Weekly Provider Q&A Session 3 rd Quarter 2017 Type Issue/Agenda Item Response/Outcome/Updates Are providers allowed to bill for the MHSS service while a member is in hospital/acute care? It is important to review the MHSS service limitations and exclusions on page 66 of Chapter 4 of the Community Mental Health and Rehabilitative Services (CMHRS) Manual. Per this manual, there is a limitation that states Medicaid Coverage for MHSS shall not be available to individuals who reside in ICF/IDS or hospitals (page 60), therefore, providers are not able to provide direct services while the member is residing in a hospital setting. A service specific intake for IIH and/or MHSS can be completed by an LMHP-e "type". Does it need to be reviewed by an LMHP? Refer to pages 15-16, Chapter 4 of the Community Mental Health and Rehabilitative Services (CMHRS) Manual, which outlines the requirements for the Service Specific Provider Intake. Per this manual, there is not a specific guideline or requirement for LMHPs to review SSPIs completed by LMHP-Es. From a clinical standpoint, it would be best practice to implement a process in which the LMHP reviews the SSPI in order to coordinate services and ensure that the member is receiving the most appropriate level of care. Providers should also make sure they are meeting the licensing/supervision requirements through the LMHP-E s individual licensing board (LCSW, LPC, etc.). Are licensed nurse practitioners able to complete MHSS assessments? On page 63 in Chapter 4 of the Community Mental Health and Rehabilitative Services (CMHRS) Manual outlines the required activities of MHSS services and the individuals that are eligible to complete those activities. A Nurse Practitioner is not on the list of individuals that can complete the service specific provider intake assessment. Providers may also refer to page 6, which outlines individuals that fall under the list of a LMHP, which does include a certified psychiatric nurse specialist (Chapter 4, CMHRS). Providers should ensure direct care staff meet criteria in order to be eligible to conduct the assessment. For questions surrounding specific staff members, please refer to your licensing specialist. 3 rd Quarter 2017: Weekly Friday Provider Call FAQs Page 1 of 6
Is the requirement for an SSPI to be completed at least every 26 weeks for Intensive Community Treatment Services? An SSPI is required at the on-set of services and a re-assessment is required for each 26 week re-authorization. ICT may be provided for a maximum of 26 weeks with a limit of 130 units annually. A provider can bill for 2 assessments per fiscal year, per member. This information can be found on page 58 in Chapter 4 of the CMHRS manual. Does a licensed therapist have to be in the building when a LMHP-E staff member is providing outpatient services, or is the requirement that the licensed therapist sign off on their sessions same day? If a Nurse Practitioner performs the medication evaluation for crisis stabilization, are we required to have the Psychiatrist co-sign his/her documentation for the medication evaluation? I am overdue in submitting a request for reauthorization. Is this OK? Can mental health outpatient and substance use outpatient services be delivered via telemedicine? If yes, must the supervisor be at the same location as the resident/supervisee? A licensed supervisor must be in facility when the session is being rendered by an unlicensed therapist and be the one who discusses the individual s treatment plan, reviews the record and cosigns the progress note documenting the session. Please refer to page 8, Chapter 2 of the Psychiatric Services Manual Direct Supervision information. Crisis Stabilization Services are outlined on page 60 in Chapter 4 of the CMHRS manual and regulation 12VAC30-50-226. There is not a guideline on who signs/co-signs the medication evaluation. Providers should ensure the nurse practitioner completing the medication evaluation is practicing within the scope of their license or keeping within the terms of their professional license. It may be best practice to have the attending psychiatrist review and co-sign documentation in order to ensure accuracy and that the most appropriate care is provided. For questions surrounding specific staff members, please refer to your licensing specialist. Yes. Providers may still submit a concurrent review as long as there is not a lapse in 30 days of direct services. The earliest start date that could be authorized (as long as the member is meeting medical necessity criteria for that level of care) would be the date submitted for the request. A request for dates prior to the submission would be considered untimely. Providers have up to 30 calendar days prior to the requested start date to submit a request. Providers may want to determine an internal process for ensuring timely submissions to prevent a break or gap in services. Yes. Mental health and substance use outpatient services can be provided face-to-face or by telemedicine according to DMAS policy regarding telemedicine. DMAS recognizes telemedicine as a means for delivering some covered Medicaid services. Please refer to the Virginia Medicaid Memo dated May 13, 2014: Updates to Telemedicine Coverage. This can be found on the DMAS website under Provider Services. Please refer to page 8, Chapter 2 of the Psychiatric Services Manual Direct Supervision 3 rd Quarter 2017: Weekly Friday Provider Call FAQs Page 2 of 6
information, which states that the licensed provider must be in the facility during the session and meet regularly with the unlicensed therapist for the purpose of discussing and reviewing the member s treatment plan and reviewing this record. Providers should also ensure direct care staff are meeting the licensing/supervision requirements through the resident under supervision or LMHP-E s individual licensing board (LCSW, LPC, etc.). For additional specific documentation requirements, please refer to page 8 in Chapter 2 of the Psychiatric Services Manual and page 16 in Chapter 4 of the ARTS Manual. Can the face-to-face visit for mental health case management be conducted via telemedicine? No. Mental Health Case Management (H0023) is not a covered service under the DMAS Telemedicine Coverage memo. Please refer to the Medicaid Memo dated May 13, 2014: Updates to Telemedicine Coverage. Medicaid Memos are posted at: https://www.virginiamedicaid.dmas.virginia.gov (DMAS website) under Provider Services. According to Chapter 4,page 70-71 of the CMHRS Manual, provider must be provide required activities for Mental Health Case Management, which also includes direct or client-related contacts and communication or activity with the client, family, service providers, significant others, and others, including a minimum of one face-to-face contact every 90 days. Can the case management assessment (which is a non-billable activity) be completed via telemedicine? Can a member currently receiving intensive in-home Services also receive crisis stabilization services? No. Case management assessments cannot be conducted via telemedicine services. The following assessments can be allowed delivery via telemedicine: H0032-U6 Psychosocial Rehabilitation Assessment, H0032- U7 Day Treatment/Partial Hospitalization Assessment (adult) and H0032- U9 Intensive Community Treatment Assessment. Providers may bill the above listed codes with dates of service February 1, 2015 and later using the GT modifier, which indicates the service was delivered via telemedicine. Please refer to 2015 Magellan Provider Communications- Titled Telemedicine Assessment Codes Billing Changes posted October 5, 2015. Members may not receive intensive in-home services or intensive community treatment Services while receiving crisis stabilization (H2019) services since both of those services include crisis response (page 61, 3 rd Quarter 2017: Weekly Friday Provider Call FAQs Page 3 of 6
Chapter 4, Community Mental Health and Rehabilitative Services (CMHRS). You may also refer to regulatory change highlights training regarding crisis services titled Regulation Changes to obtain additional information about Crisis Stabilization (H2019) services. This recorded training can be accessed on the 2016 Provider Training page at www.magellanofvirginia.com. ARTS Can Outpatient services (ASAM Level 1) or Intensive Outpatient Services (ASAM Level 2.1) be billed while a member is receiving Office Based Opioid Treatment (OBOT) services? If so, can Outpatient services (ASAM Level 1) or Intensive Outpatient Services (ASAM Level 2.1) be used in place of or in addition to Office Based Opioid Treatment (OBOT) services by the credentialed addiction treatment professional? Yes. Outpatient services (ASAM Level 1) or intensive outpatient services (ASAM Level 2.1) can be billed while a member is receiving Office Based Opioid Treatment (OBOT) services. A licensed credentialed addiction treatment professional under scope of their practice meets the staff requirements to provide outpatient services (ASAM Level 1), intensive outpatient services (ASAM Level 2.1) and office based opioid treatment (OBOT) psychotherapy services. However, office based opioid treatment (OBOT) requires for the credentialed addiction treatment professionals to be co-located at the same practice site as the buprenorphine waivered practitioner. The licensed credentialed addiction treatment professional, under the scope of their practice, provides psychotherapy during clinic sessions when the buprenorphine-waivered practitioner is prescribing buprenorphine or naltrexone to patients with opioid use disorder. The licensed credentialed addiction treatment professional shall work in collaboration with the buprenorphine-waivered practitioner who is prescribing buprenorphine products or naltrexone products to individuals with moderate to severe opioid use disorder. Community Services Boards (CSBs) have different guidelines when providing counseling during clinic sessions for office based opioid treatment. See Chapter 2, pages 29-30 of the ARTS- Provider Participation Requirements Manual for additional information. The buprenorphine waivered practitioner, intensive outpatient services (IOP) and/or the outpatient services provider need to work together to monitor the treatment plans for the member. It is important to note that members usually receives OBOT longer than they are in intensive outpatient services (IOP). These members still need to have psychotherapy when they transition out of IOP for the duration of their Office Based Opioid Treatment (OBOT). Also, since psychotherapy and substance use counseling are a significant component of IOP, for members receiving 3 rd Quarter 2017: Weekly Friday Provider Call FAQs Page 4 of 6
services through OBOT, the psychotherapy/counseling would be provided only through IOP. OBOTs would not be able to bill the OBOT counseling codes (H0004/H0005) for member also receiving IOP services. ARTS GAP Is an independent physician completing an assessment for admission required to be affiliated with the residential services for substance use or residential services behavioral health provider? Also, who conducts the multidimensional assessment? For the ARTS substance use case management ISP, must providers address two case management activities in each contact or does it mean providers must have two contacts each month? Can a licensed nurse practitioner perform GAP SMI screening? This provider type is not specifically listed as an LMHP in the manual. A physician completing the certification does not need to be independent of the hospital/facility and may be a doctor on staff. The only time an independent certification is necessary is for a Psychiatric Residential Treatment Facility (PRTF placement) or Therapeutic Group Home (TGH) for members under the age of 21. An independent certification is not required for ASAM level 3.5, 3.7, or 4.0 for members of any age. For additional information in regards to Residential Services for Substance Use and Behavioral Health for Therapeutic Group Home (TGH) and Psychiatric Residential Treatment Facility (TRF) for members under age21, please visit magellanofvirginia.com under Residential Program Process or the ARTS Information/Training/Communication page Titled: Residential Services for Substance Use and Behavioral Health Guide. ARTS Services shall meet medical necessity criteria based upon the multidimensional assessment completed by a credentialed addiction treatment professional as defined in the ARTS Chapter 4 Manual. For additional information in regards to multidimensional assessments, ARTS Manual- Covered Services and Limitations Chapter 4, pages 15 and 22. The ISP for substance use case management requires a minimum of two distinct activities being performed each calendar month and a minimum of one face-to-face client contact at least every 90 calendar days (ARTS Manual Chapter 4, page 21). Chapter 4, page 33-34 of the ARTS manual lists the substance use case management service activities. Page 3 in the GAP Manual outlines individuals that are eligible to complete the GAP SMI screening. A nurse practitioner is not on the list of individuals that can complete the screening, but this same page refers providers to page 11 in Chapter 4 of the Community Mental Health and Rehabilitative Services (CMHRS) Manual for a list of individuals that are considered a LMHP. This list does include a certified psychiatric nurse specialist. Providers should ensure that nurse practitioners on staff meet criteria in order to be eligible to conduct the screening. Ultimately, if the nurse practitioner meets the requirements for an LMHP (as a certified psychiatric 3 rd Quarter 2017: Weekly Friday Provider Call FAQs Page 5 of 6
clinical nurse specialist), then yes, they can perform the GAP SMI Screening. It is the provider s responsibility to ensure the nurse practitioner is practicing within the scope of their license. For questions surrounding specific staff members, please refer to your licensing specialist and the individual practitioner s licensing board. GAP GAP SMI Screenings As a reminder, GAP SMI screenings cannot be faxed in to Magellan or Cover VA. They must be submitted via the Magellan provider web portal, www.magellanprovider.com Providers can also check the status of their GAP SMI submissions on the website or contact Magellan for any specific questions about the status or review. GAP What will be the new federal poverty level for GAP members? As of 10/1/17, financial eligibility requirements will reflect the approved change from 80% below Federal Poverty Level (FPL) to 100%. This information can be located on the DMAS website. It is currently located under the what s new section. http://www.dmas.virginia.gov/content_pgs/gap.aspx As a reminder, Magellan of Virginia hosts a weekly call each Friday beginning at 1 p.m. The call is open to all providers to address questions and issues. We encourage providers to visit the Friday Provider Call page on Magellan of Virginia's website to review weekly agendas with program announcements, questions to be covered during the call and quarterly FAQs. Providers may submit questions using the contact us link feature on the Magellan of Virginia homepage. Questions should be submitted by the close of business each Wednesday for discussion on Friday. Any questions that require more research will be held over and answered on a subsequent call. We look forward to your participation. 3 rd Quarter 2017: Weekly Friday Provider Call FAQs Page 6 of 6