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IT System Implications for Temporary Changes to DHS/DMH UM Process Effective 4/22/11

The use of DMH UM criteria which was implemented on January 3, 2011, is being put on hold as of COB 4/21. No UM criteria will be applied 4/22 and after until DMH reinstates the criteria and authorization processes.
All UM service classes implemented on January 3, 2011 will be lifted. This includes therapy/counseling (TIN), Psychosocial Rehab (PSR), and Community Support Group (CSG).
Both Assertive Community Treatment and Community Support Team services will continue to require authorization
UM services submitted by providers will pass through the IT system 4/22 and after without any authorization on file. These services will be processed using parameters established for claims processing prior to January 3rd, 2011.
Claims related to UM services provided between January 3rd and April 21st COB will be processed using UM criteria.
UM service limits will be tracked up to 4/21 COB. When UM criteria and service threshold limits are reinstated, the count of units that are applied toward the threshold should be resumed from 4/21.
UM service units that are provided/used during the hold period will not be counted toward consumers' authorization thresholds.
Any service authorization requests for the UM services that are in process as of 4/21 or received after 4/21 will be voided and closed.
Processing of service authorization requests will continue per established parameters once the UM criteria are reinstated.