Medicaid B(3) and 1915i: Individual Supports and Individual and Transitional Support (ITS)

• Clinical Coverage Policy 8H-3
• B3 AH Individual Support T1019 U4

Submission Requirements

Medicaid B(3) Individual Supports

Initial:

• Service Authorization Request (SAR)
• Person Centered Plan (PCP) with Service Order
• Instrumental Activities of Daily Living (IADL) assessment

Concurrent:

• Service Authorization Request (SAR)
• Updated Person Centered Plan (PCP)
• Instrumental Activities of Daily Living (IADL) assessment update

Medicaid 1915i Individual and Transitional Support 

Care Managers (not the provider of the service) submit ALL requests for 1915i services.

Member must be determined eligible for 1915i services.

Initial:

• Service Authorization Request (SAR)
• Person Centered Plan (PCP) with Service Order

Concurrent:

• Service Authorization Request (SAR)
• Updated Person Centered Plan (PCP)

Service Definition Authorization Parameters

Medicaid B3 Individual Support

No authorization required for initial 7 days/up to 60 units

Initial & Concurrent:

• Up to 150 units per month for 3 months
• Annual benefit maximum of 1080 units
• This is not an entitlement service

Medicaid 1915i Individual and Transitional Support 

Initial:

• Up to 240 units/month
• Cannot exceed 180 calendar days

Concurrent:

• Up to 240 units/month for 90 calendar days

1 unit = 15 minutes