A snapshot of Georgia: Children's Intervention Services, a program of the Georgia Department of Community Health [Aug. 2007]

A Program Of The Georgia Department Of Community Health
A SNAPSHOT OF GEORGIA
Children's Intervention Services

Overview
The Children's Intervention Service (CIS) program offers coverage for restorative and rehabilitative services to eligible members in noninstitutional settings, including their home, therapist's office, child care or other community setting. CIS services must be determined to be medically necessary and be recommended and documented as appropriate intervention by a physician.
Why is the program important?
The intent of the program is for the maximum reduction of the effects of a physical disability or developmental delay.
Has the Children's Intervention Services program changed?
DCH strives to ensure the right care is provided to the right children at the right time. A child's need for therapy can change over time, and by standardizing the Prior Authorization (PA) review process and assuring medical necessity, DCH can be more certain that the program meets each individual child's medical needs. Beginning September 1, 2006, a PA was required for units over eight per member per month for therapy in the same specialty. These units include the evaluation visit. A PA is based on medical necessity and can be effective for up to six months.
What has the Georgia Department of Community Health done to enhance Children's Intervention Services systems?
In October 2006, DCH launched a system enhancement, allowing providers to attach electronic documentation directly to pending PAs. This enhancement gives the provider greater control in assuring that all documentation is associated with the review for Medical Necessity. Immediate verification goes back to the provider that the documentation was successfully uploaded. DCH also established fax lines for provider use (800-969-6358 or 678-527-3031), created a CIS inquiry e-mail address for the convenience of providers to submit questions concerning CIS PAs and set the goal for peer review turnaround time

SERVICES
nAudiology n Nursing n Nutrition provided by licensed
dietitians n Occupational therapy n Physical therapy n Counseling provided by licensed
clinical social workers n Speech-language pathology
ELIGIBILITY
Medicaid-eligible members from birth to 21-years old with physical disabilities or with a developmental delay, who have been recommended for rehabilitative or restorative intervention services by a physician and who are included in one of the following categories, may receive CIS:
nChildren who have a written service plan established by a physician.
n Infants and toddlers who are eligible under the Individuals with Disabilities Education Act (IDEA, Part C), meet eligibility for the Early Intervention Program (Babies Can't Wait) and have an authorized Individualized Family Service Plan (IFSP) developed by the multi-disciplinary team.
PROVIDER ENROLLMENT
nFY 2003 -- 2,315 CIS providers n FY 2004 -- 2,457 CIS providers n FY 2005 -- 2,778 CIS providers n FY 2006 -- 3,304 CIS providers n FY 2007 -- 2,158 CIS providers

2 Peachtree Street, Atlanta, Ga 30303 w www.dch.georgia.gov

August 2007