Mental Health Physician Clinic Training on the Integrated Behavioral Health Services Regulations.

Psychiatric Assessments Cont

Both types of Psychiatric Assessments must include

bull a review of medical amp psychiatric history or presenting problem

bull a relevant recipient historybull a mental status examinationbull a complete multi-axial DSM diagnosis bull a listing of any identified psychiatric problems

including functional impairmentsbull treatment recommendations

Psychological Testing and Evaluation

ldquoThe Dept will pay a MHPC or psychologist for psychological testing and evaluation to assist in the diagnosis and treatment of mental and emotional disordersrdquo

Psychological testing and evaluation includes

bull the assessment of functional capabilities

bull the administration of standardized psychological tests

bull the interpretation of findings

Pharmacologic ManagementldquoThe Dept will pay a MHPC for a pharmacologic management

service if that service is provided directly by a professional described in 7 AAC 135010(b)(2)rdquo

To qualify for payment a provider must monitor a recipient for the purposes of

1 assessing a recipients need for pharmacotherapy2 prescribing appropriate medications to meet the

recipients need and3 monitoring the recipients response to medication

includinga documenting medication complianceb assessing amp documenting side effects c evaluating amp documenting effectiveness ofthe medication

Psychotherapy

ldquoThe department will pay a MHPC for one or more

of the following forms of psychotherapy as codedin Current Procedural Terminology (CPT)rdquo

insight-oriented individual psychotherapyinteractive individual psychotherapygroup psychotherapyfamily psychotherapy - without recipientfamily psychotherapy - with recipientmulti-family group psychotherapy

Psychotherapy ClarificationBiofeedback or relaxation therapy may be

provided as an element of insight-oriented and interactive individual psychotherapy if

1 prescribed by a psychiatrist (if provided in MHPC)

2 included in the behavioral health treatment plan as a recognized treatment or adjunct to a treatment only for the following conditions or substantially similar conditions

a chronic pain syndromeb panic disordersc phobias

Short-Term Crisis InterventionldquoThe Dept will pay a MHPC for short-term crisis

intervention services provided by a mental health professional clinician to a recipient if that mental health professional clinician provides an initial assessment of

1) the nature of the short-term crisis 2) recipients mental emotional and behavioral status 3) recipients overall functioning in relation to the

short-term crisisrdquo

A MHPC is NOT required to use Dept form to document short-term crisis intervention

A MHPC may bill the same number of hours for service as a CBHS Provider22hrs per SFY

Facilitation of TelemedicineldquoThe department will pay a MHPC for facilitation of a

telemedicine session if the facilitating provider1 provides the telemedicine communication equipment2 establishes the electronic connection used by treating provider and recipient 3 remains available during session to reestablish the electronic connection if it fails before the intended end of the telemedicine sessionrdquo

The facilitating provider must make a note in the recipients clinical record summarizing the facilitation of each telemedicine session

The facilitating provider is not required to document a clinical problem or treatment goal in the note

Screening amp Brief Intervention

ldquoThe Dept will pay a MHPC for screening and brief intervention services if staff conducts the screening component and brief intervention utilizing self-report questionnaires structured interviews (or similar screening techniques) to detect substance use problems and to identify the appropriate level of interventionrdquo

Screening amp Brief Intervention (conrsquot)

Brief intervention is motivational discussion focused on

raising awareness of recipientrsquos substance usethe potential harmful effects of substance useencouraging positive changeBrief intervention may include1 Feedback2 Goal setting 3 Coping strategies4 Identification of risk factors5 Information amp advice

Screening amp Brief Intervention (conrsquot)

MHPC must refer to appropriate program that will meet recipientrsquos needs if

1 Screening reveals severe risk of substance use

2 Recipient is already substance use dependent

3 Recipient already received SBIRT and was unresponsive

MHPC must document SBIRT in progress note

SBIRT does not require assessment or Tx Plan

Documentation Requirements

Clinical Record RequirementsThe clinical record must include

bullAn assessmentbullA behavioral health treatment plan that

meets the requirements of 7AAC 135120bullA progress note for each day the service is

provided signed by the individual providerbullMust reflect all changes made to the

recipientrsquos treatment plan amp assessmentbullMust set out a description or listing of the

active interventions that the provider provides to or on behalf of the recipient in order to document active treatment

Treatment Plan

bull Documented in accordance with 7 AAC 135130 (clinical record)

bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal

representative (18 and older)bull Based upon the input of a Treatment Team if the

recipient is a child (under 18)bull Signed and supervised by psychiatrist operating

MHPC and by the recipient or the recipientrsquos parent or legal representative

bull Reviewed every 90-135 days to determine need for continued care

Treatment Plan Documentation

bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related

to the findings of the assessmentbullThe services and interventions that will be

rendered to address the goalsbullThe name signature and credentials of

the psychiatrist operating MHPCbullThe signature of the recipient or the

recipientrsquos parent or legal representative

Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a

recipient under 18 must include

bull The recipientbull The recipientrsquos family members including parents guardians

and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff

A behavioral health treatment team for a recipient under 18 may include

bull Representative(s) from alternative living arrangements including foster care residential child care or an institution

bull Representative(s) from the recipients educational system

Treatment Team Cont

All members of treatment team shall attend meetings of the team in

person or by telephone and be involved in team decisions unless the clinical record documents that

1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being

2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or

3 weather illness or other circumstances beyond the members control prohibits that member from participating

Progress Notes

7AAC 135130(8) Requires

bull Documented progress note for each service each day service is provided

bull Date service was providedbull Duration of the service expressed in service units

or clock time bull Description of the active treatment provided

(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward

treatment goalsbull Name signature and credentials of the individual

who rendered the service

Medicaid Billing

Medicaid is Payer of Last Resort

bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo

under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid

Military and Veteranrsquos Benefits Private Health Insurance

bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage

Behavioral Health Medicaid Payment

bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid

bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody

bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)

CAMA

bullCAMA is the acronym for Chronic and Acute Medical Assistance

bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a

limited number of health conditions andHas very limited coverage

bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the

number of medications a person can receive in a month

Medicaid Program Policies amp Claims Billing Procedures Manual

Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets

Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations

Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order

Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions

Services

New Codes Services Changing Services Codes

Code Service Description

H0031-HH

Integrated Mental Health amp Substance Use Intake Assessment

Q3014 Facilitation of Telemedicine

90846 Psychotherapy Family w out patient present

S9484-U6

Short-Term Crisis Intervention (15 min)

99408 Screening Brief Intervention amp Referral for Treatment

Code Description Change

H0031 Mental Health Assessment

bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate

90849 Psychotherapy Multi Family Group

bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour

Service Authorization bullAnnual Service Limits will switch from

CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records

currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change

bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135

days of planned services and will be submitted approximately 3 to 4 times annually

How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website

bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your

agreement and acceptance of the copyright notice Claim form instructions

CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services

Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center

School Based Services)bull select ldquoForms

Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms

bull select ldquoUpdatesrdquo Manual replacement pages

bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver

bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc