Transition and Utilization Management Guidance Concerning ACT and PROS
ACT Transition Guidance
New York City
Supplemental New York City ACT Transition Guidance - October 19, 2015
New York City Medicaid Managed Care plans, Health and Recovery Plans (HARPs) and HIV Special Needs Plans.
This guidance specifies:
- NYS expectations regarding prior authorization and referral to ACT Teams for individuals covered by managed care;
- Processes for approval for ACT level of care;
- Authorization requirements and utilization management expectations for enrollees with orders for Assisted Outpatient Treatment; and
- Expectations regarding one ACT Team that does not accept referrals from SPOA.
ACT Utilization Guidelines - August 6, 2015
Detailed program description of the ACT program and guidance on utilization management for ACT, interface with other services including Health Homes and PROS programs.
Rest of State
Guidance for Rest of State Medicaid Mainstream Managed Care Organizations (MMCOs) and Health and Recovery Plans (HARPs) regarding utilization management for Assertive Community Treatment (ACT) which incorporates specific roles and responsibility of local government units (LGUs) and Single Point of Access (SPOA) programs.
PROS Transition Guidance
PROS Utilization Guidelines - August 6, 2015
Prior and concurrent review requirements for PROS and detailed program description information, including admission, continuing stay and discharge guidelines.