“Interrupted Eligibility”; DLSS Change

Interrupted Eligibility Segments

There are times when a member has an interruption in eligibility which prevents APS Healthcare from completing an authorization for the length of time requested.

If the eligibility was interrupted at the point of a Registration or a Prior Authorization:

When the member regains uninterrupted MaineCare eligibility, the provider should call the Provider Relations department at APS Healthcare and request that the Provider Relations staff extend the date of service to match the original request (as reflected in the service grid).

If the eligibility was interrupted at the point of a Continued Stay Request:

When the member regains uninterrupted MaineCare eligibility, the provider must submit a Continued Stay Review to request another authorization (based on client need).

When this occurs at the point of a Continued Stay Request, provider agencies will see the following status in the download notification, for that particular case:

Status: CM Authorized with Changes

Definition: Request has been authorized at requested current level of service, however, the

authorization end date has been changed and units pro-rated due to member eligibility issues.

Provider Note Example: Member is only eligible until 2/29/08. Please submit Continued Stay Request for remainder of authorization when member becomes MaineCare eligible.

Service Grid Change for DLSS Services takes effect in CareConnection 4/14/08

In consultation with DHHS the following is changing for DLSS Services on 4/14/08:

• The initial authorization period is changing from 90 days, to a 30 day Assessment period, similar to other services such as Adult Home Based Service
• The Initial Authorization units are changing from 104 to 8
• The purpose of this change is so that the Initial Authorization will be used by the provider to conduct an initial assessment of the client’s need for DLSS services
• The typical Continued Stay Authorization remains unchanged at 90 days