Pathways LME

A Because the state controls how much funding is available to us and because the demand for services is always greater than the funding available, Pathways made the decision to have a closed network of providers for all IPRS-funded services. This will allow Pathways to ensure that IPRS dollars are spent in the most effective and cost-efficient mann... er. The closed network still includes multiple providers for most services. In some cases, however, there is only 1 provider for very specialized and/or facility-based services. These closed network providers have agreed to provide services for consumers referred to them and in return Pathways provides a pre-determined amount of funding on a monthly basis. 5. Q-Does the diagnostic assessment replace the current intake assessment or evaluation? A- Yes and no. In most cases, as new consumers enter the system, they will have a Diagnostic Assessment within the first 30 days rather than the previous intake evaluation. The Diagnoistic Assessment is a more thorough and comprehensive evaluation that includes face-to-face interaction with and sign off by a licensed clinical professional and a psychiatrist, nurse practitioner, physician assistant, or Ph.D. psychologist. However, each provider will probably continue to have a program intake or program assessment they complete on consumers who enter their service to ensure they are appropriately placed. 6. Q-Will consumers who only need basic benefits need to have a Diagnostic Assessment or a Person-Centered Plan? A-Consumers who only receive Basic Benefits (therapy and medication services) are not necessarily required to have a Diagnostic Assessment. Through the treatment and authorization process, it may be determined that the consumer needs a Diagnostic Assessment. Consumers who only receive Basic Benefits will need to have a version of the treatment plan, but they do not have to have the full version of the statewide Person-Centered Plan. 7. Q-What is CAP-MR/DD? What services will my child receive if he gets CAP-MR/DD? A- ...Read More