The Clinical Integrity Unit (CIU) is responsible for the utilization management of mental health and substance use disorder services. The team works toward the integration and coordination of services provided to Vermont Medicaid members with substance use disorders and mental health needs. The team performs utilization management activities including concurrent review and authorization of mental health and substance use disorder services. The UR Team also administers the Team Care program, which locks a member to a single prescriber and a single pharmacy. In addition, the Autism Specialist authorizes applied behavior analysis (ABA) services for children.  

Please note that in the Summer of 2020, the Clinical Integrity Unit, the Clinical Operations Unit, and the Pharmacy Unit came together as the Clinical Services Team.  The Units are displayed separately in this scorecard due to their different lines of work.

The CIU serves Vermonters enrolled in Medicaid who require behavioral health inpatient, residential, and ABA services.

The CIU ensures that Medicaid members get the services needed for the appropriate length of time.

For the CIU, the SFY22 priorities are:

• Team Care Program: continue to refine the review process and focus on increased provider/partner outreach.
• Increase access to specialized treatment: Work to identifying providers/facilities and assisting in enrollment with VT Medicaid. Current areas of focus include eating disorder treatment and inpatient psychiatric treatment for members with developmental disabilities.
• Continue to monitor quality of care for inpatient psychiatric stays for VT Medicaid members. Continue weekly meetings with DMH/DCF regarding disposition issues. Regular communication with utilization review staff at facilities that are providing treatment to our members. Continue to use InterQual and continue to participate in yearly training and IRR. Expand knowledge where we can i.e., trainings.