1. Specialized Recovery Services Program: Ohio’s 1915(i) program
Front Door Policy Section
Bureau of Long-Term Services and Supports

2. Agenda Program Overview Eligibility Criteria
Referral and Assessment Process
Recovery Management Entities
SRS and Pre-Termination Reviews
Q&A

3. Program Overview 3

4. SRS Program Overview
The Specialized Recovery Services Program (SRSP) is a 1915(i) program that provides continued Medicaid coverage for individuals who were on ABD Spenddown before 8/1/2016
Income between 75% - 225% FPL who are diagnosed with a serious and persistent mental illness (SPMI) or a diagnosed chronic condition (DCC)
Receive the following additional services:
Recovery Management*
Individualized Placement and Support-Supported Employment
Peer Support
Implemented for the SPMI population in August, 2016 and now includes the DCC population as of July, 2017.
*Individuals with a diagnosed chronic condition will only receive Recovery Management.

5. OAC Rules Medicaid eligibility rule:
5160: Medicaid: specialized recovery services (SRS) program.
Providers and services rules: to

6. SRSP: Pre-Termination Review Process
ODM is taking a two-pronged approach to ensure individuals who may be eligible for the SRS Program and spent-down between August 2015 – July 2016 do not experience gaps in coverage due to the redetermination process.
Protection
ODM has established a policy that will protect SRS eligible beneficiaries from losing Medicaid coverage if they have been referred and are in the assessment process, even if that process extends beyond their redetermination date.
ODM has established a process to alert the CDFJS and protect these individuals from losing coverage while they are being assessed.
Prioritization
SPMI referrals have been prioritized by redetermination date as much as possible to ensure that individuals with redetermination dates in the first half of 2017 are assessed accordingly.
Redetermination dates for DCC individuals pre-identified by ODM have been deferred until 2018 to allow time for the SRS assessments to take place.

7. SRSP Referrals 7

8. SRSP Referrals 4 Points of Entry:
Medical provider via referral template
CDJFS – must ask for SRSP
OBLTSS agency – must ask for SRSP
Self referral
Every individual will receive a NOA notifying them of the eligibility decision.
The time it takes for an eligibility determination can vary significantly from person to person due to a variety of factors.
Speaking Points
BH Providers can reach out to the State for status updates to see who has been assigned and to which RM. RMs can then provide specific status updates (contacted, assessment scheduled, etc.)
Case Managers should become authorized reps whenever possible, as they will then receive all the same notifications as the individuals applying for SRS

9. Eligibility Criteria 9

10. SRSP: Eligibility Criteria
To be eligible for enrollment an individual must:
Be at least 21 years of age
Be determined financially eligible for Medicaid
Receive Social Security Disability Benefits*
Reside in a Home and Community-Based Services (HCBS) setting
Demonstrate a need for SRS, and not otherwise receive those services
Have needs that can be safely met in an HCBS setting
Participate in the development of a person-centered care plan
*Currently revising policy regarding receipt of SSD benefits

11. SRSP: Eligibility Criteria
To be eligible for enrollment an individual must:
Be diagnosed with an SPMI, be active on the solid organ or soft tissue waiting list, or have a DCC per the attachment to OAC rule
Adult Needs and Strengths Assessment (ANSA) - demonstrate needs related to the management of the behavioral health or Score at least a 2 in one of the items in the “mental health needs” or “risk behaviors” section or score a 3 on at least one of the items in “life domains section”
Demonstrate needs related to the management of the behavioral health or diagnosed chronic condition 11

12. SRSP: Eligibility Criteria
To be eligible for enrollment an individual must also have at least one of the following risk factors prior to enrollment:
One or more psychiatric inpatient admissions at an inpatient psychiatric hospital; or
A discharge from a correctional facility with a history of inpatient or outpatient behavioral health treatment while residing in that facility; or
Two or more emergency department visits with a psychiatric diagnosis; or
A history of treatment in an intensive outpatient rehab program for greater than ninety days; or
One or more hospital admissions due to a diagnosed chronic condition

13. SRSP: Eligibility Criteria
To be eligible for enrollment an individual must meet at least one of the following:
Have a need for a SRS to maintain stability, improve functioning, prevent relapse, be maintained in the community and if not for the provision of the SRS the individual would decline to a prior level of need; or
Previously have met the eligibility criteria and but for the provision of the SRS, would decline to a prior level of need

14. Recovery Management Entities14

15. SRSP: Recovery Manager Map
Speaker Notes:
Providers may the SRS mailbox in order to determine which of their referrals have been assigned to an RM, and which RM they were assigned to.
CareSource contracts with the AAA’s in the different Regions. The POCs noted above can direct you to those POCs as needed.

16. Questions. ODM Point of Contact: Alicia Hullinger alicia
Questions? ODM Point of Contact: Alicia Hullinger 3