CI, DLSS and ACT Grant Funded Authorization with APS Healthcare FAQ - 3/26/09

1. Q: How is a consumer considered eligible for Grant Funded Services?

A: The consumer must meet Section 17 eligibility criteria for Community Integration (CI), Assertive Community Treatment (ACT) and Daily Living Support Services (DLSS) for FY2009.

2. Q: Is a non-class member consumer, who is currently being discharged from a partial hospital program or IOP eligible for Grant Funding?

A: Yes, if the consumer meets Section 17 eligibility criteria.

3. Q: Is a non-class member, pre-existing Grant Funded consumer who was eligible for Grant Funding in the past for being discharged from a hospital, jail or CSU, eligible for continued Grant Funding?

A: Yes, if current eligible diagnosis criteria are met.

4. Q: How does APS respond to a Grant Funded PA request, if the consumer is not eligible?

A: Requests for Grant Funded services that are ineligible are denied.

5. Q: Will APS find the consumer eligible if DHHS approves a waiver for Grant Funding?

A: Yes. If DHHS grants a waiver for an otherwise ineligible consumer, the person is no longer considered ineligible and APS will approve the request.

6. Q: How can a provider request a waiver from the eligibility criteria for a consumer?

A: The provider can request a waiver by contacting their local DHHS Adult Mental Health Team Lead who will administer a waiver number to be included in the additional information box of the APS review as submitted by the provider.

7. Q: Is Non-Categorical MaineCare by itself enough for a person to be eligible for Grant Funding?

A: Yes. A member is eligible for Grant Funding if they meet Section 17 eligibility criteria.

8. Q: Is low income (under 150% of federal poverty guidelines) by itself enough for a person to be eligible for Grant Funding? 

A: Yes. A member is eligible for Grant Funding if they meet Section 17 eligibility criteria.

9. Q: Will a non-class member’s eligibility for Grant Funded services be considered at each Continued Stay Review?

A: Yes. Documentation of Grant Funded services eligibility must be submitted with each Continued Stay Review.

10. Q: Should providers discharge consumers’ prior PA or CSR in APS CareConnection® prior to submitting a Grant Funded PA?

A: No.

11. Q: Should providers discharge consumers’ prior Grant Funded PA or Grant Funded CSR in APS CareConnection® before submitting a MaineCare funded CSR when a consumer obtains full MaineCare eligibility?

A: No. The provider should submit a CSR in APS CareConnection® by extending off the consumer’s last authorized MaineCare funded review and update the clinical information and request a backdate from APS Care Manager to match member’s MaineCare eligibility reinstatement date.

12. Q: Can a Grant Funded consumer who obtains full MaineCare eligibility and then loses full MaineCare eligibility, return back to Grant Funding without a waiver from OAMHS?

A: Yes. The provider should submit a Grant Funded CSR in APS
CareConnection® by extending off the consumer’s last authorized Grant Funded review in order to return back to Grant Funding. (This only applies to Grant Funded approved consumers since 9/1/08, not “first time” Grant requests).

13. Q: Can a Grant Funded consumer who is hospitalized inpatient or in jail for a period of time, return to Grant Funding without a waiver from OAMHS, upon return to community services?

A: Yes. The provider should submit a Grant Funded CSR in APS CareConnection® by extending off the consumer’s last authorized Grant Funded review in order to return back to Grant Funding. (This only applies to Grant Funded approved consumers since 9/1/08, not “first time” Grant requests).

14. Q: How do providers submit a Contact for Service Notification for consumers who are on a wait list for Grant Funded services?

A: Please go to the following link for instructions: 
www.qualitycareforme.com/MaineProvider_Update012309.htm

15. Q: Do providers request Grant Funding via an APS review to cover community support services while consumers are at Riverview, Dorothea Dix or prison for extended periods of time (months)?

A: No. Providers should request funding for these consumers by directly contacting their local DHHS Adult Mental Health Team Lead.

16. Q: Should a provider ever use the “Edit” button at the top of the page of a Grant Funded review?

A: No. This button is not to be used by providers and if pressed, will block the review from functioning properly for authorization once the review is submitted to APS. Please do not use the “Edit” button on Grant Funded reviews.

17. Q: What is the easiest and most accurate way to search for consumer’s last authorized Grant Funded review?

A: By using the “Search Request” tab, enter the consumer’s first and last name (spelling must be correct) and hit “Search”. Be careful to look for the Grant Funded reviews under “Auth Type” and then look for the most recent “Submit Date” and then be sure to check if the review was processed by checking Status”.