13.6.6 Preauthorization for Changing Tiers

Changes in the approved tier require preauthorization from a CRS program staff member. The provider must document in the participant’s record why a participant received less than the preauthorized or approved tier or why it is clinically recommended to increase the tier.

When a provider requests a change in Tier for a participant, the provider must complete the Form 3149, Comprehensive Rehabilitation Services Request for Tier Change. The form will include the requested Tier change and the justification of need detailing goals, progress or lack of progress and the type, frequency and duration of therapy services. The Request for Tier Change Form must be faxed or sent via secure email to the CRS Counselor. The CRS Counselor will review, make a determination and return to the requesting provider within five business days. Unauthorized services may not be reimbursed by the CRS program. The CRS program staff member may request documentation supporting the provider’s request. If requested, the documentation must be submitted before delivering services at the newly requested tier or the change in tier is considered unauthorized.