Agencies | Governor
Virginia Regulatory Town Hall
Agency
Department of Medical Assistance Services
Board
Board of Medical Assistance Services
chapter
Amount, Duration, and Scope of Medical and Remedial Care and Services [12 VAC 30 ‑ 50]
Action Mental Health Skill-building Services
Stage Proposed
Comment Period Ends 10/23/2015
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9/21/15  11:36 am
Commenter: Heather Rupe, Co-Chair VACSB Quality Leadership

SSPI every 6 months
 

Proposed Language:

8. Mental health support skill-building services (MHSS) shall be defined as goal-directed training and supports to enable individuals to achieve and maintain community stability and independence in the most appropriate, least restrictive environment. Authorization is required for Medicaid reimbursement. Services that are rendered before the date of service authorization shall not be reimbursed. These services may be authorized up to six consecutive months as long as the individual meets the coverage criteria for this service. The service-specific provider intake, as defined at 12VAC30-50-130, shall document the individual's behavior and describe how the individual meets criteria for this service. This program These services shall provide goal-directed training in the following services areas in order to be reimbursed by Medicaid or the BHSA: training in or reinforcement of (i) functional skills and appropriate behavior related to the individual's health and safety, instrumental activities of daily living, and use of community resources; (ii) assistance with medication management; and (iii) monitoring of health, nutrition, and physical condition with goals towards self-monitoring and self-regulation of all of these activities. Providers shall be reimbursed only for training activities defined in the ISP and only where services meet the service definition, eligibility, and service provision criteria and this section. Service-specific provider intakes shall be repeated for all individuals who have received at least six months of MHSS to determine the continued need for this service.

Comment:

This reads as if a full SSPI is required at 6 months. This is an additional burden on consumers. It is felt that a comprehensive assessment, or the original SSPI, reviewed by an LMHP, instead of redoing an SSPI is preferred.

Recommendation:

Review of SSPI at 6 months by the LMHP

CommentID: 42171