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Supported Employment (SEMP) Frequently Asked Questions
An individual I support just enrolled with Partners Health Plan (PHP). What do I have to do?
PHP has a 90-day Continuity of Care period when all waiver claims are paid without prior authorization. During first 30 days of enrollment, the member’s assigned Care Manager will contact you to gather the information regarding the services you provide, discuss goals, and invite you to the member’s Life Plan (LP) meeting.
What information do I need to bring to the Life Plan meeting?
You will be expected to discuss any issues related to the member’s employment, goals, and supports needed. You will also have to identify the type of service the member needs (Extensive or Intensive).
How is SEMP authorized?
PHP’s Life Plan serves as a prior authorization of services (Section IV). The Life Plan will include the type of service you are authorized to provide, along with the number of units authorized.
The standard authorization is for a 6-month period. No approval is needed from the DDRO.
Please note that authorizations for individual and group SEMP are grouped into a single authorization and separate authorizations for individual and group services are not necessary.
There is a separate distinction in the coding for Intensive SEMP and Extended SEMP and separate authorizations are necessary.
What if the individual needs more units before the next Life Plan?
Additional units may be requested at any point during the LP cycle. The member’s Care Manager must be notified of your request so they can schedule an Interdisciplinary Team (IDT) meeting to assess the member’s need for additional units.
If the additional services are agreed upon, an addendum to the LP will be completed to reflect changes to the SEMP authorization. The DDRO is not part of PHP’s approval process (no SARF or SAM needed).
What if I provided unauthorized SEMP services?
Any units billed in excess of the authorized units noted in the member’s Life Plan will be denied.
What are my responsibilities if SEMP services change?
The member’s Care Manager must be notified as soon as the member’s services need to change to adjust the authorization accordingly to avoid claim denials (for example: change from Extended to Intensive).
Do I need to wait 45 days to request Intensive SEMP?
No, PHP has the flexibility to waive this requirement.
What about State-Funded SEMP? (ACCES-VR)
This service is not a covered PHP benefit and continues to be funded by the State.
Can you roll over unused units to the next authorization?
No. PHP issues new authorizations every 6 months, with the standard units of 100 hours for Extended and 125 hours for Intensive SEMP.
Where do I go if I have additional questions about billing, claims, and authorizations?
Please reach out to our Provider Relations team by using our ticketing system: https://www.phpcares.org/provider-assistance
- Select DD Agency and Claim or Authorization Issue to ensure your inquiry is routed to the correct team member
Need Provider Assistance?
The Partners Health Plan Network Development and Provider Relations team is here to assist you with your billing, claims, authorization, education, and any other general inquiry. Use the Contact Us button below to complete a Provider Ticket Submission Form.