Overview of Georgia: Children's Intervention Services [Jan. 2012]

An Overview of Children's Intervention Services

Overview
The Children's Intervention Services (CIS) program offers coverage for restorative and rehabilitative services to eligible members in non-institutional settings, including their home, therapist's office, child care or other community settings. CIS services must be determined to be medically necessary and be recommended and documented as appropriate interventions by a physician. NOTE: Hospital-employed therapists who are enrolled in the CIS program may provide services and bill for services rendered in the hospital outpatient facility or outpatient clinic.

Why is the program important?
The intent of the program is to minimize the effects of a physical disability or developmental delay.

Services
Audiology Nursing

Has the Children's Intervention Services program changed?
The Georgia Department of Community Health (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 child's medical needs. Beginning September 1, 2006, a PA was required for units more than eight per member per month for therapy in the same specialty. A PA is based on medical necessity and can be approved for up to six months.
What has DCH done to enhance Children's Intervention Services systems?

Nutrition provided by licensed dietitians Occupational therapy Physical therapy Counseling provided by licensed clinical social workers Speech-language pathology
Eligibility
Medicaid-eligible members from birth up to the age of 21 years old, with physical disabilities or with a developmental delay, who have been recommended for rehabilitative or restorative intervention services by a physician.

DCH allows 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 to confirm that the documentation was successfully uploaded.

DCH developed a family of general codes that allows the provider more flexibility in their provision of CIS services.

DCH no longer requires the submission of a separate prescription and allows the physician's signature on the Letter of Medical Necessity/Written Service Plan to serve as his prescription for services.

DCH allows hospital-based providers to enroll in the CIS program with the ability to see members at their local medical facility.



Georgia Department of Community Health | 2 Peachtree Street NW, Atlanta, GA 30303 | www.dch.georgia.gov | 404-656-4507

January 2012