SUD Rate Matrix - Treatment Services

Transcription

1 SUD Rate Matrix - Treatment Services Alcohol or Drug Assessment Updated Assessment BILLABLE ITEM & RATE Code w/ H min. Duration $12.40 H0001.HF 15 min. Duration $12.40 FY18 SUD CLINICAL TREATMENT SERVICES MATRIX (Effective 1/29/2018) APPLICABLE FUNDING/INSURER TYPES - 1 FREQUENCY 1 assessment per treatment episode 20 units for 30 days 2 additional units will be authorized for assessments performed in an institution more than 1 hour per treatment episode 4 units for 30 days Service is only request when the client will not continue treatment with the provider completing the update. Travel for Professionals (1 unit = 1 mile) Follow Up S mile $0.55 Follow up 30-day Follow up 30-day unsuccessful FW.HF Interview $ FL $20.00 Must be documented in Care Plan. 120 units to be Consistent with Assessment or Interpreter Authorization Follow-up interviews will be attempted for all authorization is required to complete the survey and clients discharged from services unless the bill for the survey in WITS. client has re-engaged in treatment or missed a previous follow-up survey. Follow up 6-month Follow up 6-month unsuccessful FW.59 Interview $ FL.59 $ Follow up 12-month FW.HB Interview $30.00 Follow up 12-month unsuccessful FL.HB $20.00 MAT Bundled Services Evaluation H0020:EV $1.00 $1.00 Buprenorphine Services H0020:BU $1.00 $1.00 Suboxone Services H0020:SU $1.00 $1.00 Methadone Services H0020:ME $1.00 $1.00 MAT services not to exceed 6 months (180 days) and $2,500 per client per benefit year. more than one Evaluation per benefit year not to exceed $ Buprenorphine cost not to exceed $500 every 30 days for first 90 days, and $250 every 30 days for next 90 days. Suboxone cost not to exceed $500 every 30 days for first 90 days, and $250 every 30 days for next 90 days. Methadone cost not to exceed $300 every 30 days for first 90 days; and $150 every 30 days for next 90 days. Authorized units will be the maximum allowable amount. Provider will bill actual costs not to exceed maximum allowed amount. When Evaluation is needed, initial authorization will be for 250 units for 14 days. If continued MAT services are approved, authorization start and end dates will be authorized for 90 days. A second 90 days can be authorized upon request. Outpatient Level I Outpatient (Education) S min. Duration $4.14 OP and IOP (Group) H min. Duration $6.21 more than 8 hours of treatment per week for adults and no more than 6 hours of treatment per week for adolescents. 408 units for 90 days Outpatient (Individual) H min. Duration $12.40 Outpatient (Individual with Family Members) Outpatient (Family without client present) min. Duration $ min. Duration $ Assessment for Eligible Clients: is only available for -State Hospital- clients. 9 Follow-up Interview Service: is available for populations discharged on or after 7/1/ Adult Halfway House, Adult Residential Treatment, And Adult Medically Monitored Residential: services are not allowed for -Adult (voluntary), -Adult (voluntary)-, -IVDU, or -IVDU- populations. SA 55 1/29/2018 Last Updated January 29th, 2018 Page 1 of 5

2 SUD Rate Matrix - Treatment Services Level II.1 (Education) BILLABLE ITEM & RATE Code w/ FY18 SUD CLINICAL TREATMENT SERVICES MATRIX (Effective 1/29/2018) S min. Duration $4.14 OP and IOP (Group) H min. Duration $6.21 APPLICABLE FUNDING/INSURER TYPES - A minimum of 9 hours of treatment per week for adults and 6 hours of treatment per week for adolescents. FREQUENCY 648 units for 60 days Education ( ) Adult Halfway House (Individual) H min. Duration $ min. Duration $14.20 (Individual with Family Members) min. Duration $14.20 (Family without client present) S min. Duration $4.14 Level III.1 H0018 Day $ Consistent with OP/IOP Frequency Limits engaged in an Outpatient or Intensive Outpatient program. Consistent with OP/IOP Up to 90 days per treatment episode. Adolescent Transitional Adult Social Detox Adult Residential Adolescent Residential Adult Medically Monitored Residential Level III.1 H0043 Day $ Level III.2 H0008 Day $ Level III.5 H0017 Day $ Level III.5 H0017.HA Day $ Level III.7 H Day $ engaged in an Outpatient or Intensive Outpatient program. 5 units for 5 days 14 units for 14 days 14 units for 14 days 7 units for 7 days 1 Assessment for Eligible Clients: is only available for -State Hospital- clients. 9 Follow-up Interview Service: is available for populations discharged on or after 7/1/ Adult Halfway House, Adult Residential Treatment, And Adult Medically Monitored Residential: services are not allowed for -Adult (voluntary), -Adult (voluntary)-, -IVDU, or -IVDU- populations. SA 55 1/29/2018 Last Updated January 29th, 2018 Page 2 of 5

3 FY18 SUD RECOVERY SUPPORT SERVICES MATRIX (Effective 1/29/2018) - Code w/ Case Management (Basic and Intensive) H min. Duration $12.40 Up to 4 hours per week If client has medicaid, Case Management can be billed for services when the client is not present only. Case Management directly with the client need to be billed to. When in Case Management if client is receiving services after successfully completing treatment, authorization for 204 units for 180 days Case Management () H min. Duration $13.23 Up to 4 hours per week If client has medicaid, Case Management can be billed for services when the client is not present only. Case Management directly with the client need to be billed to. When in Case Management if client is receiving services after successfully completing treatment, authorization for 204 units for 180 days Drug/Alcohol Testing H Test $13.50 Up to 2 tests per week receiving services after successfully completing treatment - 1 Adolescent Safe & Sober Housing H0045 Day $75.00 provider Consistent with treatment authorization - 90 day treatment episode maximum. Adult Safe & Sober Housing H0044 Day $11.50 provider Consistent with treatment authorization day treatment episode maximum receiving services after successfully completing treatment - 1-year maximum of continued RSS after successfully completing Adult Safe & Sober Housing Program Fees H0044:UT $1.00 $ Client must be engaged with Adult Safe & Sober Housing. Up to 100 units ($100.00) per 30 days Consistent with Adult Safe & Sober Housing authorization. Authorized units will be the total dollars to be billed. Adult Enhanced Safe & Sober Housing H0044:EN Day $ provider. Cannot to be authorized with Program Fees. Consistent with treatment authorization day treatment episode maximum receiving services after successfully completing treatment - 1-year maximum of continued RSS after successfully completing 4 Transportation of child for Funded Clients: is only allowed those providers in the Specialty Network 5 Safe and Sober Housing Program Fees: is only allowed for - State Hospital or - State Hospital- funded clients. 10 Basic Housing Essentials: is only allowed for - State Hospital, - State Hospital-, - Mental Health Court, - Mental Health Court-, - AMH Referred, or - AMH Referred-. 12 Enhanced Safe & Sober Housing: is only allowed for - State Hospital, - State Hospital-, - AMH Referred, or - AMH Referred- when requested by approved referral source. SA 55 1/29/2018 Last Updated January 29th, 2018 Page 3 of 5

4 Transportation FY18 SUD RECOVERY SUPPORT SERVICES MATRIX (Effective 1/29/2018) - Code w/ Transportation Pick Up T2002 Pick-up & 1st $4.20 Mile Transportation of Client A mile $1.17 Initial units will be authorized based on request, care plan, and client need. Additional units can be requested. Pick Up Per Mile T2002.HA Pick-up & 1st $4.20 Mile A0080.HA 1 mile $ Consistent with client s treatment authorization. Consistent with client s Case Management authorization if client is receiving services after client successfully completed treatment - 1-year maximum of continued RSS after successfully completing Initial units will be authorized based on request, care plan, and client need. Additional units can be requested. Transportation Flat Fee T2003 $1.00 $1.00. Tx Provider will inform of total rate for transportation (i.e. bus tickets, air fare, etc.). Authorized units are total dollars billed. Authorization date will cover for day of purchase only. Rates that are not whole dollars will be rounded - $0.49 and below will be rounded down and $0.50 and above will be rounded up to the nearest dollar. Child Care T min. Duration $4.04 Authorized units will allow for billing per child in childcare services. receiving services after successfully completing treatment - 1 Life Skills Life Skills (Individual) H min. Duration $6.56 Up to 2 hours per week Life Skills ( ) Medical Needs Benefit Life Skills (Group) HQ min. Duration $3.94 Life Skills - Client not H2015.HS 15 min. Duration $6.56 present (Individual) Life Skills-Client not HQ2015.HS 15 min. Duration $3.94 present (Group) Life Skills (Group) HQ min. Duration $3.94 Life Skills-Client not present (Individual) Life Skills-Client not present (Group) H2015.HS 15 min. Duration $6.56 HQ2015.HS 15 min. Duration $3.94 H2016 $1.00 $1.00 Up to 2 hours per week $ treatment episode maximum Consistent with treatment authorization or consistent with Case Management authorization if client is receiving services after successfully completing treatment - 1-year maximum of continued RSS after successfully completing treatment for a total of 263 units 4 Transportation of child for Funded Clients: is only allowed those providers in the Specialty Network 5 Safe and Sober Housing Program Fees: is only allowed for - State Hospital or - State Hospital- funded clients. 10 Basic Housing Essentials: is only allowed for - State Hospital, - State Hospital-, - Mental Health Court, - Mental Health Court-, - AMH Referred, or - AMH Referred-. 12 Enhanced Safe & Sober Housing: is only allowed for - State Hospital, - State Hospital-, - AMH Referred, or - AMH Referred- when requested by approved referral source. SA 55 1/29/2018 Last Updated January 29th, 2018 Page 4 of 5

5 FY18 SUD RECOVERY SUPPORT SERVICES MATRIX (Effective 1/29/2018) - Code w/ Staffing (Planned Facilitation) H min. Duration $6.21 Interpreter Services T1013 $1.00 $1.00 Tx Provider will inform of hourly rate & needed hours. Authorized units will be the total dollars to be billed. If travel is needed, authorize "Travel for Professionals". Time frame consistent with treatment authorization. Time frame consistent with Case Management authorization if client is receiving services after successfully completing treatment - 1-year maximum of continued RSS after successfully completing Lodging S9976 $1.00 $1.00 $ treatment episode maximum. Consistent with treatment authorization for a total of 250 units. treatment for a total of 250 units. Recovery Coaching H min Duration $10.00 Up to 192 units for 6 months for individual sessions. Consistent with treatment authorization for a total of 192 units for 6 months. Consistent with Case Management authorization if client if treatment for a total of 192 units for 6 months. Basic Housing Essentials MAT Management Fee S5199 $1.00 $1.00 T2023 $1.00 $ $ treatment episode maximum. Consistent with treatment authorization for a total of 125 units when requested by approved referral source. $50.00 for every 30 days for 180 days (not to exceed $ per client per benefit year) Consistent with MAT Services authorization and active treatment authorization for a total of 300 units for 180 days. Aftercare (Group) (needs built in WITS for ) H min Duration $5.91 Em. / Temp. Housing (needs built in WITS for ) H0044.ET Day $25.00 Prenatal Care (needs built in WITS for ) H min. Duration Case by Case 4 Transportation of child for Funded Clients: is only allowed those providers in the Specialty Network 5 Safe and Sober Housing Program Fees: is only allowed for - State Hospital or - State Hospital- funded clients. 10 Basic Housing Essentials: is only allowed for - State Hospital, - State Hospital-, - Mental Health Court, - Mental Health Court-, - AMH Referred, or - AMH Referred-. 12 Enhanced Safe & Sober Housing: is only allowed for - State Hospital, - State Hospital-, - AMH Referred, or - AMH Referred- when requested by approved referral source. SA 55 1/29/2018 Last Updated January 29th, 2018 Page 5 of 5