Intensive Support Coordination Questions & Answers

Prior to submitting a Letter of Intent for this service, does the organization have to be accredited? If so, is there a preferred entity?
No. During open enrollment of Intensive Support Coordination in 2016 National Accreditation for providers of Intensive Support Coordination is voluntary.  Accreditation is a preferred qualification, but not a requirement.  If the organization has or is pursuing accreditation, it is preferable for the accreditation to be in case management services. Please refer to DBHDD recognized national accreditation agencies in the COMP Part II policy.

Where can I find "Compliance with CMS’s Conflict-Free Case Management" regulation?
The companion document found on the DBHDD website notes the Code of Federal Regulations citation:

Provider Enrollment Criteria:  The applicant agency must assure compliance with conflict free case management as outlined in 42 CFR §441.301(b)(1).

During the new provider forum on 3-15-16, it was stated that an agency can provide ISC for either Medical fragile, behavioral or both. If this is correct will there be 3 different billing code for this service?
No. There is one procedure code for both medical and behavioral intensive support coordination.

Can an agency provide both services, regular support coordination and intensive support coordination, or are you requiring a separate agency for intensive support coordination?  If you are enrolled and approved to provide Intensive Support Coordination are you also eligible to provide support coordination services to those who do not qualify for Intensive Support Coordination Services?
The same agency can provide both Support Coordination and Intensive Support Coordination.  At this time, Letters of Intent are being accepted for both services concurrently, as well as for Intensive Support Coordination as a stand-alone service.  Providers not currently enrolled to provide Support Coordination may apply for Support Coordination and Intensive Support Coordination when submitting an application for Intensive Support Coordination enrollment.  Since the services are considered separate and have separate requirements, providers interested in delivering both services must submit a letter of intent that indicates their request to provide both services.  On page 6 of the Letter of Intent, there is an opportunity to check boxes for one or both services.  On page 7 of the Letter of Intent, there are distinct narrative questions to answer for each service.  However, the Letter of Intent for both services is submitted and responded to as one document.  If a provider is determined eligible to provide Support Coordination, but does not meet the requirements for Intensive Support Coordination, they may still apply for Support Coordination as a stand-alone service.  Providers currently enrolled to provide Support Coordination need not reapply, however, must apply for enrollment to deliver Intensive Support Coordination by submitting a Notice of Interest and subsequent application, if wishing to provide this service.

Will the interested agency have to have a Physician on retainer to provide oversight?
Yes. The interested agency must employ or contract with a Medical/Clinical Director (MD or Licensed Psychologist), with consultation expertise for both Medical and Behavioral Intensive Support Coordination available, if the agency plans to serve both target populations.  If the agency only plans to serve individuals under the medical model, only a Medical Director is needed.  If the agency only plans to serve individuals under the behavioral model, only a Clinical Director is needed.  The Medical/Clinical Director must be available to begin providing consultation for Intensive Support Coordination, beginning on the date the agency begins offering the service.

ISC Providers must have a Medical Director.  What is the scope of work for this position?
The role of the Medical/Clinical Director is to facilitate communication with members of the medical/behavioral community for the purpose of interpreting orders, direction from other clinicians, and facilitating specialist referrals.  The Medical/Clinical Director will oversee and provide expertise in elements of the individual service plan as it relates to specialized medical and behavioral risk.  The Medical/Clinical Director may also assist in facilitating transition from acute or crisis settings such as community hospitals or crisis respite centers.

When will more guidance be available on what the role of Medical Director will be in ISC?
Following submission of a letter of intent, DBHDD will send provider applicants the draft policy manual proposed for publication on the State Medicaid Agency’s website on 4/1/16.  The policy manual includes the general role of the Medical/Clinical Director.  After 4/1/16, the policy can be found at www.mmis.georgia.gov under Policy and Procedures for Case Management – Support Coordination and Intensive Support Coordination.

Would we need both a medical and clinical director or just one or the other?
If you plan to provide Intensive Support Coordination for individuals with exceptional medical support needs, a Medical Director (MD) will be needed.  If you plan to provide Intensive Support Coordination for individuals with exceptional behavioral support needs, a Clinical Director (Psychologist) will be needed.  If you plan to provide ISC for both, then both a Medical and a Clinical Director will be needed.  However, a psychiatrist (MD) could meet the needs of both target areas served.  Keep in mind that these roles can be on a contract “a la carte” basis (hourly fee-for-service).  An agency does not need to hire a medical/clinical director as a permanent staff member.

Would we need both a behavioral clinical supervisor(s) and a medical clinical supervisor(s)?
If you plan to provide Intensive Support Coordination for individuals with exceptional medical support needs, an ISC medical clinical supervisor will be needed.  If you plan to provide Intensive Support Coordination for individuals with exceptional behavioral support needs, an ISC behavioral clinical supervisor will be needed.  If you plan to provide ISC for both, then both clinical supervisors will be needed.  You may choose to specialize in only medical or only behavioral ISC.  However, they are services rendered under the same billing code.  If your agency does not have a staffing pattern to support individuals with exceptional medical or exceptional behavioral needs, then individuals who would benefit from that specialty of ISC will not be referred to your agency. 

Can the proposed ISC supervisor be an LMFT?
No. 

How will choice be dealt with if the individual wants to opt out and stay with the existing SCA who is not accredited?
DBHDD and DCH are consulting federal Medicaid Waiver rules in consideration of opt-out options.  More information will follow as decisions are made. Whether or not an agency is accredited does not have any influence over choice.  Any waiver participant can select either an accredited agency or one that is not accredited.

Will start-up funds or other state assistance (such as pre-assigning a number of ISC individuals to a particular agency) be available to those support coordination agencies that will be new to the state?
This has not yet been considered and thus no decision has been made relating to start-up funds or other state assistance.

Given that the HRST Scores are a driving part of determining is an individual qualifies for Intensive SC, what it the plan for competency based administration of the tool?
Based on the current policy on annual assessment updates, DBHDD Field Office I&E Clinicians are responsible for reviewing the HRST of all individuals who meet the criteria for ISC.  Therefore, all of the HRST’s would have been reviewed for accuracy within the past year for individuals eligible for the service.  

Given that the SIS scoring is also going to determine who is eligible for the new Intensive Support Coordination Service, will all individuals in service receive a new SIS in order to be sure needs have not changed since the last one? Also, does the state have enough SIS Specialists who have completed the Inter Rater Reliability Process to complete this task?
At this time, we will be using the most recent SIS scores available in determining eligibility for Intensive Support Coordination.  As new SIS’s are being administered by DBHDD SIS Assessors, the new SIS scores will drive eligibility for ISC.

Where and when will the New Provider Forum for Intensive Support Coordination be held?
The Intellectual and Developmental Disabilities (IDD) New Provider Enrollment Forum occurred on Tuesday, March 15, 2016 from 9:00 am – 1:00 pm at The Morrow Center.  This forum was targeted for potential new providers of IDD services, and participation is typically mandatory. However, an additional New Provider Interest Forum for Intensive Support Coordination was held on 3/22/16.  This forum was recorded and is available for view.  If you are a new provider who was unable to attend the New Provider Enrollment Forum or call in for the New Provider Interest Forum for ISC, you must view the recorded webinar prior to submitting your Letter of Intent to ensure you have the information necessary to make an informed decision about applying to become a provider of this service.  Current providers are not required to attend a New Provider Enrollment Forum, but are urged to view the recorded webinar. 

For detailed information on the recruitment and application process and pre-qualifiers, please read DBHDD Policy #02-701, Recruitment and Application to Become an IDD Services Provider.

Will there be another New Provider Orientation? I was not able to make the one for March 15, 2016.  Is the Webinar the same thing?
Yes, see the top of the page for details about the webinar. Update: A recording of the 3/22/16 webinar is now available on this page.

What is the effective date for services?
July 1, 2016 is the effective date for Intensive Support Coordination.  We are hoping to have providers who are able to begin providing service on that date, but understand that business start-up responsibilities may delay the initiation of service provision.

This question pertains to required experience for Intensive Support Coordinators. Please elaborate on the intent of “Medical - minimum 2 years experience in a healthcare, habilitative/rehab, residential or similar setting.”  Specifically, would current Pioneer Project SCs with greater than 2 years experience serving persons with complex medical needs in the capacity of  SC/Case Management only fit this particular requirement?
"A minimum of two years of experience in a healthcare, habilitative/rehab, residential or similar setting” could include experience as a Support Coordinator, as long as the experience included serving persons with complex medical needs.  Therefore, yes, those Support Coordinators who have had 2 years of experience with the Pioneer Project/Transition Process/Enhanced Support Coordination in the State of GA or other similar services in other states would meet this requirement for relevant experience. 

HRST and SIS scores can fluctuate if a medical issue arrives but isn’t permanent. What system will be in place to monitor these scores so that a person can receive Intensive Support Coordination Services when needed and then go back to Traditional Support Coordination Services when the Intensive is no longer needed?
Should a person’s condition change such that the HRST score indicates the need for Intensive Support Coordination by virtue of the qualifying HRST or SIS scores, the expectation is that the individual’s medical or behavioral condition requires monitoring for the remainder of the ISP year (plan year).  Therefore, stabilization that might warrant a return to traditional support coordination will not be considered until the next annual reassessment and ISP development.

Will an individual be given choice among Intensive Support Coordination agencies when entering the service?
Yes.  Every individual entering services who meets eligibility criteria for Intensive Support Coordination will be provided with information on all available Intensive Support Coordination agencies that serve individuals with their risk classification (medical or behavioral) and the individual and/or their representative will have the opportunity to choose from any of those options.

Will an individual automatically go back to the provider of Traditional Support Coordination after the Intensive SC services are no longer needed, be given choice from all SC agencies, or automatically stay with the agency providing the Intensive SC services?
If an individual is assessed as needing Intensive Support Coordination, they must receive Intensive Support Coordination.  Until assessed otherwise, they must choose between Intensive Support Coordination agencies that serve their risk category (medical or behavioral).  As with traditional Support Coordination, a waiver participant has the opportunity at any time to choose whether they want to continue with their current SC/ISC agency or elect to transfer to another SC/ISC agency.  If an individual’s assessed needs result in a need for Intensive Support Coordination and they currently have Support Coordination, they (or their representative) can decide whether or not they would like to stay with their current agency (if they provide both services) or chose another agency that provides Intensive Support Coordination.  The same choice of agency is offered in the opposite circumstance, as long as the individual is able to receive the service for which they have been assessed at the agency they choose.

Of the 1500 persons currently identified, has DBHDD further identified by numbers and locations which modality of ISC (medical or behavioral) that will be needed for these persons?  Will DBHDD “tag” these and each newly-eligible person for the modality of ISC needed before referral to an ISC provider?
We do not yet have this information available, but are working to compile it.  Moving forward, yes, newly eligible persons will be designated with an ISC modality upon initial assessment for services.  Our current identification of those preliminarily eligible for intensive support coordination, 130 were identified through use of the behavioral section of the Supports Intensity Scale and the remainder of the 1,500 through use of the Health Risk Screening Tool.  DBHDD certified assessors are in process of reevaluating high risk individuals through use of the SIS, thus additional people may be identified as a wider population is reassessed.

If a person has both intensive medical and behavioral support coordination needs identified, what will be the process or expectation for determining which type of specialized ISC should take precedent for the person?
Intensive Support Coordination services will be provided based on assessed need.  The clinician conducting the most recent assessment will be responsible for determining which modality of ISC would best meet the individual’s most recent needs.  It may be recommended for individuals with concurrent extensive medical and behavioral risks to be served by an agency that has clinical supervision available in both medical and behavioral, so holistic consultation can be available within the agency.

Is a transition from a state hospital in of itself a sole eligibility criterion irrespective of a person’s HRST and/or SIS score?  If yes, and there is not a corresponding HRST or SIS score to indicate a need for ISC, which type of ISC (medical or behavioral) should be deployed for these persons?  Will these persons also be able to “opt out” of ISC as noted in the current eligibility criteria?
All individuals transitioning from state hospitals are eligible for ISC based on the sole criteria of their transition from institutional care.  Intensive Support Coordination will be provided for a minimum of one year following discharge for these individuals, under the modality where the greatest risk is assessed.  If their annual assessment indicates no further need for ISC, they will be transferred to traditional support coordination for the following ISP year.  

Do Georgia’s CMOs (Medicaid managed care contractors) cover both physical and behavioral healthcare benefits for their enrollees?  Or, are behavioral health benefits under the state’s Medicaid program delivered under another modality or network of providers?
In Georgia, adults and children served through any of the 1915c Medicaid Waiver Programs are exempt from CMO eligibility/coverage.  There is an exception for children whose Medicaid eligibility is derived by virtue of falling into the “foster care or adoption assistance” class of assistance but that number is small.  Waiver participants typically receive psychiatric or behavioral health services through State Plan, fee-for-service Medicaid or through Medicare, if eligible, as the primary payer source. 

To ensure coordination of Medicaid state plan benefits and Waiver services and access to a sufficient provider network for meeting the extensive physical and behavioral health needs for this population, is there any expectation in place or preparations being made for the CMOs (or other managed care contractors) to work closely and collaboratively with ISC providers?  If not yet developed, will the providers of ISC services be expected to establish the linkages and relationships that will be necessary, and can or will DBHDD and the state Medicaid authority assist in ensuring those linkages exist with the CMOs?
Following the question above related to exclusion from participation in CMOs, it will be the role of ISC providers to initiate some of the linkages for behavioral and physical health needs though many individuals are admitted to intensive support coordination with clinical relationships already established.    Additionally, DBHDD has initiated a linkage model through Intensive Clinical Support Services available statewide.  ICS team members are available through referral to provide evaluation and technical assistance, including assistance with linkage to community providers in the areas of physical, occupational and speech therapy, behavioral services and nursing, 

If systemic problems or gaps are identified within any of the physical or behavioral healthcare provider networks operated by the state’s Medicaid managed care contractors (CMOs), what will be the mechanism for ISCs to report those problems to the DBHDD or the state Medicaid authority for follow-up or correction? 
DBHDD administers a statewide crisis and access service which assists in identifying available behavioral health and developmental disability services.  Identified systemic problems or gaps in the healthcare provider networks should be communicated to the DBHDD Office of Health and Wellness and Integrated Clinical Support Services.  

What requirements or mechanisms are in place currently for Waiver service providers to provide healthcare oversight or coordination to persons under their care who require such?  Do providers routinely screen persons to assess individual healthcare status or needs.  Is the HRST used to determine if a person requires nursing oversight and monitoring at and by the service provider, or at some other system level?
Both provider agencies and DBHDD staff use the HRST to identify potential healthcare needs, with additional evaluation by DBHDD clinicians who recommend the type and duration of clinical services.  Nursing services are available in the COMP waiver as a reimbursed service, both on the LPN and RN levels.  Professional behavioral services are also reimbursed through the waiver program.

Will there be specific, ongoing (monthly) monitoring tools identified or required for ISCs to use (for assessing the adequacy of supports and services, healthcare status, risk monitoring, etc.)?  
Yes, monitoring tools will be made available for use by ISC’s. Additionally, interpretive guidelines for use of the tool and guidelines for evaluating service delivery under the “Recognize, Refer and Act” system will be made available as part of the training on ISC.

As a result of ISC monitoring, are Waiver service providers obligated to respond to ISCs if a problem, gap or issue with the person’s care, support or services is identified?  Has a reporting and feedback mechanism been identified so ISCs can report unresolved issues or barriers to DBHDD for assistance or remediation?  Does the mechanism include penalties or sanctions for a provider’s failure to act or respond to issues identified by the ISC monitoring?
Yes, a reporting and feedback mechanism has been developed that includes the role of the provider, the ISC, the DBHDD field office and various levels of DBHDD’s Division of Accountability and Compliance.  This information will be presented during training on ISC. 

Does the state have a required or standardized form or template for the ISP (plan of care) required for COMP and NOW Waiver enrollees?  If so, where can it be found online or obtained?
Yes, there is a standardized ISP template for waiver participants.  The ISP is currently undergoing extensive edits that will further automate the process of transferring clinical recommendations directly to the ISP from various assessments.  A redacted sample of the currently-used ISP can be provided upon request.

Will persons receive ISC services indefinitely (provided there is no change in the person’s HRST or SIS score, or the person does not opt out)?  Does DBHDD anticipate that supports and services can be stabilized or integrated through the provision of ISC to the point of resuming standard SC services for the person?
Individuals receiving ISC will receive clinical assessment updates on an annual basis.  At the time of the annual update of the assessments, the clinician can recommend continuation of ISC or transfer to transitional SC due to risk reduction and stabilization of medical/behavioral support needs.  During the plan year the individual will be served at the most-recently assessed level of support coordination unless an event or condition change warrants change to intensive support coordination.

Does DBHDD expect to have more than one provider approved in each region?  What will be DBHDD’s process for how eligible persons initially choose, or are assigned to, an approved ISC provider?  If an existing SC agency is approved to provide the new ISC service, will the ISC-eligible persons already supported by that agency remain with that agency by default?  Or, will there be an expectation that choice will be offered to those persons, if another provider is approved and available for ISC services in that same area? 
Yes, DBHDD expects to have enough providers in each region such that choice is an option for eligible waiver participants.  At the time of enrollment in ISC, the individual and/or their representative will be presented with pamphlets of the ISC providers that offer the indicated modality of ISC and they will be able to select from those available.  If an existing SC agency is approved to provide ISC, the ISC eligible individuals currently served by that agency will be offered the opportunity to either remain with their current provider, or select from other available ISC providers in their area that serve individuals with their assessed need modality.

Was a formal rate study conducted to set the ISC rate?  If one has been completed, is the methodology or model used available?  Will DBHDD be studying or monitoring the actual costs of ISC during its implementation to ensure the rate is adequate?
No.  A formal rate study has not yet been completed for ISC.  The current rate was based on provision of a similar waiver service to a similar population.  A rate study is underway and DBHDD will use actual costs and audited cost reports submitted by support coordination agencies in determining adequate rates for both traditional and intensive support coordination.  Adjustments to both rates will be proposed through waiver amendment following extensive public comment by both DBHDD and the State Medicaid Agency, DCH.

Are there rate studies underway or anticipated that will address the current rate for standard SC services?  Will that or any future study being looking at the ISC rate for the long run?  For example, does DBHDD anticipate a point in time when ISC and standard SC could be blended into one modality (with a single, comprehensive rate) that allows SC providers to assess and adjust the level of service coordination based on fluidity in a person’s acuity, or due to any disruptive change in a person’s situation or condition? 
Yes, the current rate study will address both standard SC and ISC.  We have not yet considered a blended support coordination rate, but that has not been ruled out as a future consideration.

How frequently may payment claims be submitted for ISC services?  What is the typical timeframe between the submission of a claim to the state and when that claim is paid to the provider?
Georgia Medicaid providers may submit claims through the Medicaid Agency at any time since all claims in Georgia are submitted electronically following prior authorization.  All authorization and payment history is available to providers assigned to provide services to the Medicaid member through the Agency’s billing website found at www.mmis.georgia.gov.  “Clean” claims are paid weekly through electronic funds transfer. 

It will take extraordinary effort, time and expense to start delivery of ISC services to any number of persons by any number of approved providers on July 1st.  Overall, to support 1500 persons, a minimum of 90 highly compensated professionals need to be recruited and hired across the state.  Other support staff need to be hired, and Medical/Clinical directors employed or placed on paid retainer.  All of these employees must be outfitted, orientated and trained before starting ISC services. Clearly, a number of months of expensive payrolls and operations will be incurred prior to being able to start delivery of the service and submit the first claims for payment.  To ensure qualified providers are not financially stressed or placed at financial risk during or after start-up, what provisions are being made to assist approved agencies financially or administratively? 
DBHDD is currently considering a model that allows providers newly enrolled in Georgia Medicaid programs to “roll in” participation in the COMP waiver, adding clinical and administrative staff as the member volume increases.  Further individual discussions are expected to take place following receipt of completed application. DBHDD is still considering many options relative to startup of intensive support coordination providers.

During and after startup, if DBHDD determines the cost of providing ISC services exceeds and cannot be provided as defined by DBHDD within the rate set by DBHDD, will the state indemnify providers (through its contracts with providers) against that risk and make providers whole for unforeseen cost overages identified by DBHDD?
DBHDD has not considered such at this time, preferring to temporarily modify start-up requirements for new agencies.

May an ISC approved provider utilize staff or contractors currently working in other programs operated by the provider; however, do not work in the waiver programs,  to serve as the Medical Director and/or Clinical Director for their ISC services?
There is no conflict with utilizing a staff or contractor working in another program as long as dedicated hours are sufficient to meet the needs and intent of their role within the Intensive Support Coordination service.

In reference to the following item and other related items from the checklist: "Copy of last two years agency’s business Tax Returns or audited financials to support assertions that applicant has been in business for a year." I have been in business for over a year but have not actually "done" business, thus ISC is my first attempt at doing so. What alternative documents can I submit for this/these items? 
Enrollment criteria require all of the following:

•    A minimum of five years of business experience and oversight of 5 or more employees in the health care, behavioral health or case management field.
•    A minimum of five years of experience serving individuals at risk due to medical, functional, and/or behaviorally complex conditions.

Because these enrollment criteria are considered minimum qualifications, it appears that the agency does not qualify for enrollment.

I attended the provider forum in Morrow in March but never received my link to complete a survey so I could receive an attendance certificate.  How do I obtain my certificate?
If you attended The Intellectual and Developmental Disabilities (IDD) New Provider Enrollment Forum on Tuesday, March 15, 2016 and did not receive your certificate of attendance, please contact the Georgia Collaborative at [email protected].  If you plan to submit a Letter of Intent and you missed the March 15 forum, but did participate in the New Provider Interest Forum for ISC on March 22, please indicate that in your LOI.

The FAQs on the ISC web page state the deadline for letters of Intent is April 30, 2016, but that is a Saturday.  Please clarify if this information is correct or if it is the business day prior or after the 30th.  Also, what time of day does the application deadline close?
All Letters of Intent (and Notices of Interest) must be submitted through the DBHDD website by midnight on Saturday, April 30.  

Will the ISC be a Medicaid billable reimbursed service?  Is not, how will the funds be dispersed?
Yes, ISC is a billable reimbursed service under the COMP (Comprehensive Supports) Waiver.

What is the method by which we can receive proof of attending either the provider forum or the webinar necessary within the LOI process?
See answer to FAQ #43 in regards to the new provider forum.  If you participated in the ISC provider interest webinar, please send an e-mail to [email protected] with the name of the attendee and agency represented.  The ISC provider enrollment team will then review the attendance log and send a reply e-mail acknowledging your attendance.  This e-mail can be submitted as proof of participation.

In the qualifications for ISC Medical and ISC Behavioral, it is stated that experience providing care management/coordination preferred.  Does this mean that it is preferred for ISC Medical or ISC Behavioral staff members to have previous Support Coordination experience?
It is a preferred qualification for all ISC Clinical Supervisors to have some type of experience coordinating care plans, guiding acquisition of supports within and outside of the healthcare arena, or providing clinical case management services.  Support Coordination experience is not specifically a preferred qualification, but would fall within the mentioned preferred experience.

Since we are not presently operating in Georgia, we do not have a Medical Director or Clinical Director in place there. Please advise how we should proceed in completing the portion of the LOI that requests information about these positions/individuals.
For those agencies not presently operating in Georgia, simply list the credentials of the out-of-state staff the agency will be using temporarily during implementation and phase in of service provision. 

Since we are not presently operating in Georgia, is it acceptable to indicate on the LOI that we will secure a physical site location upon acceptance of our application for Support Coordination/Intensive Support Coordination? 
Yes.

Is it permissible to select all 6 regions on the LOI with the intent to initiate service in each region incrementally (as opposed to accepting clients in all regions all at once)? Conversely, if we only select 1 region on the LOI, will we be permitted to expand into other regions at a future date? 
Yes to the first question.  The DBHDD has an enrollment policy that requires all agencies serving NOW and COMP waiver participants to provide services for a full year and then expand with good standing status.   If the agency enrolls for all six regions, phasing in service provision across regions over time is allowable.

What is the mechanism for the responsibility handoff when the ISC (intensive support coordination) team identifies an issue with consumer care and reports it to the State Recognize and Refer teams as on July 1.
In light of the clinical model of Intensive Support Coordination, it is expected that clinical needs will be managed largely by the Intensive Support Coordination team by using strategies such as: communication with primary care or other physicians and referral to non-Medicaid and State Plan Medicaid-enrolled providers for medical and behavioral follow up.  Actions initiated through the recognize and referral model will be the primary responsibility of the ISC teams, led by clinical supervision.  In those instances where community resources and waiver resources are not available, the ISC Team will be expected to reach out to the Field Office for collaboration and assistance with the opportunity to request follow up by the Integrated Clinical Support Team.

What feedback will the Field Office Regional Quality Review (RQR) teams provide to the ISC team to insure issues raised have been addressed to protect consumer health and welfare.
DBHDD RQR clinicians will work with and through Intensive Support Coordination teams to assure follow up assignment.  Prior to a visit or follow up activity, Intensive Support Coordinators will be expected to review all recent information available in the waiver participant record to familiarize him/herself with the most recent visit outcome of the RQR clinician and any follow up needs noted during that visit.  Thus, the electronic record will provide the first line of communication regarding identified needs supplemented by follow up between clinicians when necessary for coordination.

What will be the mechanism in deciding who determines the course of an individuals medical treatment between the various clinical teams, nurses and physicians? 
Medical treatment is always determined by the individual’s treating physician or healthcare provider.  ISC teams will be responsible for communication of physician orders and treatment to other team members, typically through use of the electronic record system but in some cases by direct contact or initiating case conferences.

Other than a consultation note in CIS, would a support coordination MD be required to complete any additional form of documentation? 
The Medical Director role is one of consultant to the ISC team and ISC management around unmet medical needs, changes in condition, and recommendation about what issues to communicate to the primary care physician.  In some cases the Medical Director may need to reach out to other treating providers to inform the medical provider of special issues or request follow up on particular concerns.  In cases where consultation occurred a note will document the purpose of the consult, the recommendations, and the plan for follow up.  That note need not be generated by the physician but rather may be documented by the clinical supervisor.

Along with the supervision of 5 support coordinators and monitoring of the assigned individual's health and safety, what other specific job duties will the State expect an RN to do. 
The role of the Clinical Supervisor for the ISC team has been articulated in the current Medicaid policy for support coordination/intensive support coordination found at www.mmis.georgia.gov in a stand-alone policy manual titled Support Coordination/Intensive Support Coordination.