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Out of County Enrollment Letter

December 7, 1999

From: Carolyn Givens, Rick Tully
Re: OUT-OF-COUNTY MACSIS ENROLLMENT

We are writing to clarify requirements for enrollment of clients who seek services from provider organizations outside their Board service district of residence. These clarifications in no way modify the Guidelines and Operating Principles for Residency Determinations Among CMH/ADAS/ADAMHS Boards. Rather, we seek to clarify procedural requirements for enrollment of clients in the following circumstances:

  • Enrollment of Medicaid eligible persons who seek services from provider organizations outside their Board service district in either emergency or non-emergency situations.
  • Enrollment of non-Medicaid eligible persons who seek services from provider organizations outside their Board service district in emergency situations.
  • Enrollment of non-Medicaid eligible persons who seek services from provider organizations outside their Board service district in non-emergency situations.

Because of fundamental differences in statutory requirements governing mental health and alcohol/drug addiction services, these requirements are presented in separate narrative sections below. A single matrix, also set out below, summarizes requirements for each of the two systems.

Mental Health & Addiction Services

Enrollment of Medicaid eligible persons who seek services from provider organizations outside their Board service district in either emergency or non-emergency situations. In these circumstances such persons must be enrolled with the appropriate Board residence of pursuant to the MACSIS enrollment guidelines. The reason enrollment is required is the Board of residence is responsible for paying Medicaid claims, even in out-of-county non-emergency situations.

Enrollment of non-Medicaid eligible persons who seek services from provider organizations outside their Board service district in emergency situations.
In these circumstances, such persons must be enrolled with the appropriate Board of residence pursuant to the MACSIS enrollment guidelines. The reason enrollment is required is the Board of residence is responsible for paying non-Medicaid claims for Crisis Intervention and Pre-hospitalization Screening services in emergency situations for a period up to 72 hours.

Enrollment of non-Medicaid eligible persons who seek services from provider organizations outside their Board service district in non-emergency situations.
In these circumstances the provider organization is not required to enroll such persons. However, the provider organization should refer such persons to the Enrollment Center (a complete listing will be posted on the MACSIS Website) for the person’s Board of residence in order to be linked with the appropriate provider organization. The out-of-county provider organization should offer the person assistance in contacting the Enrollment Center for the person’s Board of residence. Such assistance in referral will better ensure appropriate continuity of care.

Medicaid: Enrollment of Medicaid eligible persons who seek services from provider organizations outside their Board service district in either emergency or non-emergency situations.
In these circumstances such persons must be enrolled with the appropriate Board residence of pursuant to the MACSIS enrollment guidelines. The reason enrollment is required is the Board of residence is responsible for paying Medicaid claims, even in out-of-county non-emergency situations.

Non-Medicaid
OhioMHASrecognizes non-Medicaid services, out-of-county services, emergency services or clinically appropriate services as:

  • Level I Services (Assessment, Individual counseling, Group Counseling, Case Management, Crisis Intervention, Alcohol/Drug Screening Analysis, Medical/Somatic, Methadone Administration and Intensive Outpatient Services, plus)
  • Levels III and IV Detoxification Services

Non-Medicaid clients who present for services out-of-county are eligible for Board funding under the same considerations as if the clients presented for services in their home county. Level I services and Levels III and IV detoxification services may be provided for three days or until linkage to treatment is established in the “home county.” If out-of-county treatment is to extend beyond three days, the out-of-county placement must be approved by the home board. It is essential that collaborative efforts occur between providers and Boards to establish arrangements for a client’s continued care.

Out-of-County MACSIS Enrollment Summary Matrix
Circumstances MH AOD
Medicaid eligible person - emergency or non-emergency Enrollment: Must enroll. Services: Any Medicaid covered service. Enrollment: Must enroll. Services: Any ODADAS Medicaid covered service.
Non-Medicaid eligible person - emergency Enrollment: Must enroll. Services: Pre-hospitalization and Crisis Intervention for up to three days (72 hours). Enrollment: Must enroll Services: Level I Services: (assessment, individual counseling, group counseling, crisis intervention, case management, alcohol/drug screening analysis, medical /somatic, intensive outpatient and methadone administration) plus Levels III and IV detoxification services for three days or until linkage to treatment is established in the “home county”.
Non-Medicaid eligible person - non-emergency Enrollment: Not required. Services: Not required to pay for services. Enrollment: Must enroll Services: Level I services plus Levels III and IV detoxification services for three days or until linkage to treatment is established in the “home county”