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The purpose of this bulletin is to clarify the member benefit plans that are eligible to receive support coordination services for individuals with intellectual or developmental disability (IDD).  Support Coordination, also called targeted case management services, is a covered service option for individuals with Medicaid coverage, However, the service is not covered for members enrolled in the Family Access to Medical Insurance Security (FAMIS) benefit plan. 

This means that reimbursement for T2023 (Developmental Disability Case Management/Support Coordination) and T1017 (Intellectual Disability Case Management/Support Coordination) is not available for individuals with FAMIS benefit plans. Any support coordination claims will be denied if the individual receiving services is not enrolled in the Medicaid benefit plan. Providers must check an individual’s eligibility and benefit plan prior to providing services.  Services rendered prior to the effective date of an individual's Medicaid coverage are not eligible to receive reimbursement. However, Medicaid coverage may be retroactive up to three months prior to the month in which the application was filed, if the individual was eligible during the retroactive period. Once an individual is determined to be eligible for Medicaid, providers may bill for covered services delivered during the time the member was eligible, and, if any payments were collected from the member prior to enrollment, upon receipt of payment from Medicaid, the service provider must reimburse the member for their out-of-pocket expenses. DMAS does not reimburse members for out-of-pocket expenses.

To avoid disruption to claims payment through FFS and the MCOs providers must periodically check the DMAS provider portal, also known as the Provider Services Solution (PRSS), to ensure that the provider's enrollment, contact information, and license information is up to date, for all of the provider's respective service locations. Under federal rules, MCOs and DMAS are prohibited from paying claims to network providers who are not enrolled in PRSS. Additional information is provided on the MCO Provider Network Resources webpage and includes links to resources, tutorials and contact information to reach Gainwell with any provider enrollment or revalidation related questions.  Dental providers should continue to enroll directly through the DMAS Dental Benefits Administrator, DentaQuest.