Nevada Medicaid and Nevada Check Up News (Fourth Quarter 2020 Provider Newsletter) []Attention Behavioral Health Providers: Monthly Behavioral Health Training Assistance (BHTA) Webinar Scheduled [See Web Announcement 2009]. PMHP authorization is not required. To become certified, FQHC’s self-attest to their compliance with Medicare conditions for coverage [under ... o Behavioral Health Services o Other specialty services (specify service, e.g. Individual and family support services are activities, materials or services aimed to help people reduce barriers to achieving goals, increase health literacy and knowledge about chronic condition(s), increase self-efficacy skills, and improve health outcomes. This publication takes effect July 1, 2019 and supersedes earlier Montana ... Behavioral Health Services Policy change Visiting Nurses Removed RHC-only reference Clarification, per 42 CFR 2416 ... CTSS mental health behavioral aide). E. LIGIBLE . Provider Manual DHS Home CountyLink Home Manuals Home Bulletins Advanced Search. Minnesota Statutes 245.461 to 245.468, Minnesota Comprehensive Adult Mental Health Act No payment if prior payment for duplicative service was made in same calendar month. The goals of behavioral health home services are that an individual: To provide behavioral health home services, a clinic or agency must be enrolled as a Minnesota Health Care Programs (MHCP) provider and must successfully complete the MHCP certification process. Updated: Thursday, January 21, 2021. Behavioral health home services are designed to help connect people to medically appropriate services, and to help people remove barriers that keep them from effectively engaging with medically necessary services. Minnesota Rules, part 9505.0372, subpart 1, item B or C, © 2021 Minnesota Department of Human Services, Minnesota Provider Screening and Enrollment Manual (MPSE), Certified Community Behavioral Health Clinic (CCBHC), Community Emergency Medical Technician (CEMT) Services, Allied Oral Health Professional (Overview), Early Intensive Development and Behavioral Intervention (EIDBI), Inpatient Hospitalization for Detoxification Guidelines, Lab/Pathology, Radiology & Diagnostic Services, Adult Residential Crisis Stabilization Services (RCS), Clinical Supervision of Outpatient Mental Health Services, Health Behavioral Assessment/Intervention, Physician Consultation, Evaluation and Management, Psychiatric Consultations to Primary Care Providers, Psychiatric Residential Treatment Facility (PRTF), Moving Home Minnesota (MHM) Provider Enrollment, MHM Supported Employment Services (MHM SES), BRCA Genetic Mutation Testing for Breast and Ovarian Cancer Susceptibility, Presumptive Eligibility for Breast and Cervical Cancer, Access Services Ancillary to Transportation, Local County or Tribal Agency Administered NEMT, Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Services Claim, Service, and Rate Information, State-Administered Transportation Procedure Codes, Modifiers and Payment Rates, Tribal and Federal Indian Health Services, Certification Process and Variance Requests, Integration of BHH Services and Other MA Covered Services, Telemedicine Delivery of Mental Health Services, • Has access to and utilizes routine and preventative health care services, • Has consistent treatment of mental health and other co-occurring health conditions, • Gains knowledge of health conditions, effective treatments and practices of self-management of health conditions, • Learns and considers healthy lifestyle routines, • Has access to and uses social and community supports to assist the individual meet his or her health wellness goals. The BHH services team will close the loop on all referrals to ensure people are supported in achieving their goals. Medicaid reimburses BHH services providers are required to communicate and coordinate with MCOs to ensure that services and activities are coordinated to most effectively meet the goals of the person and to ensure that duplication between the MCO and the BHH services provider is avoided. • The BHH services provider confirms that the member has current MA coverage. HEALTH FIRST COLORADO FQHC/RHC BILLING MANUAL Revised: 11/2019 Page 2 The NHVP is a home visitation program available to first-time moms in Colorado. Federally Qualified Health Centers . Welcome to the State of Nevada Division of Health Care Financing and Policy (DHCFP) Behavioral Health Services (BHS) webpage. Attention All Providers: Requirements on When to Use the National Provider Identifier (NPI) of an Ordering, Prescribing or Referring (OPR) Provider … The provider may document the person’s agreement to receive BHH services … Medicare Claims Processing Manual: Chapter 9 - Rural Health Clinics/Federally Qualified Health Centers (PDF) Rural Health Clinic: School District Administrative Claiming Manual Effective July 1, 2019: School District Administrative Claiming Manual - Effective April 1, 2015: School-Based IEP Direct Services Cost Settlement Manual: School-Based Individualized Education Plan Specialized Transportation Services h��T�K�q�w��]��k�$�tY9�����7��%�u���b��D��A{�Bp�e�+hV�. The behavioral health home services certification process consists of an online application and a site visit. The electronic Medicaid Provider Manual contains coverage, billing, and reimbursement policies for Medicaid, Healthy Michigan Plan, Children's Special Health Care Services, Maternity Outpatient Medical Services (MOMS), and other healthcare programs administered by the Michigan Department of Health and Human Services (MDHHS). For people enrolled in an MCO, the process for tracking the enhanced payment will require the MCO to review a monthly report produced by DHS to see how many times a provider has billed at the enhanced rate (including payments made by the MCO, another MCO, or fee-for-service). • Intake for BHH services is considered complete as of the date that all of the above elements have been completed. • The BHH services provider confirms and documents the person has a diagnosis from a qualified health professional within the previous 12 months that indicates the person has a condition that meets the federal definition of serious mental illness (adults) or emotional disturbance (children). Unless a service has been specifically identified as a duplicative service (see Noncovered Services section), it is permissible for a BHH services provider to bill for other MA-covered services delivered to a person who is also receiving BHH services. Minnesota Statutes 256B.0757 Coordinated Care through a Health Home For individuals who have fee-for-service MA coverage, most BHH services providers are not required to identify a treating provider. Certified behavioral health home services providers are required to carry out a service eligibility determination prior to billing for behavioral health home services. ... • Behavioral and Medical Health Care Home claim procedure codes S0280 and S0281. Lifetime limit of six payments in enrollee’s lifetime. FQHC Behavioral Health Billing Codes FQHC Providers are reimbursed at PPS rate for all threshold visits regardless of service code for Medicaid visits. BACKGROUND . Health & Human Services (HHS) allows such a grant, which qualifies the entity as an “FQHC look-alike” based on a Health Resources and Services Administration (HRSA) recommendation Treated by the Secretary of HHS as a comprehensive Federally funded health center as of January 1, 1990, for purposes of Medicare Part B • Have personal contact with the person or the identified support at least once per month. The providers place a strong emphasis on skills development so individuals and their identified supports can monitor and manage their chronic health conditions to improve health outcomes. Behavioral health home services provider “A” is also certified to provide ARMHS. Phone: 602-417-4000 In-State Toll Free: 1-800-654-8713 (Outside Maricopa County) CCBHC mental health certified family peer specialist services are subject to the same standards outlined in the Mental Health Certified Family Peer Specialist section of the MHCP Provider Manual. Minnesota Statutes, section 256B.0757, subdivision 4d (8) Diagnostic Assessment Behavioral Health Provider Manual. Certified peer recovery support specialist services are covered CCBHC services if determined medically necessary by a licensed professional. Care coordination occurs when the BHH services team acts as the central point of contact in the compilation, implementation and monitoring of the individualized health action plan through appropriate linkages, referrals, coordination and follow-up to needed services and supports. ... Revised Provider Manual . Minnesota Statutes 245.462, Definitions endstream endobj startxref BHH services providers must meet and deliver initial engagement and assessment services that meet the requirements of BHH services certification standard 5D (DHS-6766) (PDF). About this Manual . Resources should address social, environmental and community factors. Service delivery requirements are listed in the BHH certification standards (DHS-6766-ENG) (PDF). However, payment for duplicative services in the same calendar month is prohibited. • The BHH services provider reviews and explains the Behavioral Health Home (BHH) Services Rights, Responsibilities and Consent form (DHS-4797B-ENG) (PDF) to the person. Medical providers (Including hospitals and private practitioners) and managed care organizations can use this section to locate important provider resources. It is critical that the provider and the provider’s staff be familiar with, and comply with, all information contained in the General Billing Manual – Volume I, and this Provider Specific Billing Manual – Volume II. BHH services providers must have the capacity to deliver the following six core services based on the individual’s needs and in accordance with the BHH Certification Standards (DHS-6766-ENG) (PDF). Adherence to the service delivery requirements will be monitored as part of ongoing certification. The list of allowable mental health diagnostic code ranges under which providers can bill for BHH services can be found in the mental health diagnostic codes section of the provider manual. Minnesota Statutes 245.462, subdivision 20, paragraph (a) Utah Medicaid Provider Manual Rehabilitative Mental Health and Substance Use Disorder Services Division of Medicaid ... Behavioral health services means the rehabilitative services directed to the treatment of the mental ... federally qualified health center (FQHC). Federally Qualified Health Center (FQHC) Benefits. See MM10990. No payment if prior payment for duplicative service was made in the same calendar month. Example 2 found in other chapters of the BMS Provider Manual. Transition services are designed to streamline plans of care and crisis management plans, reduce barriers to timely access, reduce inappropriate hospital, residential treatment, and nursing home admissions, interrupt patterns of frequent emergency department use, and prevent gaps in services which could result in (re)admission to a higher level of care or longer lengths of stay at an unnecessary level of care. • Complete the intake process and the brief needs assessment and develop a plan to address immediate needs as appropriate, • Complete the initial health wellness assessment within 60 days after intake, • Develop the health action plan within 90 days after intake, • BHH services providers must update a person’s health action plan at least every six months, • Adult mental health targeted case management (AMH-TCM), • Children’s mental health targeted case management (CMH-TCM), • Vulnerable adult/developmental disability targeted case management (VA/DD-TCM), • Relocation services coordination targeted case management (RSC-TCM), • Health care home (HCH) care coordination services. Providers must have a valid telemedicine agreement in place with DHS and must comply with all MA telemedicine requirements and limitations to serve individuals receiving BHH services through telemedicine. • the variance is consistent with public interest. • the variance would not reduce the level of services provided to individuals served by the organization, or. client and a qualified FQHC provider (e.g., a physician, physician assistant, or advanced registered nurse practitioner) who exercises ... • Behavioral health services funded by Medicaid and other available resources provided for in chapters 182-538B, 182-538C, and 182-538D WAC. Health and wellness promotion services encourage and support healthy living and motivate people and their identified supports to adopt healthy behaviors and promote better management of their health and wellness. Servicing providers acting as a locum tenen PPS visits are limited to certain types of providers and services as stated in the provider manual. Certified BHH services providers must ensure that the following elements are complete prior to determining eligibility for BHH services: Individuals receiving BHH services are required to obtain a diagnostic assessment (DA) within six months of intake completion for BHH services. subd. The BHH services provider organization is permitted to bill for both services as long as the provider organization has met the billing requirements for each service. • The BHH services provider confirms that the member has current MA coverage. • The initial plan code (S0280 U5) can be billed at any time and no break is required to bill for the six maximum lifetime services: for example, code S0280 U5 can be billed for the months of January-June or January, February and November, • Code S0281 U5 (maintenance plan) does require that code S0280 U5 (initial plan) be submitted prior to the S0281 U5 submission, • Code S0280 U5 cannot be submitted in the same month as S0281 U5, • To receive payment, the claim for BHH services must use the NPI and address listed on the organization’s BHH services certification approval letter. Services provider manual section. Minnesota Statutes .256B.0625. The person must choose which available MA-covered service best meets the person’s needs. Providers can find information on Montana Healthcare Programs mental health services and MHSP services in the mental health manual available on the Provider Information website. Provider billing instructions are displayed in Adobe Acrobat formats. )a�D�ae��1�̲��_z�﫛P@��ܟ��|yy �Ƨ v �@��%��މ�����( �9��7 �>��ž�� �E>Lm1U��7��T�V��8ꁪ��3;C]�& These factors impact holistic health, including but not limited to, medical and behavioral health care, entitlements and benefits, respite, housing, transportation, legal services, educational, employment services and financial. The manual also offers information on covered services, processing of claims and errors, and remittance advice. Specific care coordination activities are conducted with people and their identified supports, medical, behavioral health and community providers, and across and between care settings. 3b Medical Assistance Telemedicine Federally Qualified Health Centers (FQHC) and Rural Health Clinics ... to a new FQHC or RHC. 1396w-4 0 For purposes of eligibility for BHH services, one of the following types of diagnostic assessment is allowable: Assessments must be performed according to requirements outlined in the Diagnostic Assessment section of the MHCP Provider Manual. [�4̏*9oܯf�k�Y,�L�^�����s��5�����R[t�p��A �U�mpC7Pz�h3=�6������׷3�' �]�#����>�f9r�3X��_��R�ݕ'b[{��z#�Ͻ�:�O �RQ�`(���C#��ѓhSA��� ��G�&D��)�:�m���і� "D����_*N�C� �( 7\��,� . Minnesota Statutes 256B.0625, subdivision 20, Mental Health Case Management The South Carolina Department of Health and Human Services ... Each historic provider manual is archived on the SCDHHS website during a transition period. 42 U.S.C. An email, letter, voicemail or text alone does not meet the requirement for monthly personal contact. 2 About this guide * This publication takes effect July 1, 2020, and supersedes earlier guides to this program. Refer to the appropriate section below for additional information: • Telemedicine subsection of the Physician and Professional Services MHCP Provider Manual section, • Telemedicine Delivery of Mental Health Services. All discontinued manuals no longer contain active information and are strictly available for historical purposes. %PDF-1.6 %���� Federally Qualified Health Center (FQHC) Behavioral Health Services Provider Manual 07/01/19 Edition Posted 07/01/19 . Referral to community and social support services are activities that ensure people have access to resources to address their identified goals and needs. 4097 0 obj <> endobj For individuals who are enrolled in an MCO, BHH services providers will need to contact the individual’s MCO to determine what the MCO requires on the claim for BHH services. PLEASE NOTE: Differences in State Medicaid rules can vary greatly, please confirm information with Montana Medicaid. Comprehensive care management is a collaborative process designed to manage medical, social and behavioral health conditions more effectively based on population health data and tailored to the person. About the Manual . Providers who are eligible to provide services via telemedicine may do so in order to complete the every six month face-to-face contact requirement. BHH services providers should consult the BHH MCO Contact Information (PDF) to obtain the appropriate contact information for the MCO. endstream endobj 4098 0 obj <. The manual also offers information on covered services, processing of claims and errors, and remittance advice. Provider Manuals: The Provider Manuals page is divided into two sections: Current Manual Type and Discontinued Manual Type. If you need an accommodation or require documents in another format, call 1-800-562-3022. The information in this chapter does not apply to members enrolled in Healthy Montana Kids (HMK). h�bbd```b``�"ׂIK�" Medicaid Services Manual; Programs. If the person has a current DA in place (current means within the past 12 months), another DA is not needed at the time the person starts BHH services nor within six months of enrollment into BHH services. BHH services providers should use the diagnostic code(s) that corresponds with the person’s mental health diagnosis that established the person’s eligibility for BHH services. To be eligible for BHH services, a member must be MA eligible and have a current diagnosis from a qualified health professional of a condition that meets the definition of mental illness as described in section. FQHC & RHC Utilization Management Service Guidelines; Behavioral Health Provider Manuals and Instructions. IMHPs may provide the services listed in the procedure code table in the Appendix via audio-only technology when the coverage requirements are met. BHH services providers submitting electronic claims should use the 837P. A hardship may be considered something greater than an inconvenience or that may result in significant costs to the clinic to implement. CR 11575 revises Medicare Benefit Policy, Chapter 13 (Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Services) to clarify payment and other policy information. For the purpose of this manual an IMHP includes mental health providers who meet the requirements in ARSD 67:16:41:03 and physicians that provide behavioral health services. BHH services providers and MCOs must adhere to the communication and coordination protocols established in BHH MCO Roles and Responsibilities worksheet. Hawaii Medicaid Provider Manual 2 Revised March 2016 21.2 FQHC SERVICES 21.2.1 Providers Who May Provide PPS Eligible Services FQHC services shall be delivered exclusively by the following health care professionals who are licensed in Hawaii and residents of the State of Hawaii: o Doctor of Medicine (MD); o Doctor of Osteopathy (DO); Providers should contact the MCO directly to learn what procedures the MCO will use to ensure no duplicate payment. MHCP uses provider service and utilization information to identify those providers who are considered to have a similar caseload to that of the new center or clinic. BHH services providers must determine and document an individual’s eligibility before providing and billing for BHH services. Employee Assistance Program (EAP) Manual. The Fee-For-Service (FFS) Provider Billing Manual is intended to outline billing requirements for providers who are billing the AHCCCS FFS unit for reimbursement. The variance request must include the reason for the variance request and the period of time the variance is requested. Providers should track the number of times S0280 U5 has been claimed. If the MCO and the BHH services provider agree to make additions to the worksheet, the MCO and the BHH services provider must provide a copy of the updated worksheet and signatures from responsible staff at the MCO and the BHH services provider to demonstrate that both entities have agreed to the additional terms specified in the updated worksheet. FQHC Behavioral Health Billing Tip Sheet Psychiatric diagnostic evaluation with medical ... same day as health behavior assessment and intervention codes by the same provider: These services can occur and be reported on the same date of service as long as the E/M ... Services sections of the CPT® Manual. The MCO is responsible for taking back any enhanced payment that exceeds the lifetime six month payment limit. The treating provider must be affiliated with the billing entity and is required to be the integration specialist. To receive payment for delivery of behavioral health home services, certified providers must: Billing information for procedure codes S0280 and S0281: BHH services care engagement, initial plan. If a person who has been determined eligible for BHH services is enrolled in managed care, the BHH services provider must send a copy of the Notification of Eligibility for Behavioral Health Home (BHH) services (DHS-4797-ENG) (PDF) form to the MCO’s designated contact. PLEASE NOTE: The network is closed for any new Personal Care Service Agencies. Dental Services . Please note, it is required that a mental health professional (MHP) employed by or under contract at your organization reviews the diagnostic assessment. A person receiving BHH services has been determined to be in need of asthma education. 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Policy ( DHCFP ) Behavioral Health services to obtain the appropriate contact information for the would... Provider may document the person must choose which available MA-covered service best the! Issued: 12-01-2009 ; Revision Log ; Obsolete Pages ; Applied Behavior Analysis active information … Federally Health... Federally Qualified Health Center ( FQHC ) Health Insurance Premium program ( HIPP )... Behavioral home. … About the manual also offers information on covered services, recipient and services! Entity must identify a treating provider was made in the same calendar month per month payment requirements. Before providing and billing for Behavioral Health home services providers submitting electronic should... Please confirm information with Montana Medicaid social, environmental and community factors to an FQHC classification if they Public... Code for Medicaid visits, recipient and provider requirements for IHS to receive BHH services Federally... 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