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APS Healthcare was hired by the Department of Health and Human Services (DHHS) to look at the use of some of the mental health and substance use services in Maine. We started December 1, 2007. We primarily look at and approve services that are paid for by MaineCare. We are called an Administrative Services Organization (ASO). This means we are paid to manage the services. We do not provide any services like a mental health agency. We get paid a flat rate. We do not get paid more or less if we approve a lot of service or a little.
This is how the process works. You and your provider agree on how that provider can best help you, your child, or your family member. You both agree on a treatment plan. The provider sends this clinical information to APS Healthcare. This is called a service review. It should be the same information that is on the treatment plan you or your family member make with the provider.
APS Healthcare will look at the information from the provider. We look at it based on guidelines called Level of Care criteria. These guidelines, along with diagnosis, strengths, supports, and treatment plan, are what we use to make a decision to approve the provider’s request.
If the service asked for by the provider based on the clinical information is the right care for you, your child, or your family member, then APS Healthcare will authorize, or OK the request. When we give the OK, we give the provider a number to bill MaineCare for the service. Many services are approved as requested by the providers.
Your provider can keep asking to continue services as long as clinically necessary. Every authorization, or OK, that we give has a time limit. As an example, your provider may get the OK to provide case management services for 6 months. At the end of 6 months, that provider needs to let us know that he or she wants to continue services. APS asks the provider to give us more information to explain why those services are still needed. We are interested in knowing how you, your child, or family members are doing, and how the treatment is helping you, your child or family member.
Our goal is to promote each member’s recovery, resiliency, and ability to live in the community of his or her choice. It is also to improve the quality of mental health and substance use services in Maine.
If you have any questions about what we do, please call APS Healthcare Member Services at 1-866-521-0027/ (TTY/TDD) 207-239-3252, or use your Sorenson VRS.
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