In Lieu of Services. The Contractor may offer cost effective alternative services/equipment to members, where the services/equipment are not identified as an in-plan benefit, when EOHHS has determined that the use of such alternative services/equipment are medically appropriate and cost effective. The Contractor may not require the member to accept an in lieu of service in the place of a covered service. The Contractor has flexibility and may provide all the in lieu of services identified in ATTACHMENT A. If the Contractor seeks to provide an in lieu of service that is not listed in ATTACHMENT A, the Contractor must receive prior authorization from EOHHS to deliver the proposed service as defined in EOHHS MCO Core Contract Requirements for Requesting In Lieu of Services. The Contractor must follow the procedures below for obtaining prior approval for in lieu of services not identified in ATTACHMENT A. • Requests for prior authorization must be submitted by the Contractor only; • Requests for prior authorization must be submitted through completion of the “Request for Cost-Effective Alternative (CEA)” form along with any accompanying documentation; • Submission must be sent by secure email to the designated EOHHS employee; and • To ensure EOHHS has the opportunity to adequately consider all requests for in lieu of services, the Contractor should submit the request at least 30 days prior to the desired date of service. In addition to the services identified in ATTACHMENT A as in lieu of services, another example of an approved in lieu of service is: • Psychiatric or substance use disorder treatment services provided in an Institution for Mental Disease (IMD) for members between the ages of 21-64, subject to the limitations described in 42 C.F.R. § 438.6(e).
In Lieu of Services. The Contractor may offer In-Lieu of Services (ILOS), as approved by EOHHS, in accordance with the policies and procedures defined in EOHHS MCO Core Contract Requirements for Requesting In Lieu of Services. ILOS may be substituted for a Rhode Island Medicaid State Plan service when all of the following conditions are met:
In Lieu of Services. The projected benefit costs do not include costs for in lieu of services.
In Lieu of Services. 5.9.1 The PASSE may provide in lieu of services to an enrolled member in an Institution for Mental Diseases for fifteen (15) days per month in accordance with 42 CFR § 438.6(e) when the PASSE determines that the in lieu of services will reduce cost and avoid institutional placement or enhance the enrolled member’s ability to move from an institutional or residential setting to a HCBS setting. DHS will periodically review any stays in an IMD.
In Lieu of Services. Services that are provided in lieu of a required covered benefit. These services are not part of the PASSE covered benefit, but because of special circumstances, it is deemed more cost effective to provide a non-covered service in lieu of more expensive institutional care which is covered under the PASSE program. For services provided in an Institution for Mental Diseases, the PASSE must ensure compliance with 42 CFR § 438.6(e).
In Lieu of Services. 2.1.51.1 An “
In Lieu of Services. An HMO may cover services for a member that are in addition to those services covered under the state plan per 42 CFR §438.3(e). In lieu of services can be covered by HMOs on a voluntary basis as follows:
In Lieu of Services. As noted earlier, ODM began permitting the use of IMDs as an in-lieu-of service effective July 1, 2017. Consistent with the rate-setting guidance published by CMS, in reviewing the impact of this program adjustment we did not use the unit cost of the IMD, and instead utilized the unit cost for that of existing state plan providers.
In Lieu of Services. Effective July 1, 2017, ODM began permitting the use of IMDs as an in-lieu-of service for the 21 to 64-year-old population for up to 15 days per month. This program change was implemented in compliance with the conditions outlined in the final Medicaid managed care regulations. Consistent with the rate-setting guidance published by CMS, in reviewing the impact of this program adjustment we did not use the unit cost of the IMD, and instead utilized the unit cost for that of existing state plan providers.
In Lieu of Services. In accordance with 42 CFR 438.3(e)(2), the MCOP may propose coverage for services that are in lieu of services under the Ohio Medicaid state plan (in lieu of services). In lieu of services must be prior approved by ODM in writing. The MCOP must not require a member to use an in lieu of service as an alternative to a service covered under the state plan.
