Individualized Service Agreements (ISA)

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Individualized Service Agreements (ISA)

• State of Alaska
• Division of Behavioral Health
• Policy and Planning

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Individualized Service Agreement

• What is it -
• A provider Agreement with the State of Alaska for
  the purpose of providing individual, specialized
  services for severely emotionally disturbed (SED)
  children.

3
Individualized Service Agreements (ISA) Funding
Process

• Client Eligibility
• A resident of the state
• Under 22 years of age
• Been assessed by a MH professional and meets
  criteria for SED
• Is at imminent risk of being removed from the
  home
• Been assessed to meet residential level of care
• Has been approved by DHSS for services

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Individualized Service Agreements Examples of
Acceptable Uses

• Non-Medicaid services such as
• For Non-MC recipients all MC covered services
• Services that allow recipient to maintain at
  least restrictive level of care
• Services that would normally be covered by
  Medicaid for non-resourced recipients
• Room and board for non-custody kids in level 2-4
  BRS facilities, continued need reviewed every 90
  days.
• Vocational rehabilitation
• Rent including utilities not to exceed 90 days
• Start up costs for individual living settings
• Specialized treatments private practitioners
  physician clinic services (Must Contract thru
  Community Behavioral Health center CBHC).
• Transportation
• Parenting classes

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Individualized Service Agreements Examples of
Acceptable Uses (cont.)

• Care coordination for non Medicaid recipients or
  case management?
• Case management for recipient 90 days (60 days
  payable) prior to discharge from inpatient
  facilities. (Last 30 days should be billable to
  Medicaid)
• Respite
• Expert consultations e.g. sexual acting out,
• Limited home modifications necessary to maintain
  child in home
• Life management skills
• After school programs
• Family home assessment
• Social activities
• Mentoring
• Tuition
• Other services determined to be clinically
  appropriate.

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Individualized Service Agreements Non-Acceptable
Uses

• Individualizes services dollars will not pay for
  or augment
• foster care rates
• substance abuse treatments
• Capital Funding/substantial home renovations

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Individualized Service Agreements (ISA)

• Other billing mechanisms must be utilized
• Medicaid
• Private Insurance
• 5 Set Aside Funds for CBHCs with SED Grants
• SED Grants do not need to be spent down prior
  to receiving ISA funds

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Individualized Service Agreements (ISA) Funding
Process

• Service provider must be a CBHC Medicaid
  provider.
• CBHC may contract with other agencies for
  identified services.

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Individualized Service Agreements (ISA) Funding
Process

• Providers complete the Referral Billing Form
  which includes requested services, of unit(s)
  and costs of services (for initial referral and
  every 90 days)

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Individualized Service Agreements (ISA) Funding
Process

• Referral Billing Form faxed to DBH UR staff
  along with initial Treatment Plan or quarterly
  Treatment Plan Review

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Individualized Service Agreements (ISA) Funding
Process

• Billing submitted by provider every 30 days to
  DBH
• For initial funding requests, provider submits
  Treatment Plan to DBH UR staff
• For continued funding requests, provider submits
  quarterly Treatment Plan Review to DBH UR staff

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Individualized Service Agreements (ISA) Website
to download Agreement

• http//www.hss.state.ak.us/publicnotice/grants.
  htm

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Individualized Service Agreements (ISA)
Utilization Review Staff

• Southeast Region and Matsu Valley - Reta Sullivan
  [phone]/ Reta_Sullivan_at_health.state.ak.us
•  Northern Region- Judy Helgeson [phone]
• Judith_Helgeson_at_health.state.ak.us
• Anchorage- Maureen McGlone [phone]
  Maureen_McGlone_at_health.state.ak.us
• Southcentral Region (excluding Matsu)- Anne
  Gibson [phone]/ Anne_Gibson_at_health.state.ak
  .us