1915(i) Updates and Reminders

1915(i) service providers must use 1915(i) procedure codes once a member has successfully transitioned from 1915(b)(3) services or state-funded Community Living & Support services. 1915(i) procedure codes can be found on Alliance’s website.

All prior authorization (PA) requests for 1915(i) services must be submitted by the member’s care manager at Alliance or a CMA/AMH+. 1915(i) service providers may not submit a PA request for 1915(i) services.

Please note that there are different staffing requirements for 1915(i) Respite as compared to 1915(b)(3) Respite. Staffing requirements include, but are not limited to:

• Trauma-informed care training
• Crisis intervention training
• For staff serving recipients taking opioid medications or who have substance use disorders, training in opioid antagonist administration (Administering Naloxone or other federal Food and Drug Administration approved opioid antagonist for drug overdose).

For a complete list of staffing requirements, see Clinical Coverage Policy 8H-4.

1915(i) Respite may not be provided by relatives or legal guardians if they live in the same private residence as the member. If a relative or legal guardian is employed to provide CLS (relative as provider), the member is not eligible to receive 1915(i) Respite, as they are living with a paid caregiver. For additional information, please see Clinical Coverage Policy 8H-4.

As a reminder, IPS supported employment does not require prior authorization, however the service must be included in the member’s ISP prior to the provision of services.