UM Resources – I/DD

NC Innovations Service Requests

All NC Innovations beneficiaries have a Care Coordinator who works for Alliance. The Care Coordinator submits requests for authorization of services to the Utilization Management Department. More information about NC Innovations services is available on the NC Division of Medical Assistance website as well as on the Alliance Innovations webpage.

Annually an Individual Support Plan (ISP) is developed by the individual/legally-responsible person and their planning team and is submitted by the Care Coordinator to be effective the first day of the month following the beneficiary’s birth month and must be submitted with the following forms:

• Level of Care (LOC)
• Risk Supports Needs Assessment
• NC-SNAP/Supports Intensity Scale (SIS)
• Individual Budget
• Signature page

Note that some services or interventions require additional forms, such as a behavioral plan or additional assessments, to be submitted with the ISP.

Requests to add, increase or reduce services can be submitted as a plan revision any time throughout the year that the beneficiary’s needs change and must include the following forms:

• Update to ISP
• Signature page
• Individual Budget

Note that updated assessments, along with other additional forms, may be required based on the services requested.

Change in provider(s) can be made anytime throughout the plan year for services that are authorized and the following forms must be submitted:

• Alliance NC Innovations Provider Change request form signed by beneficiary/legally-responsible person
• Updated Individual Budget

Additional Services available through Alliance Health for Innovation Wavier Recipients (Members must meet Medical Necessity):

• Enhanced Community Living and Supports
• Enhanced Respite
• Enhanced Day Supports
• Enhanced Residential Supports
• Enhanced Residential Supports Update 1.1
• Enhanced ICF Services

Innovations Criteria and Waiver

• Clinical Coverage Policy 8P North Carolina Innovations
• Medicaid Home and Community-Based Services (HCBS) waiver program

ICF-I/ID Requests for Authorizations

For initial requests, the following information is required and is submitted through the Alpha portal:

• Level of Care signed by a medical doctor
• Medical evaluation form
• Psychological assessment

Requests for 180-day reauthorization require the following forms to be submitted through the Alpha Portal:

• Level of Care signed by medical doctor
• Medical Evaluation form
• Service Authorization Request (SAR) completed in the Alpha Provider Portal

Effective October 1, 2017 the additional authorization submission requirement will be to include the member’s Individual Program Plan (IPP) in addition to the LOC Form to the Service Authorization Request. Alliance Utilization Management will review the IPP in addition to the Utilization Review Committee’s LOC recertification that the member continues to meet the ICF/IDD criteria to determine medical necessity for continued stay for authorization up to the 180 day benefit.

Access the DMA policy for ICF-I/ID.

IDD Non-Innovations Clinical Coverage Policies/Service Definitions

IPRS and B3 services are requested by the provider. The benefit plan for IPRS and B3 services is available online here. Please review the benefit plan prior to requesting services for availability by county, required documents and service limitations.