RCPA - Rehabilitation and Community Providers Association


TSS Prior Authorization Draft Bulletin Released
October 26, 2000

The Therapeutic Staff Support (TSS) Prior Authorization Draft Bulletin for the Medical Assistance Program fee-for-service delivery system was released today during the Medical Assistance Advisory Committee (MAAC) meeting. Along with the draft two other documents were provided including:

It is anticipated that services with effective dates of February 1, 2001 will follow the bulletin, however, the Department will recognize the approval granted by the waiver process until the end of the authorized period.

Bulletin highlights include:

  • Handbook pages will be developed that describe the procedures to be followed to request prior authorization
  • Providers will be advised of the criteria used to evaluate requests for prior authorization of services

Documentation requirements include the following:

  • Psychiatric/Psychological evaluation
  • Presenting behavioral health issues or concerns
  • Treatment history
  • Child and Family Strengths
  • Mental Status Examination
  • Current services
  • Diagnoses in all five Axes (at a minimum there should be diagnosis in either Axis 1 or 2)
  • Recommendation for TSS services
  • Treatment plan
  • Coordination of care
  • All systems and persons identified

It is imperative that comments on this bulletin are submitted to Lisa Lowrie no later than November 8.

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