RetiredCareSourcePolicy AD-1056

Court Mandated Health Services

Governs coverage and administrative handling of court-ordered health services for CareSource members in Arkansas, including applicability of medical necessity determinations and coordination when services are not deemed medically necessary.

Policy Summary

PayerCareSource

PolicyCourt Mandated Health Services

Policy CodePolicy AD-1056

Change TypeRetirement

Effective Date01701/2022-07131/2022

Next Review Date

Key ActionIf court-ordered services do not meet medical necessity criteria, the member's care coordinator will assist to ensure access to appropriate treatment and coordinate necessary care.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Arkansas PASSEGeographic/program context

Withdrawal/MAT/Inpatient/OutpatientService scope

07/31/2022Archive date

Coverage Criteria for Court Mandated Services

Covered when ALL of the following are met:

Court mandated health services are subject to existing CareSource policies and procedures, including medical necessity determinations.

Services meet CareSource standards for medical necessity (proper and necessary for diagnosis or treatment, lowest cost alternative, not primarily for convenience).

If services do not meet medical necessity:

The member's care coordinator will assist to ensure access to appropriate treatment and services and will assist in coordination of necessary care.

Administrative policy statements do not guarantee authorization or payment; the plan contract (Evidence of Coverage) controls if there is a conflict.

Policy Summary

PayerCareSource

PolicyCourt Mandated Health Services

Policy CodePolicy AD-1056

Change TypeRetirement

Effective Date01701/2022-07131/2022

Next Review Date

Key ActionIf court-ordered services do not meet medical necessity criteria, the member's care coordinator will assist to ensure access to appropriate treatment and coordinate necessary care.

SourceLink

On This Page

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Authorization and Care Coordination Requirements

Prior Authorization

Authorization and Care Coordination for Court‑Mandated Services

Court-mandated health services are governed by all existing CareSource policies and procedures, including medical necessity determinations. If court-ordered services are determined to not meet medical necessity criteria, the member's care coordinator will assist to ensure access to appropriate treatment and coordinate necessary care.

Services remain subject to standard prior authorization and medical necessity review per CareSource policy.
When services are not medically necessary, the member's care coordinator must assist with identifying and coordinating appropriate alternative treatment and services.

Key Definitions

Court Mandated Health Services - Key Definitions

Court Mandated Health ServicesCourt order issued upon the decision of a judge or the result of a judicial proceeding for health-related services.

Scope of ServicesMay include withdrawal management; medication assisted treatment (MAT); community-based services; behavioral health inpatient or outpatient treatment; medical inpatient or outpatient treatment; and other treatment related to overall health.

ApplicabilityServices ordered as a result of criminal, civil, or custodial judicial proceedings.

CareSource Policy ApplicationCourt mandated services are subject to all existing CareSource policies and procedures, including medical necessity determinations.