Providers' Page

Service Implementation

Diagnostic Assessment

Initial authorizations for state-funded Community Support services for new referrals from Screening, Triage and Referral are limited to ten hours to be used within the first thirty days. These hours are to arrange for the Diagnostic Assessment (5006) or MH Evaluation (3300) and develop the Person-Centered Plan. For additional information on pre-authorized services, please see the memo dated 1/25/07 "Changes to the IPRS Authorization Process" posted on the Provider > IPRS page.

If there is medical necessity to request a Diagnostic Assessment (instead of a MH Evaluation) for a state-funded consumer, this must be pre-authorized. The one-page Request for Authorization form is used to request the Diagnostic Assessment.

Those who are endorsed for Diagnostic Assessment, please be aware of the following:

Medicaid law requires recipients to have the opportunity to select any willing and qualified provider of their choice (42 CFR 431.517) (Section 1902(a)(23) of the Social Security Act); therefore, providers must offer a choice of providers for Diagnostic Assessment and document such with a signed Provider Choice Form detailing the list of choices provided. This means that consumers cannot be required to use your agency and not be provided with a choice of providers for a Diagnostic Assessment.

AND

If you are an endorsed provider of Diagnostic Assessment, the Division indicates that Diagnostic Assessments cannot be completed exclusively to those consumers for whom you are doing Community Support Services. Please refer to your endorsement MOA.

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