Agencies | Governor
Virginia Regulatory Town Hall
Agency
Department of Medical Assistance Services
 
Board
Board of Medical Assistance Services
 
Previous Comment     Next Comment     Back to List of Comments
4/28/21  5:07 pm
Commenter: ICT Services, Inc

Mental Health Services (formerly CMHRS) App. D/ Provider Qualifications and ACT Billing Guidance
 

Provider Guidance

ACT Team Fidelity Standards

ACT Teams are required to undergo the standardized rating process using the Tool for Management of Assertive Community Treatment (TMACT) as specified in their DBHDS license.

  • ?  A new ACT team may obtain a conditional DBHDS license for ACT if their initial TMACT fidelity scores are in the low fidelity range of 2.7-3.3, but the team must rate at 3.4 or higher on the subsequent review to avoid losing this provisional license.

  • ?  ACT teams may reach full ACT certification status and a one-year DBHDS license if they obtain a TMACT score in the base fidelity range of 3.4-3.9.

  • ?  ACT providers scoring 4.0-5.0 are considered high fidelity (this category has two tiers: 4.0-4.3 are high fidelity and 4.4-5.0 are exemplary fidelity).

    ACT reimbursement rates are tiered based on the size of the team and fidelity rating status; information on these rates is available in the “Billing Guidance” section of this appendix.

If ACT Teams are to maintain fidelity ratings according to the TMACT model to not only keep their license but also to obtain the reimbursement rates shouldn't services required to meet fidelity within the TMACT Model be reflected in what we can bill under DMAS regulations?

 

Billing Guidance

The Per Diem Rate includes any of the following service components provided by a qualified provider:

  • ?  assessment

  • Billing Code -H0040 and Team Modifier
  • Unit- N/A
  • Description- Comprehensive Needs Assessment

Does this billing guidance for the "CNA" pertain to initial assessments for ACT? How does this apply for clients who are assessed at not meeting ACT admission criteria?

 
CommentID: 97752