In Lieu of Services (ILOS) are services determined by the state to be medically appropriate and cost-effective substitutes for covered services or settings under the State Medicaid Plan. ILOS
must meet requirements outlined in
42 CFR 438.3(e)(2).
Coordinated care organizations (CCOs) are not required to offer ILOS to members. A member cannot be required to use the alternative service or setting.
Supporting health system transformation
ILOS can support key services, such as the Diabetes Prevention Program and Traditional Healthcare Workers, and enables covered services to be provided in non-traditional settings.
ILOS also connects to the larger vision for CCO 2.0 and key transformation objectives by:
- Improving access to services in a more culturally responsive manner;
- Enhancing care coordination for high-need/traditionally underserved members; and,
- Reducing hospital care, nursing facility care, and emergency department utilization.
Webinars and meetings
Join us for an opportunity to ask questions and discuss ILOS concepts with OHA staff.