Requirements for Licensed and Unlicensed SBHS Providers. Presented by: Provider Network Management
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1 Requirements for Licensed and Unlicensed SBHS Providers Presented by: Provider Network Management
2 Session Outline New LDH Requirement Requirements for licensed and unlicensed staff Where to find required documents FAQs Contacts AmeriHealth Caritas Louisiana 2
3 New LDH Requirement
4 Behavioral Health Claims and Billing Act 582: What is this law? This piece of legislation, now law, affects behavioral health services providers (BHSPs) who provide psychosocial rehabilitation (PSR) or community psychiatric supportive treatment (CPST) to Medicaid recipients. More specifically, it changed the law regarding several requirements for provider agencies and individuals providing services within those agencies. (Updated with information from LDH Informational Bulletin published 11/13/2014.) In order to be eligible to provide these services, Provider Agencies must meet all of the following requirements: 1. Be licensed as a BHSP agency 2. Be accredited by a department-approved accrediting organization 3. Have a National Provider Identification Number (NPI) 4. Implement a member choice form 5. Be credentialed and in the provider network of the MCO 6. Employ at least 1 full-time physician or LMHP to supervise 7. Provide supervision for unlicensed individuals AmeriHealth Caritas Louisiana 4
5 Act 582 Continued: INDIVIDUALS PROVIDING SERVICES: In order to be eligible to receive Medicaid reimbursement, BHSPs must ensure that any individuals rendering PSR or CPST services for their agency meets all of the following requirements: Have a National Provider Identification number (NPI) Effective for services rendered on or after January 1, 2019, the individual rendering the PSR or CPST services for the licensed and accredited provider agency must have an individual NPI number, and that number must be included on any PSR or CPST claim submitted by that provider agency for Medicaid reimbursement (in addition to the agency NPI number). Have a minimum of a bachelor s degree from an accredited university or college in the field of counseling, social work, psychology or sociology. Individuals rendering PSR services for a licensed and accredited agency who do not possess the minimum bachelor's degree as described here but have met all provider qualifications in effect prior to Jan. 1, 2019 may continue to provide PSR services for the same provider agency. However, prior to the individual rendering the PSR services for a different provider agency, the individual must comply with the minimum bachelor s degree provisions of this section. AmeriHealth Caritas Louisiana 5
6 Act 582 Continued: INDIVIDUALS PROVIDING SERVICES: Have a minimum of a bachelor s degree from an accredited university or college in the field of counseling, social work, psychology or sociology. Currently, educational qualifications for providing the individual supportive behavioral intervention component of CPST require a master s degree. Effective Jan. 1, 2019, individuals must have a minimum of a master s degree from an accredited university or college in the field of counseling, social work, psychology or sociology to render the individual supportive behavioral intervention component of CPST. Individuals rendering the individual supportive behavioral intervention component of CPST for a licensed and accredited agency who do not possess the minimum master's degree in the four listed educational fields but have met all provider qualifications in effect prior to Jan. 1, 2019 may continue to provide the individual supportive behavioral intervention component of CPST for the same provider agency. Prior to the individual rendering the individual supportive behavioral intervention component of CPST for a different provider agency, the individual must comply with the minimum master s degree provisions as established in the Medicaid Behavioral Health Services Provider Manual available online at AmeriHealth Caritas Louisiana 6
7 New LDH Requirement Effective 1/1/2019 Effective for services rendered on or after January 1, 2019, the Louisiana Department of Health (LDH) will require claims submitted for Specialized Behavioral Health Services (SBHS) to include the provider agency s NPI number and the NPI number of the individual staff rendering the service(s). AmeriHealth Caritas Louisiana 7
8 Where should the NPI be placed on the CMS 1500? Agency s NPI number must be placed in Box 33 b The NPI number of the individual rendering the service(s) on behalf of the agency must be placed in Box 24 j on the claim form. AmeriHealth Caritas Louisiana 8
9 Requirements for Licensed and Unlicensed Staff
10 Requirements for Licensed and Unlicensed Staff To help ensure continued claims payment, all licensed and unlicensed staff need to complete the following, as applicable. All required documents must be submitted via no later than December 1, 2018, to AmeriHealth Caritas Louisiana 10
11 Documents Required for Licensed Staff 1. If a licensed staff person is NOT registered with the Council for Affordable Quality Health Care (CAQH), submit the following: Louisiana Standardized Credentialing Application; Items required on the Provider Contract/Credential- Recredential Checklist; Behavioral Health Provider Enrollment Form including list of services to be provided; and Provider Directory New Patient Acceptance Form. AmeriHealth Caritas Louisiana 11
12 Documents Required for Licensed Staff 2. If a licensed staff person is registered with CAQH, submit the following: Items listed under CAQH Application column; Behavioral Health Provider Enrollment Form including list of services to be provided; and Provider Directory New Patient Acceptance Form. AmeriHealth Caritas Louisiana 12
13 Documents Required for Unlicensed Staff 3. If a staff person is unlicensed, submit the following: Behavioral Health Provider Enrollment Form including list of services to be provided and Copy of degree or transcript. AmeriHealth Caritas Louisiana 13
14 Frequently Asked Questions (FAQs)
15 Frequently Asked Questions 1. Where do I complete the unlicensed staff information on the enrollment form? AmeriHealth Caritas Louisiana 15
16 Frequently Asked Questions 2. How do I apply for an NPI number? For instructions on how to apply for an NPI number, visit the main page of the National Plan & Provider Enumeration System (NPPES) website at: 3. Do I complete the Provider Directory Member Acceptance Form for each practitioner? Yes. You must complete the Provider Directory Member Acceptance for each practitioner. AmeriHealth Caritas Louisiana 16
17 Where do I find required documents?
18 Required Documents Can Be Found on Our Website All documents referenced above can be found in the Providers section of our website at under Behavioral Health Resources. The documents are labeled Specialized Behavioral Health Credentialing Packet. AmeriHealth Caritas Louisiana 18
19 Required Documents Can Be Found on Our Website AmeriHealth Caritas Louisiana 19
20 Required Documents Can Be Found on Our Website AmeriHealth Caritas Louisiana 20
21 Required Documents Can Be Found on Our Website AmeriHealth Caritas Louisiana 21
22 Contacts
23 Contact Information Provider Enrollment Stacie Zerangue Gwen Matthews AmeriHealth Caritas Louisiana 23
24
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