Service Authorization. 19.1 Contractor will collaborate with County to complete authorization requests in line with County and DHCS policy and Contract Exhibit A. [BHRS-77: Substance Use Residential Authorization] 19.2 Contractor shall respond to County within 24 hours when consultation is necessary for County to make appropriate authorization determinations. 19.3 County shall provide Contractor with written notice of authorization determinations within the timeframes set forth in BHIN 24-001, or any subsequent DHCS notices. 19.4 For SUD Non-Residential and Non-Inpatient Levels of Care service authorization: 19.4.1 Contractor shall follow County’s policies and procedures around non-residential/non- inpatient levels of care according to BHIN 24-001. 19.4.2 Contractor is not required to obtain service authorization for non-residential/non-inpatient levels of care. Prior authorization is prohibited for non-residential DMC-ODS services. 19.5 For SUD Residential and Inpatient Levels of Care service authorization: 19.5.1 Contractor shall have in place, and follow, County written authorization policies and procedures for processing requests for initial and continuing authorization, or prior authorization, for residential treatment services, including inpatient services, but excluding withdrawal management services. 19.6.2 County will review the DSM and ASAM Criteria to ensure that the beneficiary meets the requirements for the service. 19.6.3 Prior authorization for residential and inpatient services (excluding withdrawal management services) shall be made within 24 hours of the prior authorization request being submitted by the provider. 19.6.3.1 County will ensure that prior authorization processes are completed in a manner that assures the provision of a covered SUD service to a client in a timely manner appropriate for the client’s condition. 19.6.4 Contractor shall alert County when an expediated service authorization decision is necessary due to a client’s specific needs and circumstances that could seriously jeopardize the client’s life or health, or ability to attain, maintain, or regain maximum function. Expediated service authorizations shall not exceed 72 hours after receipt of the request for service, with a possible extension of up to 14 calendar days if the client or provider requests an extension. 19.6.5 Contractor shall alert County when a standard authorization decision is necessary. Standard service authorizations shall not exceed 14 calendar days following receipt of the request for service, with a possible extension of up to 14 additional calendar days if the client or provider requests an extension.
Appears in 4 contracts
Samples: Services Agreement, Professional Services, Professional Services
Service Authorization. 19.1 Contractor will collaborate with County to complete authorization requests in line with County and DHCS policy and Contract Exhibit A. [BHRS-77: Substance Use Residential Authorization]
19.2 Contractor shall respond to County within 24 hours when consultation is necessary for County to make appropriate authorization determinations.
19.3 County shall provide Contractor with written notice of authorization determinations within the timeframes set forth in BHIN 2423-001, or any subsequent DHCS notices.
19.4 For SUD Non-Residential and Non-Inpatient Levels of Care service authorization:
19.4.1 Contractor shall follow County’s policies and procedures around non-residential/non- inpatient levels of care according to BHIN 2423-001.
19.4.2 Contractor is not required to obtain service authorization for non-residential/non-inpatient levels of care. Prior authorization is prohibited for non-residential DMC-ODS services.
19.5 For SUD Residential and Inpatient Levels of Care service authorization:
19.5.1 Contractor shall have in place, and follow, County written authorization policies and procedures for processing requests for initial and continuing authorization, or prior authorization, for residential treatment services, including inpatient services, but excluding withdrawal management services.
19.6.2 County will review the DSM and ASAM Criteria to ensure that the beneficiary meets the requirements for the service.
19.6.3 Prior authorization for residential and inpatient services (excluding withdrawal management services) shall be made within 24 hours of the prior authorization request being submitted by the provider.
19.6.3.1 County will ensure that prior authorization processes are completed in a manner that assures the provision of a covered SUD service to a client in a timely manner appropriate for the client’s condition.
19.6.4 Contractor shall alert County when an expediated service authorization decision is necessary due to a client’s specific needs and circumstances that could seriously jeopardize the client’s life or health, or ability to attain, maintain, or regain maximum function. Expediated service authorizations shall not exceed 72 hours after receipt of the request for service, with a possible extension of up to 14 calendar days if the client or provider requests an extension.
19.6.5 Contractor shall alert County when a standard authorization decision is necessary. Standard service authorizations shall not exceed 14 calendar days following receipt of the request for service, with a possible extension of up to 14 additional calendar days if the client or provider requests an extension.
Appears in 4 contracts
Samples: Professional Services, Professional Services, Professional Services Contract
