New ILOS Definition for Long Term Community Supports

This update is for providers of Medicaid eligible adult members with an I/DD diagnosis who are currently receiving state-funded residential services or in need of ICF treatment. Alliance has adopted an alternative definition in lieu of ICF-IDD under the Medicaid 1915(b) waiver called Long Term Community Supports.

Long Term Community Supports (LTCS) consists of a broad range of services for adults with developmental disabilities who, through the person-centered plan (PCP) process, choose to access active treatment to assist them with skills to live as independently as possible in the community. This service enables Alliance to provide comprehensive and individualized active treatment services to adults with I/DD and related conditions to maintain and promote their functional status and independence. This is also an alternative to home and community-based waiver services for individuals that potentially meet the ICF-IDD level of care.

Long Term Community Supports (LTCS)

Note: Any person who is living in a licensed facility, group home, supervised living setting, alternative family living arrangements or any other setting that they or their family do not own must have a lease agreement in place with the owner/provider to receive LTCS.

Transition plan for existing members with an active authorization and paid claims within 90 days:

1. Our Provider Network Department will add the necessary codes to provider contracts on the back end. It is not necessary for providers to submit Provider application requests (PAR) to add the new services as our contracting team will automatically add the codes to your contract.
2. It is our intention for our utilization management and care management teams to create a service crosswalk for providers to reference. More information on this is forthcoming but we are currently verifying if this can be done.

Important information to be aware of and prepare for:

1. Transitions will be complete by the April 1, 2023, go-live date. Additional transition plans are forthcoming.
2. If a member has not had a paid claim within 90 days of November 30, 2023, their authorization will not be transferred.
3. New members to residential services who do not have an extenuating circumstance will not be considered at this time due to budget constraints. The referral freeze is still in effect unless the member is transitioning from a hospital, crisis program or another acute situation. Any member that may fit those criteria must be referred or assigned to care management to be considered for admission.

Please refer to the in lieu of service definition. Also, please note that any non-Medicaid eligible members will be transitioned to the appropriate service mentioned in JCB #J408 and JCB #J417.

Please note that JCB #J408 and #J417 have replaced the previous guidance from DHHS regarding changes in the intellectual and developmental disabilities and traumatic brain injury benefit plan for the Division of Mental Health, Developmental Disabilities and Substance Abuse Services state-funded service definitions. The new and revised service definitions include residential supports I/DD and TBI and supported living periodic I/DD and TBI. The new service definitions and frequently asked questions for residential supports (I/DD and TBI) and supported living periodic (I/DD and TBI) are available at the NCDHHS website.