CurrentCareSourcePolicy PASSE-MM-1543

Intensive In-Home (IIH) Services-AR PASSE-MM-1543, MEDICAL POLICY STATEMENT Arkansas PASSE

Defines medical necessity, admission, continuation, discharge, program requirements, provider qualifications, documentation, telemedicine billing modifier, and exclusions for Intensive In-Home (IIH) behavioral health services for Arkansas PASSE members (ages 3-20). Applies to Medicaid/1915 waiver HCBS context and requires prior authorization.

Policy Summary

PayerCareSource

PolicyIntensive In-Home (IIH) Services-AR PASSE-MM-1543, MEDICAL POLICY STATEMENT Arkansas PASSE

Policy CodePolicy PASSE-MM-1543

Change TypeClarified (annual reviewreferences updated)

Effective DateNov 1, 2024

Next Review Date

Key ActionPrior authorization (PA) is required for all IIH services; providers must submit documentation supporting admission criteria and treatment plan.

SourceLink

POLICY UPDATE CHANGES

Document notes annual review and updated references; no clinical policy statement changes indicated.

3-20Target age range (years)

>=3Minimum weekly contacts

1-6Typical duration (months)

Every 4 weeksProgress documentation

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Overview: Intensive In-Home (IIH) Services for children and adolescents (subject: Intensive In-Home (IIH) Services for children and adolescents) define medical necessity criteria, admission/continuation/discharge rules, program requirements, provider qualifications, documentation expectations, telemedicine billing modifier use, and exclusions for Arkansas PASSE members aged 3-20. Policy number: PASSE-MM-1543. Effective date: 2024-11-01 (policy period documented through 09/30/2025).

IIH Key Stats & Thresholds

Target age range3-20 years

Minimum weekly contacts>= 3 contacts per week (except during tapering)

Typical duration1 to 6 months

Progress documentation frequencyNot less than every 4 weeks

Contacts per week thresholdMinimum 3 contacts per week (except during tapering)

Service duration thresholdTypical range 1 to 6 months; follow-up reevaluation by licensed professional after this period

Progress documentation thresholdDocument measurable progress not less than every 4 weeks

Family engagement reattempt periodProvider unable to engage/re-engage family in more than 30 days -> discharge consideration

Medical Necessity Criteria and Program Requirements

General Guidelines and Program Requirements

IIH services are subject to the following program requirements and limitations:

General program requirements

Prior authorization (PA) is required for all IIH services
See provider actions: submit documentation supporting admission criteria and treatment plan.
Model of care and individualization: IIH services must utilize a recognized model of care and be individualized in partnership with the family
Duration and scope must be outlined by providers; services intended to stabilize home environment and prevent out-of-home placement.
Duplication and school-based QBHP: HCBS services under 1915() and 1915(c) waivers that are duplicative and provided by the IIH provider may not be billed while a member is actively receiving IIH services; QBHP school-based services will be reviewed individually and should be requested by the IIH provider
Claims may be denied if duplicative HCBS services are billed concurrently.
Psychotherapy and medication coordination: IIH provider will provide psychotherapy and medication management services or collaborate/coordinate with a provider who will provide these services, if medically necessary
Licensed professional oversight required.
Assessment documentation: A thorough assessment of the member and family must be completed and clearly documented to support service delivery and treatment plan development
Providers must complete and document assessments, person-centered treatment plan with measurable baseline and goals, progress notes and reassessments.
Availability and minimum contacts: Services must be available 24/7 via on-call arrangements and providers must offer a minimum of 3 contacts per week with the member/family except during taperingminimum 3 contacts per week
On-call practitioners skilled in crisis intervention must be available 24 hours a day, 7 days a week.
Duration and reevaluation: Duration and intensity typically 1 to 6 months with higher frequency at onset and taper toward discharge; follow-up reevaluation by a licensed professional after typical service durationtypical 1-6 months
Follow-up reevaluation to determine progress and need for continuation of services.
Person-centered treatment plan content: A person-centered treatment plan must be developed and include specific documented items: identification of behavioral impairments, specific measurable age-appropriate goals linked to diagnosis, baseline measures, member progress, anticipated duration and reassessment timelineprogress documented not less than every 4 weeks
Treatment plan should follow fidelity model standards for reassessment timelines.
Monitoring and consultation: Providers must monitor and document progress, efficacy of strategies, and consult with identified medical and non-medical professionals as neededprogress documentation frequency: not less than every 4 weeks
Licensed professional must monitor and document interventions outlined in care plan.

Initial Admission (Medically Necessary) Criteria

Initial requests will be considered medically necessary when ALL the following criteria are met:

Initial admission criteria

Target age range and population: Member is a child or adolescent in target age range (ages 3-20) with behavioral health needsages 3-20
IIH services provided to children, adolescents, and families to treat conditions that significantly impair functioning.
Documented diagnosis: A licensed professional has documented a behavioral health diagnosis as defined in the most recent DSM edition
Documentation may be accepted from BH agency, other provider, or possible self-report and is reviewed case-by-case.
Symptoms and functional impairment: Documentation of specific symptoms, mood, or behaviors linked to functional impairment or risk of serious harm that are directly related to the IIH services requested and are expected to improve with targeted goals

Provider Actions & Billing Impact

Prior Authorization

Prior authorization required

Prior authorization (PA) is required for all IIH services. PA submissions must include documentation that supports the member meets admission criteria and must include the treatment plan that justifies the requested services.

Documentation Required

Comprehensive assessment and treatment plan documentation

Providers must complete and keep in the record a thorough assessment and a person-centered treatment plan. The treatment plan must document specific behavioral/psychological impairments, provide measurable baselines and age-appropriate objective goals, and include member progress. Progress notes and reassessments must be documented, with measurable progress documented not less than every 4 weeks to support ongoing medical necessity.

Billing Rule

Telemedicine modifier usage

When using telemedicine to provide IIH services, the GT modifier shall be utilized in documentation and in claims submission.

Use modifier: GT

Documentation Required

Coordination with other services

Do not bill HCBS services under 1915() or 1915(c) waivers that are duplicative and provided by the IIH provider while the member is actively receiving IIH services. QBHP services offered in the school setting will be reviewed individually and should be requested by the IIH provider.

Denial Risk

Duplicate billing risk

Claims may be denied if duplicative HCBS services under 1915 waivers are billed concurrently by the IIH provider while the member is actively receiving IIH services.

Background & Definitions

Background: IIH services are comprehensive, multifaceted behavioral health services provided to children and adolescents (ages 3-20) and their families to treat conditions that significantly impair functioning, address co-occurring substance use, or meet neurodevelopmental needs. The service goal is to prevent out-of-home placement or facilitate successful transition back into the home through clinical stabilization, promotion of reunification, crisis defusing, and prevention of recurrence.

Service scope and components: IIH uses a team approach delivering individualized services in the member's home or community setting, developed in full partnership with the family. Services include counseling, skills training, resource coordination, and crisis response (immediate access/safety planning). A licensed professional monitors and documents progress, efficacy of strategies, and interventions; consultation with medical and non-medical community providers (for example primary care, juvenile justice, or child welfare) is expected to engage supports and ensure linkage to resources.

Duration, intensity and program expectations: IIH must use a recognized model of care, outline duration and scope (typically 1 to 6 months), provide higher frequency at treatment onset with tapering toward discharge, and make services available 24/7 via on-call arrangements. Providers must offer a minimum of 3 contacts per week with the member/family except during tapering. Continued services require reassessment by licensed professionals and clear documentation of assessment, a person-centered treatment plan with measurable baseline and goals, and progress monitoring.

Applicability to Arkansas PASSE: This policy applies within the Arkansas PASSE Medicaid/1915 waiver HCBS context and includes program-specific rules such as prohibition on billing duplicative HCBS 1915 services while the member is actively receiving IIH, review of school-based QBHP services on an individual basis, and requirement to use the GT modifier for telemedicine claims and documentation when telemedicine is used.

Term	Definition
Crisis Response	Immediate access and availability to the member and family which may include crisis stabilization services, safety planning, and alleviation of the presenting crisis.
QBHP (Qualified Behavioral Health Provider)	A person who does not possess an Arkansas license to provide clinical behavioral health care, works under the direct supervision of a mental health professional (MHP), has completed prescribed initial and annual training, and provides services under the direct supervision of an MHP according to client care plans.
Home	Family living arrangement including but not limited to biological, kinship, adoptive, foster, and non-custodial families who have made a commitment to the member.

OpenPayer

Intensive In-Home (IIH) Services-AR PASSE-MM-1543, MEDICAL POLICY STATEMENT Arkansas PASSE

Coverage Summary

Medical Necessity Criteria and Program Requirements

Provider Actions & Billing Impact

Coding and Modifiers

Background & Definitions

Revision History