1915(i) Service Authorization Updates

Blue Cross Blue Shield of North Dakota (BCBSND) wants to stay connected with our 1915(i) service providers.

Enrolled providers of one or more 1915(i) services, may have recently seen an email from the Department of Health and Human Services (DHHS) regarding authorizations.

Effective Jul. 3, 2023, new quality standards were introduced for 1915(i) Plans of Care and the goals contained within, and it was established that service authorization/precertification requests would no longer be approved if the plans and goals did not meet those standards. This impacted both BCBNSD Medicaid Expansion and traditional Medicaid. DHHS had offered training opportunities to learn about these critical changes throughout the month of June, and each enrolled agency should have also received an explanation of the changes via email from DHHS. Their website https://www.hhs.nd.gov/1915i/trainings keeps a list of recordings and trainings.

A few that may be beneficial to you under the “Technical Assistance Calls” section:

  • Quality Assurance- Needs, SMART Goals and Services (recording)
  • Quality Assurance- Needs, SMART Goals and Services (slides)

For agencies actively providing 1915(i) services, you may have noticed a recent increase in requests for information. This is a result of the changes that took place in July.

The two main items that are routinely asked for are:

  • An updated plan of care with SMART goals with each new service request. New requests will not be approved without a Plan of Care attached that fully meets the established standard.
    • For example, if a new request is submitted for another service provider, a plan of care identifying the current need and goal for that member is required. Please ensure all questions in the SMART goal section are completed for each separate goal identified.
    • The Care Coordinator is responsible for the plan of care and will need to work with the accepting agency to provide the plan of care for the request.
  • Request for the acknowledgment form and the meeting attendees signature page. These forms need to be submitted with the Plan of Care.

The UM team will request this information and if it is not received the case will be canceled and the provider can resubmit the request when the documentation is acquired. This may mean the start date of care changes.

We value our partnerships with our community providers and appreciate the feedback and continued collaboration as we strive to make this program better.