in an AFL situation. The site must be the primary residence of the AFL provider (includes couples and single persons) who receive reimbursement for the cost of care. Primary AFL Staff who provide Residential Supports should not provide other waiver services to the member.
- 2. Individuals are provided opportunities to seek employment and work in competitive integrated settings, engage in community life and control personal resources.
- 3. Individuals select the setting from among available options, including non-disability specific settings and an option for a private unit in a residential setting (with consideration being given to financial resources)
Exclusions
- • The amount of Residential Supports is subject to the Limits on Sets of Services.
- • A member who receives Residential Supports may not receive Home Modifications, Community Living and Supports, Respite (unless the individual resides in an AFL), Supported Living, or State Plan Personal Care Services.
- • Assistive Technology Equipment & Supplies may be accessed when the item belongs to the individual and can transition to other settings with the individual.• This service is not available at the same time of day as Community Networking, Day Supports, Community Living and Supports, Supported Living, Supported Employment or one of the State Plan Medicaid Services that works directly with the person such as Private Duty Nursing.
- • Payments for Residential Supports do not include payments for room and board, the cost of facility maintenance and upkeep.
- • In specific situations, to ensure member health and safety Trillium may approve the AFL to serve as short term back up staff for day services (Day Supports, Community Networking or Supported Employment). This approval must be documented in the Individuals record at both Trillium and the provider agency.
- • Transportation to and from the residence and points of travel in the community is included to the degree that they are not reimbursed by another funding source.
- • NC Innovations respite may also be used to provide temporary relief to individuals who reside in Licensed and Unlicensed AFLs, but it may not be billed on the same day as Residential Supports. Respite may also be provided for participation in non-integrated camps or for participation in non-integrated Support Groups
- • Back-up staff must be employees of the agency.
- • The setting is integrated in and supports full access of a member to the greater community.
- • Settings optimize, but do not regiment, individual initiative, autonomy and independence in making life choices.
- • Settings facilitate individual choice regarding services and supports, and who provides these.
- • In Provider Owned or Controlled Residential Settings: a) Provide, at a minimum, the same responsibilities and protections from eviction that tenants have under the landlord tenant law for the state, county, city or other designated entity; b) Provide privacy in sleeping or living unit; c) Provide freedom and support to control individual schedules and activities, and to have access to food at any time; d) Allow visitors of the member’s choosing at any time; e) Are physically accessible.
- • Refer to North Carolina DHHS’s HCBS Transition Plan for additional information https://www.ncdhhs.gov/about/department-initiatives/home-and-community-based-services-final-rule/hcbs-resources.
- • Exclusions, limitations & exceptions detailed in the Eligibility Requirements, Terms of Service, Limits on Sets of Services, General Limitations on Coverage, Relative as Provider, Individual and Family Directed Services, and Claims sections of this Benefit Plan apply.
- • See the CCP for all applicable exclusions, limitations & exceptions.
Additional Service Specifics
Residential Supports levels are determined by the IBT and other evidence of support need. The SIS Level is only one piece of evidence that may be considered.
Level 1: SIS Level A Level 2: SIS Level B Level 3: SIS Level C and D Level 4: SIS Level E, F, and G
Other Information
Requesting the core service automatically includes the use of the telehealth (GT) code when approved. A separate request is not needed, and the GT service code should not be requested separate from the non-telehealth service code.
How to Submit
Please submit your request to Trillium Health Resources (iTransact for TP Medicaid members and Provider Direct for MCD Direct members)
Resources
Residential Supports
Residential Supports provides individualized services and supports to enable a member to live successfully in a Group Home or Alternative Family Living (AFL) setting of their choice and be an active participant in his/her community. The intended outcome of the service is to increase or maintain the member’s life skills, provide the supervision needed, maximize his/her self-sufficiency, increase self- determination, and ensure the person’s opportunity to have full membership in his/her community. Residential Supports includes learning new skills, practice and improvement of existing skills, and retaining skills to assist the person to complete an activity to his/her level of independence. Residential Supports includes supervision and assistance in activities of daily living when the member is dependent on others to ensure health and safety.
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Limits
- 1. Residential Supports may be provided in an AFL situation. The site must be the primary residence of the AFL provider (includes couples and single persons) who receive reimbursement for the cost of care. Primary AFL Staff who provide Residential Supports should not provide other waiver services to the member.
- 2. Individuals are provided opportunities to seek employment and work in competitive integrated settings, engage in community life and control personal resources.
- 3. Individuals select the setting from among available options, including non-disability specific settings and an option for a private unit in a residential setting (with consideration being given to financial resources)
Exclusions
- • The amount of Residential Supports is subject to the Limits on Sets of Services.
- • A member who receives Residential Supports may not receive Home Modifications, Community Living and Supports, Respite (unless the individual resides in an AFL), Supported Living, or State Plan Personal Care Services.
- • Assistive Technology Equipment & Supplies may be accessed when the item belongs to the individual and can transition to other settings with the individual.• This service is not available at the same time of day as Community Networking, Day Supports, Community Living and Supports, Supported Living, Supported Employment or one of the State Plan Medicaid Services that works directly with the person such as Private Duty Nursing.
- • Payments for Residential Supports do not include payments for room and board, the cost of facility maintenance and upkeep.
- • In specific situations, to ensure member health and safety Trillium may approve the AFL to serve as short term back up staff for day services (Day Supports, Community Networking or Supported Employment). This approval must be documented in the Individuals record at both Trillium and the provider agency.
- • Transportation to and from the residence and points of travel in the community is included to the degree that they are not reimbursed by another funding source.
- • NC Innovations respite may also be used to provide temporary relief to individuals who reside in Licensed and Unlicensed AFLs, but it may not be billed on the same day as Residential Supports. Respite may also be provided for participation in non-integrated camps or for participation in non-integrated Support Groups
- • Back-up staff must be employees of the agency.
- • The setting is integrated in and supports full access of a member to the greater community.
- • Settings optimize, but do not regiment, individual initiative, autonomy and independence in making life choices.
- • Settings facilitate individual choice regarding services and supports, and who provides these.
- • In Provider Owned or Controlled Residential Settings: a) Provide, at a minimum, the same responsibilities and protections from eviction that tenants have under the landlord tenant law for the state, county, city or other designated entity; b) Provide privacy in sleeping or living unit; c) Provide freedom and support to control individual schedules and activities, and to have access to food at any time; d) Allow visitors of the member’s choosing at any time; e) Are physically accessible.
- • Refer to North Carolina DHHS’s HCBS Transition Plan for additional information https://www.ncdhhs.gov/about/department-initiatives/home-and-community-based-services-final-rule/hcbs-resources.
- • Exclusions, limitations & exceptions detailed in the Eligibility Requirements, Terms of Service, Limits on Sets of Services, General Limitations on Coverage, Relative as Provider, Individual and Family Directed Services, and Claims sections of this Benefit Plan apply.
- • See the CCP for all applicable exclusions, limitations & exceptions.
Additional Service Specifics
Residential Supports levels are determined by the IBT and other evidence of support need. The SIS Level is only one piece of evidence that may be considered.
Level 1: SIS Level A Level 2: SIS Level B Level 3: SIS Level C and D Level 4: SIS Level E, F, and G
Other Information
Requesting the core service automatically includes the use of the telehealth (GT) code when approved. A separate request is not needed, and the GT service code should not be requested separate from the non-telehealth service code.
How to Submit
Please submit your request to Trillium Health Resources (iTransact for TP Medicaid members and Provider Direct for MCD Direct members)
Resources
Residential Supports
Residential Supports provides individualized services and supports to enable a member to live successfully in a Group Home or Alternative Family Living (AFL) setting of their choice and be an active participant in his/her community. The intended outcome of the service is to increase or maintain the member’s life skills, provide the supervision needed, maximize his/her self-sufficiency, increase self- determination, and ensure the person’s opportunity to have full membership in his/her community. Residential Supports includes learning new skills, practice and improvement of existing skills, and retaining skills to assist the person to complete an activity to his/her level of independence. Residential Supports includes supervision and assistance in activities of daily living when the member is dependent on others to ensure health and safety.
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Limits
- 1. Residential Supports may be provided in an AFL situation. The site must be the primary residence of the AFL provider (includes couples and single persons) who receive reimbursement for the cost of care. Primary AFL Staff who provide Residential Supports should not provide other waiver services to the member.
- 2. Individuals are provided opportunities to seek employment and work in competitive integrated settings, engage in community life and control personal resources.
- 3. Individuals select the setting from among available options, including non-disability specific settings and an option for a private unit in a residential setting (with consideration being given to financial resources)
Exclusions
- • The amount of Residential Supports is subject to the Limits on Sets of Services.
- • A member who receives Residential Supports may not receive Home Modifications, Community Living and Supports, Respite (unless the individual resides in an AFL), Supported Living, or State Plan Personal Care Services.
- • Assistive Technology Equipment & Supplies may be accessed when the item belongs to the individual and can transition to other settings with the individual.• This service is not available at the same time of day as Community Networking, Day Supports, Community Living and Supports, Supported Living, Supported Employment or one of the State Plan Medicaid Services that works directly with the person such as Private Duty Nursing.
- • Payments for Residential Supports do not include payments for room and board, the cost of facility maintenance and upkeep.
- • In specific situations, to ensure member health and safety Trillium may approve the AFL to serve as short term back up staff for day services (Day Supports, Community Networking or Supported Employment). This approval must be documented in the Individuals record at both Trillium and the provider agency.
- • Transportation to and from the residence and points of travel in the community is included to the degree that they are not reimbursed by another funding source.
- • NC Innovations respite may also be used to provide temporary relief to individuals who reside in Licensed and Unlicensed AFLs, but it may not be billed on the same day as Residential Supports. Respite may also be provided for participation in non-integrated camps or for participation in non-integrated Support Groups
- • Back-up staff must be employees of the agency.
- • The setting is integrated in and supports full access of a member to the greater community.
- • Settings optimize, but do not regiment, individual initiative, autonomy and independence in making life choices.
- • Settings facilitate individual choice regarding services and supports, and who provides these.
- • In Provider Owned or Controlled Residential Settings: a) Provide, at a minimum, the same responsibilities and protections from eviction that tenants have under the landlord tenant law for the state, county, city or other designated entity; b) Provide privacy in sleeping or living unit; c) Provide freedom and support to control individual schedules and activities, and to have access to food at any time; d) Allow visitors of the member’s choosing at any time; e) Are physically accessible.
- • Refer to North Carolina DHHS’s HCBS Transition Plan for additional information https://www.ncdhhs.gov/about/department-initiatives/home-and-community-based-services-final-rule/hcbs-resources.
- • Exclusions, limitations & exceptions detailed in the Eligibility Requirements, Terms of Service, Limits on Sets of Services, General Limitations on Coverage, Relative as Provider, Individual and Family Directed Services, and Claims sections of this Benefit Plan apply.
- • See the CCP for all applicable exclusions, limitations & exceptions.
Additional Service Specifics
Residential Supports levels are determined by the IBT and other evidence of support need. The SIS Level is only one piece of evidence that may be considered.
Level 1: SIS Level A Level 2: SIS Level B Level 3: SIS Level C and D Level 4: SIS Level E, F, and G
Other Information
Requesting the core service automatically includes the use of the telehealth (GT) code when approved. A separate request is not needed, and the GT service code should not be requested separate from the non-telehealth service code.
How to Submit
Please submit your request to Trillium Health Resources (iTransact for TP Medicaid members and Provider Direct for MCD Direct members)
Resources
If you find any wrong or out of date information on our pages, we want to know. Please email info@TrilliumNC.org with any corrections.