Medicaid B - Assertive Community Treatment Team (ACTT)

• Clinical Coverage Policy 8A-1
• ILOS Child Act H0040 HA U5 U1
• ILOS AH ACT-SD H0040 TS

Submission Requirements

Assertive Community Treatment Team (ACTT)

• Initial: Service Authorization Request (SAR), Service Order, Comprehensive Clinical Assessment (CCA)
• Concurrent: Service Authorization Request (SAR), Updated Person Centered Plan (PCP)

Assertive Community Treatment Team (ACTT) Step Down

• Initial: Service Authorization Request (SAR), Service Order, Comprehensive Clinical Assessment (CCA)
• Concurrent: Service Authorization Request (SAR), Updated Person Centered Plan (PCP)

Child Assertive Community Treatment Team (ACTT) H0040 HA U5 U1

• Initial: Service Authorization Request (SAR), Person Centered Plan (PCP) with Service Order, Comprehensive Clinical Assessment (CCA)
• Concurrent: Service Authorization Request (SAR), Updated Person Centered Plan (PCP)

Service Definition Authorization Parameters

Adult Assertive Community Treatment Team (ACTT)

• Clinical Coverage Policy 8A-1
• Initial: 6 months/4 units per month
• Concurrent: 12 months/4 units per month

Adult Assertive Community Treatment Team (ACTT) Step Down

• In Lieu of Service Definition
• Initial: up to 6 months
• Concurrent: up to 6 months
• Billing limits of 2 units per month. Service must go through end of the month

Child Assertive Community Treatment Team (ACTT) H0040 HA U5 U1

• Initial: 6 months/4 units per month
• Concurrent: 1 month/4 units per month

COVID Prior Approval Flexibility
Adult ACTT and ACTT Step Down: Waive prior approval for concurrent requests

Authorization Guidelines

Locus Level

1	2	3	4	5	6

Calocus Level

1	2	3	4	5	6