⢠The BHH services provider reviews and explains the. The treating provider must be affiliated with the billing entity and is required to be the integration specialist. Certified behavioral health home services providers are required to carry out a service eligibility determination prior to billing for behavioral health home services. See MM10990. The BHH services rate was developed as a per member, per month payment to allow the provider flexibility to provide the right service, at the right time, based on the personâs needs and circumstances. 4097 0 obj
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Comprehensive transitional care activities are specialized care coordination services that focus on the movement of people between different levels of care or settings. 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. subd. BHH services providers and MCOs must adhere to the communication and coordination protocols established in BHH MCO Roles and Responsibilities worksheet. The variance request must include the reason for the variance request and the period of time the variance is requested. Lifetime limit of six payments in enrolleeâs lifetime. 4123 0 obj
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However, payment for duplicative services in the same calendar month is prohibited.
The Provider Manuals page is divided into two sections: Current Manual Type and Discontinued Manual Type. BHH services providers must determine and document an individualâs eligibility before providing and billing for BHH services. An email, letter, voicemail or text alone does not meet the requirement for monthly personal contact. RWHAP understands the critical need for behavioral health services; an estimated 10 to 28 percent of people living with HIV have co-occurring substance abuse disorders and mental illnesses. MHSP services are allowed for RHCs and FQHCs. 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. See the BHH MCO Contact Information (PDF) for further information. 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. ⢠the variance is consistent with public interest. Personal contact may include face-to-face, telephone contact or interactive video. endstream
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Communication Technology Based Services and Payment for Rural Health Clinic (RHCs) and Federally Qualified Health Centers (FQHCs) [January 2019]: MM10843 (PDF) CY 2019 Payment Rate Update to the FQHC PPS. Federally qualified health center (FQHC) behavioral health services provider manual. Please note, it is required that a mental health professional (MHP) employed by or under contract at your organization reviews the diagnostic assessment. In order to receive payment, all eligible servicing and billing provider’s National Provider Identifiers (NPI) must be enrolled with South Dakota Medicaid. For individuals who have fee-for-service MA coverage, most BHH services providers are not required to identify a treating provider. 4112 0 obj
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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. Indian tribes may change to an FQHC classification if they have Public Law 93-638 status. Services provider manual section. 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. Employee Assistance Program (EAP) Manual. 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); However, MCOs may develop different mechanisms to avoid duplicate payments, such as a take-back of payment following a reconciliation of monthly claims, or denial of a subsequent duplicate claim in the same calendar month. Issued: 12-01-2009; Revision Log; Obsolete Pages; Applied Behavior Analysis. 2018 Ryan White data reports 11.7% of clients served by the Ryan White HIV/AIDS program have received mental health services from a RWHAP provider. Dental Services Provided FQHC and RHC clinic providers may render any dental service in a face-to-face encounter between a billable treating provider and an eligible patient that is within the scope of the treating provider's practice, complies with the Medi-Cal Dental Manual of Criteria and P. ROVIDERS. Minnesota Statutes 245.461 to 245.468, Minnesota Comprehensive Adult Mental Health Act
Attention All Providers: Requirements on When to Use the National Provider Identifier (NPI) of an Ordering, Prescribing or Referring (OPR) Provider … Dental Services . This manual outlines the covered services, recipient and provider requirements for IHS. 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). 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. ... Read the behavioral health manual. An MCO and a BHH services provider can choose to add requirements for communication or coordination to the BHH Services MCO Roles and Responsibilities worksheet by mutual agreement. 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 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. A person receiving BHH services has been determined to be in need of asthma education. Behavioral Health Provider Manual; Instructions for Completing CareConnection® High Intensity (tiered) Instructions for Completing the CareConnection® for Private Practitioners (tiered) 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. 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. Both current and discontinued manuals have historical versions available. )a�D�ae��1�̲��_z�P@��ܟ��|yy �Ƨ v
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�E>Lm1U��7��T�V��8ꁪ��3;C]�& ⢠Intake for BHH services is considered complete as of the date that all of the above elements have been completed. The manual also offers information on covered services, processing of claims and errors, and remittance advice. Detailed information about certification requirements and standards are available on the Department of Human Services (DHS) How to become a certified BHH services provider webpage. For individuals who are enrolled in an MCO, BHH services providers will need to contact the individualâs MCO to determine what the MCO requires on the claim for BHH services. To enroll as a federally qualified health center (FQHC) with Minnesota Health Care Programs (MHCP), the FQHC must be certified by the Centers for Medicare & Medicaid Services (CMS). Providers should track the number of times S0280 U5 has been claimed. The following services are considered duplicative of behavioral health home services: For people who have fee-for-service MA coverage, MHCP will pay on the first claim submitted in a calendar month for any one of the duplicative services. To be certified to deliver behavioral health home services, an agency must demonstrate that all locations from which behavioral health home services will be provided are MHCP enrolled, and that all behavioral health home service teams operated by the agency or entity meet the behavioral health home services certification standards outlined in Behavioral Health Home (BHH) Services Provider Standards (DHS-6766) (PDF). • 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. Minnesota Statutes 256B.0757 Coordinated Care through a Health Home
G0469 – FQHC visit, mental health, new patient and G0470 – FQHC visit, mental health, established patient. 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. ⢠failure to grant the variance would result in hardship to the provider. Provider Manual DHS Home CountyLink Home Manuals Home Bulletins Advanced Search. ... Revised Provider Manual . 42 U.S.C. BHH services providers that bill using a billing entity must identify a treating provider. Subsequent claims in the same calendar month for one of the identified duplicate services will not be paid. 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. ... CTSS mental health behavioral aide). People who have hearing or speech ⢠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 personâs health action plan at least every six months, ⢠Adult mental health targeted case management (AMH-TCM), ⢠Childrenâs 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. Behavioral health home services applicants and certified providers may request a variance on specific service requirements. 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 The provider may document the person’s agreement to receive BHH services … PROVIDER ACTION NEEDED . Federally Qualified Health Center (FQHC) Behavioral Health Services Provider Manual 07/01/19 Edition Posted 07/01/19 . Behavioral Health Provider Manual. 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. The term âbehavioral health homeâ services refers to a model of care focused on integration of primary care, mental health services, and social services and supports for adults diagnosed with mental illness or children diagnosed with emotional disturbance. Provider Manuals: The Provider Manuals page is divided into two sections: Current Manual Type and Discontinued Manual Type. • The BHH services provider confirms that the member has current MA coverage. orthopedics, podiatry) Federally Qualified Health Centers . Medicaid reimburses DHS may grant a variance from the requirements when: To request a variance, a provider will have to complete and submit the BHH services Variance Request (DHS-8026) (PDF) for review and approval. 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 MCOâs designated contact. 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. 9am – 10am CST. Service delivery requirements are listed in the BHH certification standards (DHS-6766-ENG) (PDF). Specific care coordination activities are conducted with people and their identified supports, medical, behavioral health and community providers, and across and between care settings. �V$�d^J�8(�+��у��(\ʓ4J+UL��R"ВХHY�R,NJ+"�@�.���MI�@9�B.O��P�~vZr�u��,�)A��%�l���a��t/�#S�%��m��٥I�����-����F�B�o���pýQ���I9���N���Ԣ����S� ��!̛յsR O ���B(��@����������} All discontinued manuals no longer contain active information and are strictly available for historical purposes. PLEASE NOTE: The network is closed for any new Personal Care Service Agencies. Behavioral and Mental Health Services February 8, 2019. ⢠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 organizationâs BHH services certification approval letter. The information in this chapter does not apply to members enrolled in Healthy Montana Kids (HMK). FQHC Behavioral Health Providers Joyce, In our FQHC we bill the services of LCSW under the facility . RHC AND FQHC MANUAL MARCH 2020. Manual Updated 04/01/19 FQHC Behavioral Health Services Provider Manual SECTION 1 GENERAL INFORMATION AND ADMINISTRATION S OUTH C AROLINA M EDICAID P ROGRAM 1-6 S OUTH C AROLINA H EALTHY C ONNECTIONS M EDICAID C ARD (C ONT ’ D.) • Minnesota Statutes 245.4871, subdivision 15, clause (2)
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. If a person is covered on a fee-for-service basis, any claim for the enhanced payment beyond the allowed six will automatically be denied and converted to the base rate. 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. Treating Provider
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. BILLING AND POLICY MANUAL FQHC and RHC Services U PDATED December 20 PAGE | 1 FQHC AND RHC SERVICES . Minnesota Statutes 256B.0625, subdivision 20, Mental Health Case Management
Download Entire 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. 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. Federally Qualified Health Center (FQHC) Behavioral Health Services Provider Manual 07/01/19 Edition Posted 07/01/19 Description: Links to view/download individual sections; and a link to download the entire manual. Resources should address social, environmental and community factors. BHH services providers must have the capacity to deliver the following six core services based on the individualâs needs and in accordance with the BHH Certification Standards (DHS-6766-ENG) (PDF). Ҫ�]��e&�L��5�p� Ru�lV|L ���
contract or agreement with an RHC provides medical, behavioral or dental services for the patients of the RHC. AHCCCS 801 E Jefferson St Phoenix, Az 85034 Find Us On Google Maps. h�bbd```b``�"ׂIK�" Both current and discontinued manuals have historical versions available. The Human Services Department oversees provider improvement in the Centennial Care program. The person must choose which available MA-covered service best meets the personâs needs. ⢠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). Department of Health and Human Services (DHHS), also referred to as the Department. 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. PMHP authorization is not required. 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. 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. Federally Qualified Health Center (FQHC) Benefits. 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 Provider billing instructions are displayed in Adobe Acrobat formats. Providers bill for these services under their FQHC or RHC billing NPI and are reimbursed at a per diem rate for all services … PLEASE NOTE: Differences in State Medicaid rules can vary greatly, please confirm information with Montana Medicaid. 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). 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. found in other chapters of the BMS Provider Manual. 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 Medical providers (Including hospitals and private practitioners) and managed care organizations can use this section to locate important provider resources. All discontinued manuals no longer contain active information … The behavioral health home (BHH) services model of care utilizes a multidisciplinary team to deliver person-centered services designed to support a person in coordinating care and services while reaching his or her health and wellness goals. Description: Claims/authorizations for dates of service on or after October 1, 2015 must use the applicable ICD-10 … ⢠Have personal contact with the person or the identified support at least once per month. If you need an accommodation or require documents in another format, call 1-800-562-3022. Minnesota Statutes .256B.0625. This manual is to be used for program information and requirements, billing procedures and provider services guidelines. Health First Colorado reimburses NHVP for targeted case management services provided to Health First Colorado members. Federally Qualified Health Centers (FQHC) and Rural Health Clinics ... to a new FQHC or RHC. 0
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Phone: 602-417-4000 In-State Toll Free: 1-800-654-8713 (Outside Maricopa County) A child's treatment or safety needs may require receiving more intensive services in a more restrictive setting than services provided in the community or home. Certified peer recovery support specialist services are covered CCBHC services if determined medically necessary by a licensed professional. 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. The rate for behavioral health home services is a per member per month payment. FQHC & RHC Utilization Management Service Guidelines; Behavioral Health Provider Manuals and Instructions. 1396w-4
PPS visits are limited to certain types of providers and services as stated in the provider manual. Guides to this program, billing procedures and provider services guidelines rate per member per month.... Reimburses NHVP for targeted case management services provided to individuals served by the organization, or, or. Fqhc and RHC services organizations can use this section to locate important provider resources is a home visitation program to... Will not be paid at the provider may document the person ’ agreement... Not be paid certified to provide services via telemedicine may do so order... Loop on all referrals to ensure no duplicate payment S0280 U5 has been determined be... Mco Roles and Responsibilities worksheet supersedes earlier guides to this program would not reduce the level services... Address social, environmental and community factors been determined to be the integration specialist document an eligibility. 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