1.
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Georgia Families 360°
Legal Community Training
2015

2.
Who is Amerigroup Georgia?
• Incorporated as Amerigroup Georgia Managed Care
Company, Inc. Wholly owned subsidiary of Anthem, Inc.
• Amerigroup is a part of the Georgia Families Medicaid
program administered by the Georgia Department of
Community Health (DCH). DCH is Georgia’s Medicaid
authority.
• Amerigroup was chosen to be the single statewide Care
Management Organization (CMO) for the youth in the
Georgia Families 360 program.
– Georgia Families 360° is staffed separately from
general Amerigroup CMO employees.
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3.
Georgia Families 360° Populations
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Adoption
Assistance
~ 12,000
Youth who have
been adopted
out of state
custody – keep
Medicaid til 18
Juvenile Justice
~ 200 – 400
Youth committed to
the state who are in a
non-secure,
community
placement
Foster Care
~ 10,000
Youth in state
custody due to
abuse or
neglect

4.
Georgia Families 360°: Main Goals
• Integration of care on the physical,
behavioral health, and dental needs of
Georgia’s children in foster care, receiving
adoption assistance, and in juvenile justice
community residential programs
• Improve health and well-being outcomes
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5.
Intake Process
• There are several key items to be done when a
youth enters foster care
– A Medicaid application must be submitted as soon
as possible to determine eligibility
– An initial E-Form should be sent to Amerigroup
coinciding with the 72 hour hearing.
– Amerigroup immediately assigns staff to the youth
and begins outreach efforts to the identified
placements, state agency staff, and providers
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6.
E-Form Importance
• The E-Form is a vital tool as it is the primary method
of communicating information/changes about the
member.
• The 72 hour notification is important as it impacts
several down stream processes and timeliness
• Completed E-Form within 72 hours of youth entering
care
• Demographic information
• Medical Information
• Placement Information
• Identified CCFA provider
• Other – other referrals 6

7.
Other E-Form Uses
• The E-Form must also be submitted for:
– Placement changes
– Change in demographic info (name change)
– Child/Youth exits care
– CCFA Provider: Chosen by DFCS case
manager and noted on E-Form
– Other referrals made for youth such as Babies
Can’t Wait
– E-form should be sent within 24 hours of any
change to a youth’s record
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8.
What is a Care Coordinator?
• Every youth in the Georgia Families 360° program
will be assigned to a specified Care Coordinator.
• Assigned based on county of custody for youth in
foster care.
• Care Coordinator are the primary partner for
identifying and referring for services that a youth
needs.
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9.
• Each youth will have an individualized care plan made
with them that will address their identified physical and
behavioral health needs.
• Work with community agencies to ensure appropriate
services are referred to families, children, youth and
young adults.
• Education to members, foster parent, and adoptive
parents on the service needs of the members
• The Care Coordinator will be the primary conduit for
information regarding status of services to the DFCS
Case Manager. No letters will be mailed directly to foster
care members.
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What Does an Amerigroup Care
Coordinator Do?

10.
Psychotropic Medication
Management
• Every youth with one or more psychotropic
medication will have their meds reviewed
by Georgia Families 360° Medical Director
or pharmacy review team.
• Goal is to ensure evidence based
medication guidelines are followed for
youth and that the medication is
appropriate for the identified diagnosis.
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11.
DFCS/DJJ Responsibilities
Amerigroup works in
partnership with DFCS and
DJJ state agency staff*.
State agency staff will
continue to make decisions
regarding*:
• Medical Care
• Placements
• Safety Issues
• Medication
• Transportation
• Service Choices
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* For children in foster care or juvenile justice.

12.
How We Work with DFCS
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• Youth enters GF 360°via foster care:
– AGP is notified by E-form from DFCS worker
• AGP depends on timely and accurate information, via the E-form, from
DFCS to be able to reach out to appropriate people
– Youth is assigned to Care Coordinator (CC) and Outreach Case
Specialist
– Outreach Case Specialist works with DFCS CM to make initial
appointments
• Medical/Dental check within 10 days
• Trauma Assessment completed within 15 days of entering care
• Health Risk Screening within 30 days
– Once these items are completed the Outreach Case Specialist’s
work is complete and the CC will be the primary contact for AGP

13.
How We Work with DJJ
GAPEC-0521-13 13
• Select DJJ youth entering non-secure placement setting
• AGP is notified via E-Form by Office of Federal
Programs
• Youth is assigned to CC, based on placement location,
and Outreach Case Specialist
• Outreach Case Specialist works with DJJ Juvenile
Probation and Parole Specialist to make initial
appointments
• Medical/Dental check within 10 days
• Health Risk Screening within 30 days
• Once these items are completed, the Outreach Case
Specialist’s work is complete and the CC will be the
primary contact for AGP

14.
Placements
• DFCS and DJJ retain placement
responsibility and authority
• Amerigroup does not decide placement
• PRTF is considered a treatment service
and not a placement
– Children and adolescents who do not need the intensive services of a
PRTF, but need a placement resource, may be referred by the
Department of Human Services, Department of Juvenile Justice or
Parent/Legal Custodian to Child Caring Institutions or Child Placing
Agencies which are not covered under Medicaid, but are funded with
State General Funds, Title IV-E funding and other private funding
resources*.
*DBHDD PRTF Provider Manual
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15.
Accessing Services
• Many behavioral health services do not require any type of pre-
authorization to commence with a youth.
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Common Behavioral Health Services
Pre-Authorization Required Pre-Authorization Not Required
Inpatient mental health Individual therapy
Partial Hospitalization program Group therapy
Intensive Outpatient program Family therapy
Chemical dependency services Trauma Assessments
Residential treatment Facility Psychiatrist Appointments
Psychological and neuropsychological
testing
Evaluation and Monitoring

16.
Requirements for Psych Testing
Must meet all points of medical necessity:
– Must be for the purpose of helping to establish the diagnosis of and
to develop a treatment plan for a mental disorder, when this
information is not adequately available from one or more
comprehensive medical or behavioral health evaluations with the
member and appropriate ancillary sources (e.g., family members,
health care providers, school records); AND
– It should not be for the primary purpose of assessing learning
disorders, vocational testing or educational planning. Custody
evaluation, court referral for evaluation (unless medically
necessary) and testing for research purposes, are not covered;
AND
– There is evidence to suggest that the testing results will have a
timely and direct impact on the member's treatment plan
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17.
When Psych Testing is Not
Medically Necessary
• Educational/Vocational Services Assessment
• Placement Determination
• Annual/Regular Checkup
• Admission to nonmedical programs
• Non-medically indicated court-ordered tests
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18.
Applicable Uses of
Psych Testing
Examples:
– When a youth has been treated for a condition, but
has not made improvements and there is a need for
additional diagnostic clarification
– For purposes of differentiating between organic
versus psychogenic conditions
– When a provider has completed a thorough clinical
assessment, obtained data from other sources
(family, collateral contacts, medical records) and
administered questionnaires/rating scales and the
diagnosis is still unclear
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19.
Example
Child with primary diagnosis of ADHD mixed with
disturbances in mood and behavior:
• Learning disorders have been ruled out by testing at
school
• Behavior rating scales have mixed or unclear findings
(done by provider)
• Child has been treated with various medications and
behavioral treatment without improvement
• Provider requests testing to aid in clarifying diagnosis
and to shape treatment planning
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20.
Commonly Used Behavioral Health
Assessment Types
Standardized Bio-Psycho-Social type assessments used to
determine need for therapeutic services:
• Psycho-Educational Testing – administered by a school
(typically) to determine educational needs/capacity.
• Trauma Assessment – a component of the CCFA that is
completed by an Amerigroup BH provider that is
equipped to assess trauma-related issues. The Trauma
Assessment should include service/treatment
recommendations.
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21.
Requesting Psych Testing
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Child Enters Care Child Currently In Care
Ensure required
Medicaid paperwork
and e-form is complete
1) Find an AGP provider
to do the testing
2) Discuss the need for
testing with provider
3) Provide the
necessary paperwork
for provider to request
psych test
1) Find an AGP provider
to do the testing
2) Discuss the need for
testing with provider
3) Provide the
necessary paperwork
for provider to request
psych test
After provider
receives PA,
schedule appt.
Do not take
youth to provider
until the PA is
received.

22.
Additional Resources
• The Care Coordinator can assist by:
– Discuss with them the need for psych testing
– They can help locate an Amerigroup provider
– They can assist involved parties in gathering needed
items for clinical documentation
(i.e., dates of last PRTF admit)
– Liaison between stakeholders, providers, and the
Amerigroup Utilization Management department
• You can also discuss the need for psych testing with
your DFCS WEPAC Specialist
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23.
Ombudsman Role
• The Amerigroup Ombudsman Office
provides confidential, impartial assistance
to members, their representatives, and
caregivers of Georgia Families 360 ° who
are experiencing health care related
issues.
• We also work with advocacy groups and
state agencies to discuss trends and
issues within the community.
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24.
Contact Information
• Intake Number
– Juvenile Court Email
– Gf360juvenilecourt@anthem.com
• Ombudsman
– 1-855-558-1436 (phone)
– helpOMB@amerigroup.com (email)
– 1-888-375-5067 (fax)
• Amerigroup Website
– https://www.myamerigroup.com
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For further information regarding the
program, please contact the following:
Amerigroup
• Training Team
- Ga360Trng@amerigroup.com

25.
Further Questions and Training
• Amerigroup is committed to providing you
and your court the information you need. If
you have any further need of information
or training, please contact:
ga360trng@amerigroup.com
• Generally a training can be scheduled
within 2 weeks of the request
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