| Category | Flexibility / Change Description | Partners UM Guidance |
| 1915(i) | 1915(i) Individual and Transitional Support: Service may be provided by two-way, real-time audio and video as well as telephonically. |
Providers may use GT and KX modifiers. No authorization required at this time. |
| 1915(i) | 1915(i) Supported Employment for Individuals with Intellectual and developmental disabilities, service may be provided by two-way, real time audio and video, as well as telephonically. | Providers may use GT and KX modifiers. |
| 1915(i) | 1915(i) Community Living and Support: Service may be provided by two-way, real-time audio and video. |
Providers may use the GT modifier available under the All Code. |
| Behavioral Health Services | Ambulatory Withdrawal Management with Extended On-Site Monitoring: Waive authorization requirement after the first three days of service has been provided.
Waive staff training requirements for length of the state of emergency or unless otherwise notified. (CCP 8A-8) |
No authorization required at this time. |
| Behavioral Health Services | Ambulatory Withdrawal Management without Extended On-Site Monitoring: Waive requirement for authorization after the first three days of service has been provided.
Waive staff training requirements for length of the state of emergency or unless otherwise notified. (CCP 8A-7) |
No authorization required at this time.
|
| Behavioral Health Services | Assertive Community Treatment Team: Real-time, two-way interactive audio and video telehealth.
Telephonic if telehealth not accessible. Waive prior authorization and reauthorization. (CCP 8A-1) |
Providers may use the GT and KX modifiers (Medicaid & State). No authorization required at this time. |
| Behavioral Health Services | Child and Adolescent Day Treatment: Allow service to be provided outside of the facility by telehealth, telephonically or in-person, including in the person’s residence. Service may also be provided outside of school hours. (CCP 8A). |
Provider may use GT (telehealth) and KX (telephonic). (Medicaid and State) |
| Behavioral Health Services | Community Support Team: Real-time, two-way interactive audio and video telehealth. Telephonic if telehealth not accessible.
Allow functional assessments and crisis interventions to be completed by telehealth or telephonic modalities, as clinically appropriate. Waive auth requirement after 30-day pass-through. Waive reauthorization requirement. Waive maximum of eight units for first and last 30-day period for individuals transitioning to and from other services and allow for 40 units of service overlap. Waive Comprehensive Clinical Assessment beyond six months of treatment.
(CCP 8A-6) |
Provider may use the GT and KX modifiers. (Medicaid and State). No authorization required at this time. |
| Behavioral Health Services | Developmental and Psychological Testing provided via telehealth:96112, 96113, 96136, 96137, 96138, 96139 (Policy 8C) | Provider may use GT modifier. (Medicaid and State) |
| Behavioral Health Services | Diagnostic Assessment: Waive prior authorization for additional units beyond one unmanaged Diagnostic Assessment per state fiscal year. (Policy 8A-5) | No authorization required. |
| Behavioral Health Services | Facility-Based Crisis Services for Children and Adolescents:
Waive requirement that authorization request must be submitted within two business days of admission. Allow service to be provided outside of the facility by telehealth, to include psychologist. (CCP 8A-2) |
No authorization required at this time. |
| Behavioral Health Services | Intensive In-Home:
Waive prior authorization for Initial and Concurrent requests. Real-time, two-way interactive audio and video telehealth Telephonic may be used if telehealth is not available. (CCP 8A) |
Provider may use GT modifier. Provider may use KX modifier if telehealth is not available (Medicaid and State). No authorization required at this time. |
| Behavioral Health Services | Multisystemic Therapy:
Waive prior authorization for Initial and Concurrent requests. Waive maximum limit of 3-5 months duration of service. Waive limit of 480 units over 3 months. Real-time, two-way interactive audio and video telehealth Telephonic may be used if telehealth is not available (CCP 8A) |
Provider may use GT and KX modifiers (Medicaid and State). No authorization required at this time. |
| Behavioral Health Services | Partial Hospitalization: Allow service to be provided outside of the facility by telehealth, telephonically or in-person, including in the person’s residence.Waive Initial Authorization. (CCP 8A) |
Provider may use GT or KX modifiers (Medicaid and State). No authorization required at this time. |
| Behavioral Health Services | Peer Support Services: Waive the requirement for telehealth or telephonically, audio-only communication be limited to 20% or less of total service time provided per beneficiary per fiscal year.Waive initial and reauthorization. (CCP 8G) |
Providers may use GT and KX modifiers. No authorization required at this time. |
| Behavioral Health Services | Psychosocial Rehabilitation: Waive requirement for a minimum of five hours per day, five days a week of service availability.
-Service must be available a minimum of 10 hours per week. Allow service to be provided outside of the facility by telehealth, telephonically or in-person, including in the person’s residence. (CCP 8A) |
Provider may use GT or KX modifiers. (Medicaid and State). No authorization required. |
| Behavioral Health Services | Psychiatric Residential Treatment Facilities for Children (PRTF):
Allow psychiatrist to provide services via telehealth instead of providing on-site at the facility. Allow licensed therapist(s) to provide services via telehealth instead of providing on-site at the facility. (CCP 8D-1) |
UM will allow retro review (Medicaid and State). Notification SAR is required for pass-through. Retro allowed (Medicaid and State). |
| Behavioral Health Services | Research Based – Behavioral Health Treatment (RB-BHT):
If two-way audiovisual options are not accessible to the beneficiary, the following services may be offered by telephonic modality: 97151, 97152, 97153, 97154, and 97155. (Policy 8F) |
KX modifier is available in the All-Code authorization. Providers should bill the appropriate code. |
| Behavioral Health Services | Residential Treatment Services Level I – Family Type:
Allow QP, licensed professional, psychologist, psychiatrist to provide treatment and consultation by telehealth and/or telephonically, as clinically indicated and based on level of expertise, instead of providing on-site at the facility. All supervision and daily structure services must be provided in-person by the appropriate staff. Waive reauthorization. (CCP 8D-2) |
Notification SAR required for pass-through, initial, and concurrent requests (no clinical documentation needed). Allow retro (Medicaid and State). |
| Behavioral Health Services | Residential Treatment Services Level II – Family Type:
Allow QP, licensed professional, psychologist, psychiatrist to provide treatment and consultation by telehealth and/or telephonically, as clinically indicated and based on level of expertise, instead of providing on-site at the facility. All supervision and daily structure services must be provided in-person by the appropriate staff. Waive reauthorization. (CCP 8D-2) |
Notification SAR required for pass-through, initial, and concurrent requests (no clinical documentation needed). Allow retro (Medicaid and State). |
| Behavioral Health Services | Residential Treatment Services Level II – Program Type:
Allow QP, social worker, psychologist or psychiatrist to provide treatment, services and consultation by telehealth and telephonically, as clinically indicated and based on level of expertise, instead of providing on-site at the facility. Waive reauthorization. (CCP 8D-2) |
Notification SAR required for pass-through, initial, and concurrent requests (no clinical documentation needed). Allow retro (Medicaid and State). |
| Behavioral Health Services | Residential Treatment Services Level III:
Allow QP, social worker, psychologist or psychiatrist to provide treatment, services and consultation by telehealth and telephonically, as clinically indicated and based on level of expertise, instead of providing on-site at the facility. (CCP 8D-2) |
Notification SAR required for pass-through (no clinical documentation needed). Allow retro (Medicaid and State). |
| Behavioral Health Services | Residential Treatment Services Level IV:
Allow social worker, psychologist or psychiatrist to provide services via telehealth instead of providing them in-person at facility. (CCP 8D-2_ |
Notification SAR required for pass-through (no clinical documentation needed). Allow retro (Medicaid and State). |
| Behavioral Health Services | Substance Abuse Comprehensive Outpatient Treatment: Waive reauthorization after the initial 60-day pass through.
Waive Urine Drug Screening requirements. Waive requirement for family counseling if family is unavailable or unwilling to participate in telehealth or telephonic interventions. Waive the required for minimum service availability of four hours per day, five days per week. -Service must be provided for a minimum of two hours of treatment per day, five days per week to bill for the service. Allow service to be provided outside of the facility by telehealth, telephonically or in-person, including in the person’s residence. (CCP 8A) |
Provider may use the GT or KX modifiers. (Medicaid and State). No authorization required at this time.
|
| Behavioral Health Services | Substance Abuse Intensive Outpatient Program: Waive Urine Drug Screening requirements. Waive requirement for family counseling if the family is unavailable or unwilling to participate in telehealth or telephonic interventions.
Waive reauthorization after the initial 30-day pass through. Allow service to be provided outside of the facility by telehealth, telephonically or in-person, including in the person’s residence. Waive the required minimum service availability of three hours per day, three days per week. -Service must be provided for a minimum of 1.5 hours of treatment per day, three days per week to bill for the service. (CCP 8A) |
Provider may use GT or KX modifier (Medicaid and State). No authorization required at this time.
|
| Behavioral Health Services | Substance Abuse Non-Medical Community Residential Treatment: Waive prior authorization and reauthorization request.
Allow LCAS and CCS to provide services by telehealth or telephonically in lieu of being provided in-person at the facility. (CCP 8A) |
Provider may use GT or KX modifier. (Medicaid and State). No authorization required at this time.
|
| Behavioral Health Services | Substance Abuse Medically Monitored Community Residential Treatment: Waive prior authorization and reauthorization request.
Allow LCAS and CCS to provide services by telehealth or telephonically in lieu of being provided in-person at the facility. (CCP 8A) |
Provider may use GT or KX modifier. (Medicaid and State). No authorization required at this time.
|
| Behavioral Health Services | Transition Management Services: Allow use of telehealth, two-way, real time interactive audio and video, to provide care and services when participants are in different physical locations. | Provider may use the GT modifier. (State Only) No authorization required at this time. |
| Behavioral Health Services | Therapeutic Leave for Residential Treatment Services Level I-IV:
Allow an increase of Therapeutic Leave days from 45 days to 90 days. (CCP 8D-2) |
No prior authorization required (Medicaid and State). |
| I/DD State Funded | Allow prior approval to be waived up to 60 days, when state-funded recipients are displaced out of state by Hurricane Helene. Or the individual must transfer to a new provider for delivery of services. Applies to: YP620, YM851, YM852, YM580, YM590, YA389, YM846, YM847, YM848, YP012, YP013, YP014, YP015, YM854, YP642, YM849, YM853 | For initial I/DD requests, UM will review retro requests. Concurrent requests remain unmanaged. |
| I/DD State Funded | Allow utilization review of Individual Support Plans (ISP) and/or revised ISPs to be reviewed and approved (if the request meets medical necessity) retroactively to 09/25/2024 for state-funded recipients impacted by Hurricane Helene. Applies to: YP620, YM851, YM852, YM580, YM590, YA389, YM846, YM847, YM848, YP012, YP013, YP014, YP015, YM854, YP642, YM849, YM853 |
For initial I/DD requests, UM will review retro requests. Concurrent requests remain unmanaged. |
| Innovations | Additional services hours may be provided without PA due to issues related to Hurricane Helene. This should only be in cases where additional hours are needed by the beneficiary because of the hurricane, and either the beneficiary could not reach the provider to notify them of this need or the provider did not have the time/ability to submit a PA. | UM will allow retro authorizations. TCM will need to document in the ISP the need to use hurricane flexibility. TCM will submit an ISP revision. UM will process for waiver compliance. |
| Innovations | Allow prior approval to be waived up to 60 days, when beneficiaries are displaced out of state by Hurricane Helene. Or the individual must transfer to a new provider for delivery of services | UM will allow retro authorizations. TCM will need to document in the ISP the need to use hurricane flexibility. TCM will submit an ISP revision. UM will process for waiver compliance. |
| Innovations | Allow replacement or repair of existing home and vehicle modifications damaged by Hurricane Helene when cost of repair or replacement will exceed the Innovations/TBI Waiver limit. | External Tailored Care Manager will need to staff with the Partners Clinical Support Specialist to review situation and determine what documentation will be needed to demonstrate item is not coverable elsewhere (e.g FEMA, insurance). Internal Tailored Care Management will review situation with their leadership staff. |
| Innovations | Allow Support Intensity Scale (SIS) to be waived. The SIS can be completed virtually when appropriate and accessible. | If SIS is unavailable, TCM will need to cite the need to use hurricane flexibility in the ISP. |
| Innovations | Allow Annual reassessments of level of care that exceeds the 60-calendar-day approval requirement beginning on Sept. 25, 2024, to remain open, and services will continue for three months to allow sufficient time for the Tailored Care managers to complete the annual reassessment paperwork. Additional time may be awarded on a case-by-case basis when conditions from Hurricane Helene impedes this process. Annual reassessments of level of care may be postponed by 90 calendar days to allow sufficient time to complete the annual reassessment and accompanying paperwork. | UM will allow late annual ISPs to be reviewed. TCM will need to document in the ISP the need to use hurricane flexibility. |
| Innovations | Allow a change from Day Support Group to Day Supports Individual without a change in the ISP or prior authorization for Waiver individuals impacted by Hurricane Helene. The ISP should be updated as soon as the provider is able to meet with the Waiver member either telephonically or virtually. | UM will allow retro authorizations. TCM will need to document need to use hurricane flexibility. UM will process for waiver compliance. |
| Innovations | Allow approved services in the Individual Support Plan (ISP) to exceed amount, frequency, scope, and duration to plan the needs of waiver participants who were impacted by Hurricane Helene. The amount shall not exceed the Innovations cap/limit for services as noted in Clinical Coverage Policy 8P. If the QP (qualified professional), i.e., provider agency, is not able to sign the plan. The Tailored Care Manager or Care Coordinator should make the best efforts to coordinate with QP (telephonically or virtually) to review ISP updates. |
TCM will need to document need to use hurricane flexibility. UM will review retro reviews for medical necessity. |
| Innovations | Allow utilization review of ISP and/or revised ISPs to be reviewed and approved retroactively to Sept. 25, 2024 (if the request meets medical necessity) for individuals impacted by Hurricane Helene. | UM will allow retro authorizations. TCM will need to document need to use hurricane flexibility. UM will process for waiver compliance. |
| Innovations | Allow annual ISPs that are expiring and currently meeting a waiver participant’s needs impacted by Hurricane Helene to be extended by three months. The requirement to approve the plan by the last day of the birth month may be extended by three months after the birth month, provided that telephonic or virtual monitoring is conducted to ensure the plan continues to meet the participant’s needs. |
UM will allow retro authorizations. TCM will need to document need to use hurricane flexibility. |
| Innovations | Allow replacement of existing Assistive Technology damaged by Hurricane Helene when cost of repair or replacement will exceed the Innovations Waiver limit. | TCM will need to document need to use hurricane flexibility. UM will review. |
| Innovations | Allow Utilization review and approval of ISPs only with Tailored Care Manager or Innovations Care Coordinator signature if QP (provider agency) is not able to sign the plan. The Tailored Care Manager or Care Coordinator should make the best efforts to coordinate with QP (telephonically or virtually) to review ISP updates. | TCM will need to document need to use hurricane flexibility. UM will allow plan submission without QP signature. |
| Innovations | Allow Residential Supports in place of Community Living and Supports, when an individual requires out-of- home placement, and a relative as a Direct Support Provider or EOR is not providing services. Allow service transition without a change in the Individual Support plan or prior authorization for Waiver individuals impacted by Hurricane Helene. The ISP should be updated as soon as the provider is able to meet with the Waiver member/family telephonically or virtually. | UM will allow retro authorizations. TCM will need to document need to use hurricane flexibility. UM will process waiver compliance. |
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