APS Prior Authorization (PA) Requirement Changes Training Available

December 9, 2013

APS Healthcare is currently contracted with the State of Maine’s Department of Health and Human Services (DHHS) to provide a Utilization Management System for services purchased through the State of Maine’s Office of MaineCare Services. DHHS in collaboration with APS Healthcare would like to announce the following services which will be incorporated into the APS Healthcare Program.

Effective December 1, 2013, Utilization Review done by APS Healthcare for Section 28 School Based Rehabilitation and Community Support Services and Section 65 Day Treatment Services Provided in an Educational Setting will be required. This will include a redetermination of eligibility and ongoing review of medical necessity criteria for services. The review cycle will include a PA determination at time of admission and Continued Stay Reviews every 180 days.

Current authorization end dates will be adjusted to allow for utilization review process to occur prior to 2/28/14. The authorization end dates will be staggered based on member last name.

APS Healthcare will be hosting the trainings to review the new process. Due to limited space, please limit attendance to one representative.

Tuesday 12/10/13 Presque Isle (ACAP 771 Main Street Presque Isle) 9-10 School Based Section 28 1-2 Section 65 Day Treatment

Wednesday 12/11/13 Bangor (Dorothea Dix Psychiatric Center 656 State Street Bangor) 9-10 School Based Section 28 1-2 Section 65 Day Treatment

Thursday 12/12/13 Portland (DHHS- 1037 Forest Ave Portland) 9-10 School Based Section 28 1-2 Section 65 Day Treatment

Friday 12/13/13 Augusta (Riverview Psychiatric Center 250 Arsenal Street Augusta) 9-10 School Based Section 28 1-2 Section 65 Day Treatment

Monday 12/16/13 Sanford (DHHS Office 890 Main Street Suite 208 Sanford) 9-10 School Based Section 28 1-2 Section 65 Day Treatment

Tuesday 12/17/13 Lewiston (DHHS Office 200 Maine Street Lewiston) 9-10 School Based Section 28 1-2 Section 65 Day Treatment

Thursday 12/19/13 Ellsworth (DHHS Office 17 Eastward Lane Ellsworth) 9-10 School Based Section 28 1-2 Section 65 Day Treatment

What does this change mean for providers? Effective December 1, 2013, providers will be required to submit PA requests for new members entering service, and Continued Stay Review requests every 180 days for members remaining in service. Providers may contact APS Healthcare Provider Relations with questions at 1-866-521-0027, Option 1, or via email at MaineCare-Prov@apshealthcare.com

What does this change mean for members? This change primarily affects the authorization requirements for providers. Members may contact the APS Healthcare Member Liaison with questions at 1-866-521-0027, Option 3, or via email at rlavigne@apshealthcare.com