region/plan-specific news
: Commercial Health Plans - excluding California
Facilities: Requesting an in-lieu of service (ILOS) for Dell Children's Health Plan STAR members
Magellan* authorizes intensive outpatient program (IOP), partial hospitalization program (PHP), coordinated specialty care (CSC), and institution of mental disease (IMD) services as an in-lieu-of service (ILOS) for Dell Children’s Health Plan STAR eligible members. This process does not apply to CHIP members.
What you need to know
Aa Magellan provider, you must be familiar with the Texas Health and Human Services Commission (HHSC) requirements published in the Uniform Managed Care Manual, chapter 16.3, “In-Lieu-of Covered Services and Settings,” online at https://www.hhs.texas.gov/sites/default/files/documents/16-3.pdf.
When requesting IOP, PHP, CSC or IMD level of care, prepare to respond to the following three questions:
- Did the member request the ILOS service?
- Did you review the ILOS service with the member?
- Did the member agree to utilize the ILOS service (IOP, PHP, CSC or IMD)?
Answers to these questions will determine the next actions, including a possible medical necessity review to determine the benefit. Magellan will retain the answers to the questions. You must document and retain documentation of the member’s choice to receive an ILOS. HHSC may require you and/or Magellan to provide this documentation upon request. Only providers designated by Texas Health and Human Servies as a Coordinated Specialty Care for First Episode Psychosis (CSC-FEP) program will be eligible for authorization for CSC services.
With you, Magellan seeks to provide the most medically appropriate setting for all members, while also considering a member’s choice in discussions/requests pertaining to IOP, PHP, CSC or IMD services. Per the Texas HHSC requirements cited above, do not offer outpatient services as an alternative to inpatient hospitalization for members who are at risk of harm to self or others.
You will find information about requesting an In-Lieu of Service in the Provider Handbook Supplement for Dell Children’s Health Plan Texas Medicaid STAR and CHIP Programs (PDF), section 3, The Role of the Provider and Magellan.