Chapter IV
Page 1 : Medicaid managed Care: MCOs may have different service authorization criteria. I am concerned about this issue as we already have to work with 7 different entities and this should be standard based on the regulations not the MCOs.
Page 18: Case Management Assessments : need a clear definition of the requirements it is the same document and compressive needs assessment just with different credentials
Page 29“all services that do not require service authorizations require registration and refer to appendix C. In appendix C page 5 there is strike through on Psychosocial Rehab services under service auths. Does this mean we go back to registrations?
Page 77: The CM compressive needs assessment is referenced again.
Page 78: new language for CM activities. Increasing a more direct role for CM in the service ie : not just giving referrals but assisting the individual directly, enhancing community integration by contacting other entities to arrange….community access and involvement…to learn community living skills, and use vocational, civic, and recreational services.
Chapter VI page 14
For services where group counseling is allowed, reimbursement is not allowed for more than 10 individuals regardless of Medicaid eligibility: not sure if this means if you have 12 people in a group and they all Medicaid you can only bill for 10? We don’t usually have more than 10 in a group but sometimes as people are moving from one group to another we might have some overlap of members making the total more than 10.
Page 16 under PSR it states notes shall be individualized and child- specific instead of adult/person specific
The comment on “Crisis Treatment:”
Chapter IV, p. 10
“Crisis Treatment” means behavioral health care, available 24-hours per day, seven days per week, to provide immediate assistance to individuals experiencing acute behavioral health problems that require immediate intervention to stabilize and prevent harm and higher level of acuity.
This language should be clarified to reflect the current VACSB performance contracts, stating that “Immediate access means as soon as possible and within no more than 15 minutes.”
My Question: Is the C.N.A. now the only billable assessment per service or are we still allotted the 2 billable assessments per year (at least for PSR this was what it was) – Will the 6 month month mark of the ISP when “Psychosocial rehabilitation services of any individual that continue more than six months shall be reviewed by an LMHP, LMHP-Supervisee, LMHP-Resident, or LMHP-RP to determine if the individual continues to meet the medical necessity criteria. The results of the review must be presented to receive approval of reimbursement for continued services.” Count as the second or the first? Can we admend the C.N.A. or another smaller ‘blurb?’
p.53 – same input and questions…What does “must be presented” mean?