Provider Update
Wednesday, June 24, 2015 12:30 PM
To: Providers of Adult HCBS for 1915(i) SPA Members
Subject Line: 90-day Plan of Care review – It’s not only important, it’s required!
Adult 1915(i) 90-day Plan of Care review –
You don’t want to miss this important step when providing care
The expanded home and community-based services (HCBS) of the 1915(i) State Plan Amendment (SPA)
are key to the independence experienced by adult Medicaid members with serious mental illness.
Within the state plan amendment, Magellan and 1915(i) SPA service providers must abide by specific
oversight and review requirements. These requirements help to ensure members are receiving the right
services in a way that is responsive to their changing needs.
One very important requirement is the completion of a 90-day review of a member’s Plan of Care
(POC). This review helps to ensure the member continues to receive the services he/she needs in the
appropriate duration, intensity, and frequency. This review is required by the 1915(i) SPA and is a
function Magellan audits when reviewing member records.
Did you know that updating your treatment plan is NOT the same as reviewing the Plan of Care?
Both are important. However, the POC is developed by an Independent Assessor/Community-Based
Care Manager and represents what kind of services the member is to receive.
Conducting and documenting a member’s POC review is simple
Conducting a POC review:
As the treating provider, meet with the member, discuss the POC services and ask if he/she believes the
current level and types of services (treatment) are meeting his/her needs.
 If yes, document that the POC was reviewed and no update was needed.
 If no, contact the IA/CBCM to conduct a Plan of Care Update.
Documenting a POC review:
 Review the POC with the member and complete the 90-Day Review form (located on page 22 of the
Initial POC form),
OR
 Review the POC with the member and write a progress note of the review.
Remember:
 If the member needs more, less, or different services than what is listed on the POC, contact the
Independent Assessor/Community Based Care Manager (IA/CBCM) to do a Plan of Care Update for
the member.
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
If you do not have a copy of the POC, please reach out to the IA/CBCM who assessed the member.
The IA/CBCM can make a copy of the POC available to you.
Do you want to learn more about the Plan of Care and Treatment Plan relationship? Please join us this
Friday for our June Provider Call on this topic.
Thank you for all you do in supporting the members of the LBHP.
Magellan Health in Louisiana
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