Exhibit 1C- Interim Services Enhancements Authorization Parameters.pdf

This document is Exhibit 1C - Interim Service Initiative (ISI) Enhancements Authorization Parameters, which outlines the fee-for-service authorization parameters for various interim services under the ISI program. The services covered include urine drug screening, oral swabs, crisis intervention, recovery support care management, new patient evaluations, and continuing care. For each service, the document specifies the service rate, unit type, CPT code, and authorized limits in terms of days, weeks, months, or annually. The general limits also indicate that an encounter entry is required before the expiration of the authorization.

The pricing details include the service rate per unit for each service, ranging from $8.46 to $82.94. The document also provides the total value of the authorization parameters at $724.19. This information is relevant for understanding the financial aspects of the interim services provided under the ISI program.