The only Collaborative Care reimbursability rules that have not yet been built relate to court outcomes and the age requirements for Collaborative Care. Below is a list of the reimbursability rules:
Submitting an eligible collaborative care determination results in a status period that is “No Admin” for the duration of the status period.
CEU workers will only see Collaborative Care status periods that are known to be current.
CEU workers can click into a status period to see the details of the individual criteria
Hitting Calculate triggers a timeline calculation that includes Collaborative Care
If a focus child is placed at resource that has a license in the closed status, that child will be claim admin through the end of the calendar month in which the change occurred.
If a focus child is placed at a resource whose relicensure application has been denied, that child will be claim admin the day after the denial takes place.
If a focus child is placed at a resource whose license status is inquiry or non-inquiry that child’s status is No Admin.
If a focus child is placed at resource whose license status is expired, the child will keep their prior status until the first day of the next calendar month.
If a focus child is placed at resource whose license status is closed, the child will keep their prior status until the first day of the next calendar month.
If a focus child is placed at a resource that has been revoked, that child will be claim admin the day after the revocation takes place.
If the child is placed at a resource that is in initial application pending, the child will be claim admin the entire time they are located there.
If the focus child is placed at a licensed CC resource they will be eligible for the entire time that they are located at that location.
If a focus child is placed at a resource whose status changes to probation after the child has been placed there, the child is claim admin. If the child was placed at a resource that was already on probation, the child is no admin.
If there are any placement gaps, continue with the prior status for the child.
If the focus child is placed at a CC resource that is pending re-licensure they will be eligible for the entire time that they are located at that location.
When a retroclaim is administered, the focus child is claim admin to the start of the prior calendar month or the start of the most recent no-admin placement.
If the child is placed in a collaborative care resource, and meets all other criteria he/she is automatically eligible.
If a focus child who is CC eligible runs away from the home or placement, the focus child’s CC eligibility status changes to “Claim Admin”
If the focus child goes on THV placement, they are claim admin if it is within the first 6 months or within 12 months if there is an extension.
If the focus child is in a temporary absence, the prior status will be applied when the temporary absence is not the first removal location in an episode.
For the period the child is receiving SSI, they are claim admin.